Background: Eating Disorders (ED) are serious psychiatric conditions characterized by persistent disturbances in eating behavior and related distressing cognitions and emotions. EDs significantly impair physical health or psychosocial functioning and are not explained by another medical or mental condition. EDs may affect children and adolescents and disturb development.Anorexia Nervosa (AN) is the most life-threatening ED, typically presenting with significant weight loss, body image disturbance, compensatory behaviours, endocrine dysfunction (e.g. amenorrhea/delayed puberty/growth retardation), and high risk of hospitalization or even mortality. While restrictive ED and especially AN most often affect girls, boys can develop at an early age atypical symptoms that make diagnosis difficult and are hardly differentiable from the symptoms captured by the relatively new diagnostic category “Avoidant/Restrictive Food Intake Disorder (ARFID)”.ARFID also involves restrictive food intake (in quantity or variety), the difference being that this occurs at any weight level and is not accompanied by weight or body dysmorphic phobic ideation that characterizes AN. The prevalence is estimated at about 3.2% with higher frequency in males. Clinical consequences may be equally severe than those of AN, including weight loss, growth retardation and psychosocial impairment.Material & Methods: Written informed consent for publication was obtained from child and parents.Case Presentation: We report the case of a 12-year-old boy with restrictive eating since age six, with symptom aggravation. At admission, his weight was at the 3rd age percentile, with concentration difficulties, fatigue and markedly limited food variety. Previous outpatient interventions had been unsuccessful; therefore, clinical treatment was indicated. He described avoidance of high-caloric foods and fear about eating larger amounts and potential weight gain—partly suggestive of AN.Despite the implementation of structured behavioral interventions, including nutritional advice, a meal plan, occasional probing, and reinforcement strategies, adherence was insufficient.Following day clinic and subsequent inpatient treatment, re-evaluation during ward transfer revised the diagnosis to ARFID, due to absence of body image disturbance and the predominance of food avoidance. Parents also reported sensory difficulties which permitted interpreting the avoidance of high-caloric foods as most likely consistency-related.Discussion: This case illustrates the diagnostic challenges in restrictive EDs in children. Overlapping symptoms may initially suggest AN, but the absence of body image disturbance and the presence of sensory-based avoidance patterns indicate ARFID.Male children may present differently, risking delayed or incorrect diagnosis. Comprehensive history taking is essential, including systematic exploration of sensory sensitivities, aversive experiences, and food interest.Early recognition of ARFID is crucial to prevent severe complications such as growth retardation, micronutrient deficiencies, and psychosocial impairment. A formal diagnosis enables tailored treatment, psychoeducation, and access to specialized resources.In this case, stabilization was only partially achieved after prolonged inpatient care, highlighting the need for early identification, individualized strategies, and ongoing follow-up to monitor weight, nutritional assessment, and gradual expansion of food variety.Conclusion: ARFID can mimic AN in children but differs in psychopathology. Careful anamnesis, including specific questions about sensory sensitivities and food avoidance, is crucial to avoid misdiagnosis and to enable early, tailored interventions.
