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Avoidant/restrictive food intake disorder (ARFID) is a relatively recent diagnostic category within feeding and eating disorders and is increasingly recognized in pediatric populations. Although ARFID shares some clinical features with other eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN), important differences in psychiatric comorbidity, sex distribution, and clinical severity have been suggested.A systematic search was conducted in PubMed, Embase, PsycINFO, Scopus, and Web of Science from database inception to November 2025. Observational studies including participants aged ≤ 18 years diagnosed with ARFID, AN, or BN and reporting comparative data for at least one outcome of interest were eligible. Random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) for each outcome.Twenty-two studies met the inclusion criteria. Compared with anorexia nervosa (AN), individuals with avoidant/restrictive food intake disorder (ARFID) showed significantly higher odds of anxiety (OR = 1.41, 95% CI: 1.05-1.89) and significantly lower odds of depressive disorders (OR = 0.30, 95% CI: 0.17-0.51). ARFID was also associated with a markedly higher proportion of males (OR = 4.18, 95% CI: 3.44-5.08) and lower hospitalization rates (OR = 0.23, 95% CI: 0.11-0.52). In addition, individuals with ARFID were significantly younger than those with AN (g = -0.90, 95% CI: -1.27 to -0.54). Comparisons with bulimia nervosa (BN) showed a similar pattern. Depressive disorders were significantly less frequent in ARFID (OR = 0.25, 95% CI: 0.12-0.53), and ARFID included a substantially higher proportion of males (OR = 5.29, 95% CI: 2.90-9.67). Anxiety tended to be higher in ARFID than in BN, although this difference did not reach statistical significance. Individuals with ARFID were also significantly younger than those with BN (g = -1.31, 95% CI: -1.89 to -0.74).ARFID demonstrates a distinct clinical profile compared with AN and BN in children and adolescents, characterized by higher anxiety-related features, lower prevalence of depressive symptoms, a more balanced sex distribution, and lower hospitalization rates. These findings support ARFID as a distinct eating disorder in youth and underscore the need for tailored assessment and treatment.