Physical guidance procedures can be effective in the treatment of severe pediatric food refusal. Researchers evaluating the use of physical guidance procedures often include a procedure referred to as a jaw prompt, but other variations of physical guidance may also be effective. An additional form of physical guidance, the finger prompt, might increase food acceptance. We evaluated nonremoval of the spoon and physical guidance (jaw prompt or finger prompt) in a reversal design. Results showed treatment packages including both procedures were effective in increasing food acceptance and decreasing inappropriate mealtime behavior.Trained observers recorded all responses on laptop computers. The primary dependent variables were latency to bite acceptance and IMB. All variables were measured only 263 Two physical guidance procedures

Research has shown that nonremoval of the spoon and physical guidance procedures can be effective in treating active food refusal (e.g., head turning and spoon pushing) and increasing food consumption. These procedures alone may not be effective in treating more passive food refusal (e.g., sitting still without opening mouth). We defined and evaluated the use of a side deposit procedure using a reversal design. Results showed that this procedure, when added to a treatment package including other components (e.g., nonremoval of the spoon and physical guidance), was effective in increasing food consumption and treating passive food refusal.

Children with feeding disorders often engage in refusal behavior to escape or avoid eating. Escape extinction combined with reinforcement is a well‐established intervention to treat food refusal. Physical guidance procedures (e.g., jaw prompt, finger prompt) have been shown to increase food acceptance and decrease inappropriate mealtime behavior when more commonly employed escape extinction (e.g., nonremoval of the spoon) procedures are ineffective. The finger prompt, however, has not been extensively evaluated as a treatment adjunct to target food refusal, thus necessitating further examination. The purpose of this prospective study was to assess a variation of a finger prompt procedure to treat food refusal and to assess caregivers' acceptability of the procedure. Three children age 1 to 4 years admitted to an intensive feeding disorders program and their caregivers participated. The finger prompt was effective in increasing bite acceptance across all participants and decreasing or maintaining low levels of inappropriate behavior for 2 participants. The procedure was also acceptable to all caregivers.

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This article reviews behavioral treatments of pediatric feeding disorders using physical guidance procedures as an open‐mouth prompt (i.e., jaw prompt, finger prompt, Nuk prompt, side deposit) to increase food acceptance. We identified 9 articles containing 35 systematic evaluations. We coded participant and study characteristics and assessed the experimental rigor, quality, and outcomes of each evaluation. Of the high‐quality research present, the finger prompt variation and side deposit reliably increased acceptance. We found mixed results on the efficacy of the jaw prompt, although it was the most widely researched procedure. Further, authors reported interobserver agreement for 100% of the participants, procedural integrity for 60%, social validity for 80%, fading for 5%, and follow‐up for 55%. Based on the invasive nature of physical guidance, we provide recommendations for researchers and clinicians to increase the quality of their treatment evaluations. We discuss limitations, implications for practice, and future research.