Purpose Feeding challenges in children are common, at times reaching a severity that requires the placement and long-term use of enteral feedings. A significant barrier to advancing the oral eating of some tube-dependent children is the presence of oral aversion. Although some research exists regarding the treatment of tube-dependent children who are averse to food or the process of eating, specifically, there has yet to be an examination of children who are truly “orally” averse—resisting not just the presentation of food or liquid but also nonnutritive stimuli presented extra- or intra-orally. Method Using a retrospective chart review, the current study aimed to examine the treatment outcomes of 18 feeding tube-dependent children with significant oral aversion (nine boys, nine girls; M age = 46.7 months, SD = 20.0 months, range: 11.4–89.3 months) as compared to 29 tube-dependent, but nonorally averse, clinical controls. Children completed approximately 6–8 weeks of intensive interdisciplinary feeding treatment. Results Analyses revealed significant improvements in all measured treatment outcomes for both patient groups, including children's rates of acceptance and maladaptive mealtime behavior. Significant reductions in tube use were also observed across both groups, with tube utilization decreasing, on average, by 76.2% for orally averse and by 64.3% for nonorally averse children by program discharge. Conclusion Results demonstrate the therapeutic benefits of intensive interdisciplinary intervention for both groups of tube-dependent children, highlighting that orally averse children, believed to be an especially challenging subset of pediatric feeding patients, demonstrate similarly positive treatment responses. Interestingly, in this preliminary examination, orally averse children demonstrated significantly greater reductions in tube utilization following discharge when compared with their nonorally averse clinical peers.

Introduction:Enteral feeding pumps at times may deliver different volumes than are prescribed, which can negatively impact growth, nutrition, and well-being. This study sought to assess whether challenges with pump accuracy for patients on food-based formulas contributed to challenges with weight gain.Methods:Chart review identified complex feeding patients receiving food-based enteral nutrition via feeding pump with unexpected weight loss. Relevant data, such as enteral formula type, and anthropometric information were extracted.Results:Five complex pediatric feeding patients were identified and 2 of these cases were summarized as representative examples, showing weight loss in children following the introduction of enteral food-based formulas because of feeding pump inaccuracy.Conclusions:Complex pediatric feeding patients may display unexpected and poor weight gain and growth while receiving food-based enteral feeding interventions because of pump errors. It is vital for providers to be aware of these challenges for timely intervention.

Purpose Significant feeding problems often, but not always, co-occur with medical, developmental, emotional, or behavioral difficulties. Consequently, providers from multiple disciplines often interact with these patients for treatment. There is limited research and guidance in the literature about working with young adolescent patients who demonstrate feeding challenges. This article describes some of the most common evidence-based psychological techniques used in the treatment of adolescents with feeding disorders, including motivational interviewing and cognitive behavioral techniques. A case example is also used to illustrate these principles in practice. The goal of this article is to provide a high-level overview of these concepts so that providers outside of psychology may utilize some of the theories in treatment with similar patients, when referral to a behavioral specialist or psychologist is not feasible. Conclusions This clinical commentary discusses common strategies used by psychologists to treat feeding disorders, especially those primarily with anxiety presentation, in the outpatient setting. The psychological techniques described herein are complementary with most therapeutic strategies for the treatment of feeding disorders and, in many cases, may further enhance the success of the therapy treatment process. The most important theme of these techniques is a gradual approach to exposure and teaching of appropriate coping strategies to manage anxiety when practicing a new or challenging task. Providing education to the patient and parent, while also allowing understanding of the underlying process of anxiety as it relates to behavior, mood, and thoughts, can help guide treatment planning and goal setting.

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