Mealtimes can become a daily battle for parents if they have a child who refuses to eat vegetables or insists on the same meal every day.

Plenty of kids are picky eaters, but the problem of refusing foods can move beyond picky eating and become far more serious.

Some children develop a little-known eating problem called avoidant/restrictive food intake disorder or ARFID.

Many toddlers eventually outgrow selective eating, children with ARFID generally do not. Instead, their restricted diets can result in deficiencies of important nutrients.

Unlike children with eating disorders like anorexia or bulimia, youngsters with ARFID aren't concerned about their weight or body image.

ARFID is often mistaken for ordinary picky eating, but it is far more extreme and longlasting. ARFID children avoid food because they have little interest in eating, are extremely sensitive to certain tastes or textures or have developed a fear of eating after a frightening experience, such as choking or an allergic reaction.

The disorder affects an estimated 2 to 6 percent of children and adolescents. If left untreated, it can lead to poor growth, nutritional deficiencies and significant disruption of family life.

Researchers at Stanford Medicine have good news for these kids and their families. They have found that two different forms of therapy can help children become more open to a variety of foods.

The study, the first randomized, controlled clinical trial to evaluate treatments for children with avoidant/restrictive food intake disorder, involved 98 children, ages 6 to 12 from across the United States. It was recently published in the Journal of the American Academy of Child & Adolescent Psychiatry.

The research team, led by James Lock, MD, PhD, the Eric Rothenberg, MD Professor of Psychiatry and Behavioral Sciences and a member of the Comprehensive Eating Disorders Program at Stanford Medicine Children's Health, randomly assigned participating families to one of two treatment approaches.

Every child who participated in the study was underweight and met the diagnostic criteria for ARFID. Both groups received 14 one-hour therapy sessions over four months, which were delivered online so families nationwide could participate.

One approach, called family-based therapy, placed parents in charge of helping their child gradually change eating behaviors. Therapists coached parents on how to respond to food avoidance, while encouraging children to assume more responsibility as they grew older.

The second approach focused more directly on the child. Called psychoeducational motivational therapy, it used games, imagination and age-appropriate activities to help children identify their own reasons for trying new foods, while parents learned strategies to reduce conflict at mealtimes and support their child's progress.

Researchers tracked each child's weight and the severity of AFRID symptoms throughout the study. By the end of treatment, children receiving family-based therapy had gained significantly more weight than those in the individual therapy group.

Both treatments produced meaningful improvement in ARFID symptoms, however, giving clinicians two evidence-based options for helping children.

“This is the first study, worldwide, to take a systematic, randomized, adequately powered approach to testing treatments for this disorder,” Lock said in a press release. “We now have evidence base for how to help children with ARFID, at the age when they often present for treatment.”

Family-based therapy placed parents in charge of helping their child gradually change eating behaviors.

While many toddlers eventually outgrow selective eating, children with ARFID generally do not. Instead, their restricted diets can result in deficiencies of important nutrients such as vitamins A and C, poor growth, short stature and even future fertility problems. Socially, the disorder can make birthday parties, sleepovers, vacations and school lunches stressful or impossible.

The researchers say the study marks an important turning point for children with ARFID and their families. Until now, clinicians had little research to guide treatment. Having two therapies that improve symptoms, including one that also promotes healthy weight gain, offers new hope that children can overcome the disorder, enjoy a wider variety of foods and participate more fully in everyday childhood experiences.