In this section...

  1. Adult community services
  2. Carers corner
  3. Children's services
  4. Community mental health services
  5. Community response to COVID-19
  6. Dementia and older people’s mental health
  7. Health for Homeless Service
  8. Learning disability services
  9. Medication
  10. Mental health crisis
  11. Personalised care planning
  12. Physiotherapy
  13. SilverCloud
  14. Spiritual and pastoral care
  15. Suicide Liaison Service
  16. Talking Therapies
  17. Transforming wound care
  18. Tuberculosis Service
  19. Useful information following a bereavement
  20. Video appointments
  21. Virtual wards
  22. Wheelchair Service

Key service changes

The service will reopen on 1 April 2026. We will begin a phased relaunch, initially accepting high risk referrals only (getting risk support), that meet referral criteria and clinical threshold.

  • Referrals will only be accepted from GPs or paediatricians.
  • The minimum age has changed. Referrals will only be accepted for children aged 8 to 18 years, in line with the Children's and Young People's Eating Disorder Service.
  • All children and young people must be registered with a Cornwall GP.

We will confirm the launch date for moderate risk (getting more help) referrals once full staffing capacity has been restored.

High Risk Avoidant Restrictive Food Intake Disorder Service

The service is a countywide specialist community eating disorder team for children referred by healthcare professionals.

The team offer community-based assessment and intervention for children and young people between the ages of 8 and 18 years old, with suspected or diagnosed avoidant restrictive food intake disorder, sometimes referred to as ARFID.

We do not offer treatment for anorexia nervosa, bulimia nervosa or binge eating disorder. If you feel that you or your child are suffering from these conditions, refer to the links further down this page.

Contact the service

Call 01726 873 408 or email the High Risk Avoidant Restrictive Food Intake Disorder Service.

Open Monday to Friday, 9am to 5pm, except for bank holidays.

The address below is for correspondence only. We do not hold clinics at these premises. Check your appointment letter for clinic location.

Write to: First Floor Offices, Building A, Green Court, Truro Business Park, Threemilestone, Truro, TR4 9LF.

What is avoidant restrictive food intake disorder?

Avoidant restrictive food intake disorder is a relatively newly recognised condition that describes feeding difficulties such as:

  • an apparent lack of interest in eating or food
  • avoidance based on the sensory characteristics of food
  • concern about aversive consequences of eating (for example being sick or choking)

To be given a diagnosis, the feeding difficulties must be severe enough to impact the child or young person’s ability to meet their:

  • energy needs
  • nutritional needs
  • psychosocial functioning (ability to perform their day-to-day activities)

This would typically be associated with:

  • concerns around weight or failure to grow as expected
  • nutritional deficiency
  • dependence on alternative feeding (such as supplements or tube feeding)
  • significant difficulties in psychosocial functioning, which means difficulties functioning in daily life (such as poor school attendance, not eating all day at school, unable to attend family, peer or school functions)

About the team

Our team comprises a:

  • clinical psychologist
  • specialist dietician
  • specialist occupational therapist
  • clinical coordinator

We also work alongside our colleagues from community paediatrics and child psychiatry.

Guiding principles

  • Not every child or young person with restricted food intake or with disordered eating will have an eating disorder. Eating disturbances including acute food refusal can be features of other conditions or difficulties.
  • The team works with families, young people and other services known to them, to consider what may be driving or maintaining their restrictive eating difficulty.
  • Joint working approaches are the foundation to deliver holistic care for mental and physical health needs. We work with other services because a joint approach is needed to better meet the needs of children experiencing restrictive eating difficulties.
  • We may signpost to other services and resources, where other needs are identified as a priority.
  • All young people and families can access and engage with recommended resources for learning, support and avoidant restrictive food intake disorder awareness.
  • We value hearing the child or young person’s voice and understanding the difficulties the avoidant and restrictive eating has on the whole family.

Referrals

High risk referral criteria

Referrals can only be accepted from a GP or paediatrician.

To be accepted, children and young people must meet all of the following.

  • 8 to 18 years old.
  • Registered with a Cornwall GP.
  • Referred by GP or paediatrician.
  • A likely diagnosis of ARFID. This will include 1 or a combination of the following features:
    • sensory-based avoidance of foods
    • concern or fear about the aversive consequences of eating (such as choking or emetophobia)
    • low interest in eating

They must also present with significant:

  • faltering growth and/or risk of nutritional deficiency
  • impact on psychosocial functioning caused by the restricted eating (for example interference with daily functioning, school attendance, social eating, or extreme distress due to eating behaviour

Read the diagnostic reference.

High risk clinical threshold (getting risk support)

Referrals will be accepted only if there is persistent failure to meet nutritional and/or energy needs leading to high risk of physical compromise or hospital admission, demonstrated by:

  • significant nutritional deficiency

Evidence must include 1 of the following:

  • blood tests showing deficiency requiring supplementation (ARFID blood screen available on ICE)
  • food diary showing very limited intake (less than 5 foods from 1 to 2 food groups)

MEED observations and weight-for-height must be attached and include:

  • weight-for-height in amber (less than 80%) or red (less than 70%) range

Read MEED guidance.

Referral required information
Essential information Rational
Demographics, including social history and education Confirms eligibility and supports triage
Previous medical history and diagnosis Identifies relevant comorbidities
Growth measures (2 or more weights and heights, plus growth history) Evidence of significant faltering growth
Detailed food intake description or food diary Evidence of significant risk of nutritional deficiency
Nature of feeding issue (sensory, appetite, fear based related to eating) Supports ARFID diagnostic formulation
Impact of child's restricted eating on the child and family psychosocial functioning Confirms significant functional impairment
High risk only: ARFID blood screen (ICE system) and MEED observations Essential for effective triage and expediting treatment

Exclusion criteria

  • Any other medical, emotional, or psychological concern which might be causing an inability to eat (this includes pain).
  • Lack of access to adequate food and fluid.
  • Functional swallowing difficulties.
  • Intentional restriction to lose weight or avoid weight gain such as anorexia, bulimia, or other specified feeding or eating disorder (these conditions are managed by the Children and Young People's Eating Disorder Service).
  • Neurodegenerative or other significant long-term condition.

How to make a high risk referral

GP's and paediatricians can email the ARFID Referrals Team to request a referral form. They can also send a referral letter, which contains all the essential information listed above.

More information

There are resources available in the dropdown boxes below.

For selective eating referrals with concerns around growth of nutrition that do not meet the criteria, read advice on dietetic support available for children or young people with restricted eating.

Families

Lots of information is available for families. The other dropdown boxes on this page will signpost you to extra support.

For immediate concerns, contact the child or young person's GP. In an emergency, call 999 or refer to the emergency department. Young people and families can also receive mental health support from NHS 111. Call 111 and select option 2.

Useful information

Information for professionals including risk management

Avoidant restrictive food intake disorder is most typically a chronic condition, with food restriction being long standing and so the child or young person may not present as acutely physically unwell.

Any of the red flags below indicate a clinical emergency and referrers must follow the guidance given.

Red flags

Any 1 or more of the following:

  • heart rate less than 40 beats per minute or irregular
  • blood pressure sitting systolic less than 80mmHg, diastolic less than 50mm Hg
  • temperature less than 35.5 C
  • food intake of no food or less than 500Kcal per day for 5 days or more
  • weight loss of more than 1kg per week for 2 consecutive weeks
  • fluid restriction resulting in symptoms of dehydration or poor urine output

For any red flags, the referrer must contact the child or young person’s GP on the day for advice and onward referral to the local paediatric team (for all young people up to the age of 18).

Contact information

  • Royal Cornwall Hospitals NHS Trust (Treliske), call 01872 250 000 or contact the on-call consultant paediatrician
  • University Hospitals Plymouth NHS Trust (Derriford), call 01752 202 082 or contact the on-call consultant paediatrician

Resources

Information for parents and carers

Should your child or young person’s mental health, physical health or risk worsen, contact their current health professional to share this information.

If following assessment your child or young person is accepted for further sessions, they will be placed on a waiting list. Waiting times for this can vary depending on the clinical demand for the service.

Although your child or young person may be allocated a link professional to assist with your communication with the team, we provide a team approach to support your child or young person’s journey through our service.

Due to demand for our services, we encourage you to inform of us of any appointments you may need to cancel or rearrange. We follow a ‘was not brought’ policy. This policy means we have a limit of missed appointments we can accept before considering discharge from the service. This is to ensure all children and young people waiting are safeguarded and allows other people waiting for support to access help in a timely way.

We are not a crisis service. Professionals can provide a maximum number of appointments at any given time due to supporting many children and young people. This means that if your child or young person is open to the team and requires more intensive support due to an increased risk to themselves or others, a support request can be made to our Multi-Agency Rapid Response Service for enhanced risk support if clinically appropriate.

Information for young people

We understand that coming to meet unfamiliar people and sharing personal information with us can feel an overwhelming or a worrying experience.

Your first experience of meeting our team will be at your initial assessment. This assessment hopes to explore a range of topics so that we can better understand you.

We will ask you questions about:

  • family life
  • hobbies
  • education
  • your physical health including eating and drinking
  • what you are struggling with at present
  • how things could be better for you
  • any goals you might have
  • your safety within yourself, at home and in the community

We encourage you to think about some of these topics, your strengths, and challenges ahead of the appointment and you are welcome to write notes down and bring this with you. This might be helpful in making sure you share as much information with us as you can to help your assessment outcome.

We offer you time to be seen alone in the assessment if that would be helpful for you.

We are here to learn what your needs are. This might mean that other services might be more helpful for you based on what you would like support with.

Attending appointments is not something you have to do. It is your choice to work with us as your care will be led by you.

If you do not feel ready to work with us, or if you decide you would like to stop attending once you have started, we will respect your decision and will provide safety planning for you.

If we feel that you are at high risk of harm and not feeling able to work with us, we may discuss alternative options with you and your parent or carers.

All information you share with us in your appointments will be kept confidential between yourself and the team. If you share any information with a professional that suggests you may have been or are currently at risk of harm from others or to others, we have a duty of care to share this with the relevant services. If we need to do this, we will be open with you as to why we are doing this and who we are sharing this information with.

If you require reasonable adjustments to be made prior to your appointment, let us know as soon as possible.

Resources

Welcome to our guide to avoidant restrictive food intake disorder resources. We hope you find them helpful. We cannot be responsible for the content of external sites, although we are working hard to keep this page up to date.

Parent and family resources