Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026
Fear and picky eating-related ARFID behaviors in children with food allergy.
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Karaca Şahin Merve, Çalışkan Nilay, Şarman Hasan Tunç, Öztürk Turan Çağla, Yıldırım Güler, Güzeloğlu Eren, Güngör Hilal, Topçak Aslı Berivan, Boloğur Hamit, Papağan Şule, Ulutaş Ömer Yılmaz, Erbay Muhammed Fatih, Kökcü Karadağ Şefika İlknur, Özçeker Deniz
Аннотация
BACKGROUND: Food allergy is a chronic condition with psychosocial consequences for both children and their families. Strict elimination diets and fear of adverse reactions may contribute to maladaptive coping including behaviors avoidant/restrictive food intake disorder (ARFID)-related eating patterns. Therefore, this study aimed to compare ARFID-related eating behavior scores between children with food allergy and healthy controls and to identify the affected domains.
METHODS: In this prospective controlled study, 234 children aged 2-9 years were enrolled, including 117 children with physician-diagnosed food allergy and 117 age- and sex-matched healthy controls. Eating behaviors were assessed using the Nine Item Avoidant/Restrictive Food Intake Disorder Screen-Parent Report (NIAS-PR). Total and subscale scores (picky eating, fear, and appetite) were compared between groups. Within the food allergy group, associations between clinical characteristics and NIAS-PR scores were analyzed.
RESULTS: Children with food allergy demonstrated significantly higher NIAS-PR total scores compared with controls. The median total NIAS score was higher in the patient group than in the control group (17 [11-24] vs. 12 [7-18], p < .001). This difference was primarily driven by higher fear- and picky-eating-related scores, whereas appetite scores did not differ significantly. Fear subscale scores were significantly higher in children with a history of urticaria or anaphylaxis.
CONCLUSION: Pediatric food allergy is associated with increased ARFID-related eating behaviors, particularly fear- and picky-eating patterns. In addition, fear-related scores were higher among children with a history of immediate-type reactions, such as urticaria and anaphylaxis. These findings suggest that ARFID-related eating behaviors should be considered in the assessment of children with food allergy.
METHODS: In this prospective controlled study, 234 children aged 2-9 years were enrolled, including 117 children with physician-diagnosed food allergy and 117 age- and sex-matched healthy controls. Eating behaviors were assessed using the Nine Item Avoidant/Restrictive Food Intake Disorder Screen-Parent Report (NIAS-PR). Total and subscale scores (picky eating, fear, and appetite) were compared between groups. Within the food allergy group, associations between clinical characteristics and NIAS-PR scores were analyzed.
RESULTS: Children with food allergy demonstrated significantly higher NIAS-PR total scores compared with controls. The median total NIAS score was higher in the patient group than in the control group (17 [11-24] vs. 12 [7-18], p < .001). This difference was primarily driven by higher fear- and picky-eating-related scores, whereas appetite scores did not differ significantly. Fear subscale scores were significantly higher in children with a history of urticaria or anaphylaxis.
CONCLUSION: Pediatric food allergy is associated with increased ARFID-related eating behaviors, particularly fear- and picky-eating patterns. In addition, fear-related scores were higher among children with a history of immediate-type reactions, such as urticaria and anaphylaxis. These findings suggest that ARFID-related eating behaviors should be considered in the assessment of children with food allergy.