Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder that typically manifests in childhood and can follow a chronic course due to difficulties in recognition and treatment. This mental disorder was formally recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association over a decade ago (American Psychiatric Association (APA) 2013) and was recently included in the eleventh revision of the International Classification of Diseases by the World Health Organization (World Health Organization (WHO) 2021). Children with ARFID exhibit insufficient food intake that significantly impairs their health and functioning (American Psychiatric Association (APA) 2013; World Health Organization (WHO) 2021). They generally present within three clinical phenotypes: lack of interest in feeding or diminished appetite, sensory selectivity regarding food characteristics, and avoidance due to fear of aversive consequences of intake (Willmott et al., Jan). Treatment of this condition may vary depending on the clinical presentation subtype, but a fundamental component involves gradual and progressive exposure to foods with emphasis on family training to achieve long-term sustainability (Willmott et al., 2024 Jan).

The inclusion of ARFID in nosological frameworks and public health priorities relates to the increased disease burden associated with eating disorders in recent years (Pastore et al., 2023 Dec). This eating disorder represents one of those with the earliest age of onset, and research has focused on characterizing its symptoms, comorbidities, and treatment possibilities. The review by Willmott et al. (Willmott et al., 2024 Jan) compared 50 studies describing psychological interventions for patients with ARFID and demonstrates that the vast majority of treatment modalities rely heavily on family-based approaches. Meanwhile, the review by Kennedy et al. (Kennedy et al., 2023 Nov 6) highlights how treatment should consider caregivers' beliefs and family dynamics to ensure greater effectiveness. However, limited research exists on the social and family correlates that may be associated with ARFID, despite the fact that family dynamics and parenting patterns play crucial roles in the development and maintenance of eating disorders generally.

Several studies have examined the relationship between family environment and eating habits in children and adolescents. In preschoolers, a Swiss study found that inconsistent parenting is associated with higher levels of emotional eating, food responsiveness, disorganized eating, satiety responsiveness, and food enjoyment (Leuba et al., 2022 Nov 22). The same study found that corporal punishment, authoritarianism, and low monitoring are also associated with greater emotional eating, food responsiveness, and eating slowness (Leuba et al., 2022 Nov 22). Similarly, a study of school-age children in California (United States) demonstrated how different parenting styles are associated with parenting practices related to feeding, particularly the structure of feeding times, which in turn significantly affects healthier eating patterns (Lopez et al., 2018 Sep 1).

Globally, the meta-analysis by Yee et al. (Yee et al., 2017 Apr 11) showed that food availability and parental modeling are the variables that exert the greatest influence on increasing or reducing the intake of specific foods. These associations persist throughout childhood into adolescence and young adulthood across multiple cultural contexts, and it has been suggested that they may contribute to the origin and maintenance of eating disorders.

For example, a study with African American families showed that parents with higher body mass index may exhibit different parenting patterns, particularly greater behavioral modeling, and that parents who practice certain parenting patterns have adolescents with higher consumption of fruits and vegetables, specifically those employing greater reasoning and monitoring in parenting (Monroe-Lord et al., 2021 Dec 23). The review by Hampshire et al. (Hampshire et al., 2022 Jan 27) also indicates that overprotective parenting styles with low levels of warmth are associated with the presence of disordered eating and even symptoms of bulimia nervosa. In patients with ARFID, a study from Indonesia suggests that one of the key factors is effective mutual parenting, primarily in terms of care and interaction with the child, and this parenting approach more readily promotes feeding when there are fewer children in the household (Prasetyo et al., 2019 Sep 19).

Many of these studies lack structured assessment of eating problems or parenting patterns or fail to consider the broader context in terms of covariates that serve to control for direct and indirect effects. These types of methodological limitations have been highlighted by various authors in reviews of the topic (Hampshire et al., 2022 Jan 27; Yee et al., 2017 Apr 11). The present study attempts to address these limitations by exploring the longitudinal relationship between ARFID risk in a sample of Colombian children and variables of interest in the child population, specifically active play and symptoms of psychiatric problems (externalizing and internalizing), as well as relevant variables in their primary caregivers, specifically parental dynamics and depression risk.