Parents are told that picky eating is a normal part of toddlerhood, and it is for many children.

Around 2 years, children enter the age of autonomy where they become aware of their individuality. As such, they begin the developmental task of separating from their parents, becoming increasingly independent and testing the waters — especially with eating.

Kids are most likely to be picky eaters between ages 2 and 6. By the time preschool rolls around, many kids are expanding their food preferences. However, some children don’t move out of the picky eating stage within this timeframe. They may continue to refuse foods they once liked eating, and may not add them back into their diet. Over time, the list of foods these children will eat shrinks.

Many parents instinctively know that their child’s picky eating is more involved than what is typical. These kids may have what’s called avoidant/restrictive food intake disorder, otherwise known as ARFID.

[See: 10 Concerns Parents Have About Their Kids’ Health.]

ARFID is a feeding disorder of infancy or early childhood, according to the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5. It constitutes an eating or feeding disturbance with a persistent failure to meet appropriate nutritional or energy needs associated with one or more of the following:

— Significant weight loss, failure to achieve expected weight gain or faltering growth in children

— Significant nutritional deficiency

— Dependence on tube feedings or liquid nutritional supplements

— Marked interference with psychosocial functioning, such as refusing to attend or participate in social eating events.

Some signs of ARFID include refusing food due to its smell, texture or flavor, or a generalized lack of interest in eating. Children may have poor eating or feeding abilities, such as preferring pureed foods or a refusal to self-feed. They may be underweight or demonstrate slowed growth as a result of inadequate or poor nutrition. And, they may show signs of anxiety, as well as a fear of eating.

Kids with ARFID may also have other health issues or conditions, such as attention deficit hyperactivity disorder, autism, sensory processing disorder, food allergies, anxiety and constipation.

If you think your child may have ARFID, there are a few things you need to know so you can ensure your child gets the help he needs.

There Is a Root Cause

As mentioned, children with ARFID have an underlying reason for their notable pickiness. For example, children who were born prematurely may have required breathing and feeding tubes during hospitalization, which can increase oral sensitivity. Premature babies are at higher risk for feeding problems.

A child who had a choking episode in the past, was forced to eat or who had multiple respiratory infections at a time when she was learning to eat may have developed negative associations with eating.

Lastly, some children may have a sensory system which is offended by the texture, smell, odor or appearance of food. These sensitivities may alter how kids experience food and result in their refusing to eat many foods.

There are many reasons for ARFID, and often, more than one reason is to blame. For example, a child may be sensitive to certain textures, have an early negative eating experience, may not be getting the nutrition he needs or have a fear of eating. Each of these factors must be addressed to truly help the child with ARFID.

[Read: Is Your Approach to Feeding Your Child All Wrong?]

The Anxiety Is Real

According to a 2015 study in the journal Pediatrics, selective eating — or picky eating — was associated with anxiety, depression and ADHD in moderate and severe cases. The researchers found as eating worsened, the psychological impact did, too.

Anxiety can stem from the food itself, especially if it’s unfamiliar or disliked. Or it can result from other factors, such as pressure to eat at mealtime or a negative memory of eating. Children can also feel anxious because they sense their parents’ disappointment, frustration and anger.

Children with ARFID may potentially experience stress at home around mealtime, as well as in the school lunchroom. Older kids with ARFID may experience social anxiety around their peers.

Parenting May Make Things Worse

Pressuring a child to eat may complicate things for the child with ARFID. Although this may feel like the right thing to do, it’s not.

Research suggests that too much negative pressure (as perceived by the child) may reduce a child’s appetite, spur anxiety, elicit an emotional response — including tears and anger — or leave the child dreading meals.

Pressure may include persistent encouragement to take another bite, rules about eating a certain number of bites before leaving the table, or pushing the child to try a new food when she is resistant.

“We encourage parents to be sensitive to how their child responds to attempts to get him to eat (or interact with) different foods,” says Dr. Katja Rowell, co-author of “Helping Your Child with Extreme Picky Eating.”

Help Is (Most Likely) Needed

The big difference between typical picky eating and ARFID is that typical picky eating fades away in conjunction with repeated food exposure, a positive mealtime environment and good parenting.

Kids with ARFID, however, are complex and may need more help, including a supportive program to address their underlying challenges. Children with ARFID may benefit from working with a professional, such as a registered dietitian nutritionist; a therapist; an occupational therapist or a speech and language therapist who specializes in feeding therapy; or a medical doctor.

The goal is to help the child with ARFID grow in confidence with food and eating, expand her diet diversity through paced exposure to new flavors, repair any nutritional deficits and improve growth, as well as to address anxiety, if present.

Treatment should be positive and supportive, while preserving a child’s developing relationship with food.

“There are vastly different approaches to feeding therapy, but we feel that if a strategy increases gagging, vomiting, anxiety (a contributing factor for many with ARFID) or power struggles, it is probably the wrong approach,” Rowell says. “There are ways parents can facilitate progress without force or pressure, which has been shown in many studies to make eating worse.”

[See: What 10 Nutritionists Learned About Cooking From Their Moms.]

Building awareness of ARFID is a key step to ensuring parents are able to get kids the help they need at the right time for their child. While there’s no overnight fix, sensitive, caring and progressive treatment can help children with ARFID move forward with food.

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What Parents Need to Know About Extreme Picky Eating originally appeared on usnews.com