The New Rome V Criteria

What It Means for ARFID and Paediatric Feeding Disorders

Written by: Professor Rosan Meyer

The Rome Criteria are the international gold standard for diagnosing disorders of gut–brain interaction, such as IBS and functional dyspepsia. Developed by the Rome Foundation, they are updated every few years as new research emerges.

For the first time, the Rome Criteria now include paediatric feeding disorders, dividing them into two broad categories: medically grounded and functional paediatric feeding disorders.

At a high level, that distinction makes sense - some feeding difficulties are primarily medically driven, while others are more functional. But one of the biggest proposed changes is that the authors suggest retiring the term Avoidant Restrictive Food Intake Disorder (ARFID) in favour of four more specific diagnoses:

• Hypersensitivity dysphagia

• Anticipatory restrictive feeding

• Hunger dysregulation feeding disorder

• Medically triggered functional feeding disorder

On paper, these categories broadly align with the three drivers we already associate with ARFID: fear of negative consequences, sensory hypersensitivity, and low interest in or appetite for food.

However, this is where I think things become more complex.

The Rome V criteria appear to place sensory sensitivity within the medically triggered category, framing it as a regression in oral motor skills. As someone who works with these children every day, I'm not convinced sensory differences can be explained by oral motor regression alone.

Sensory challenges show up in so many ways, texture, smell, appearance, temperature, and more -and they occur across all ages, including adolescents. That doesn't fully fit with the idea of regression in oral motor skills.

I'm still working through this new criteria, so these are very much my initial thoughts. 

Do get in touch with Rosan at info@rosan-paediatricdietitian.com if you think your child may benefit from a consultation. Rosan’s dietetic practice does prefer to work on a referral basis, to ensure that any underlying medical conditions are fully explored and where appropriate nutritional bloods are taken. However, she will consider each case on an individual basis.