A comparison of Nuk presentation and Nuk redistribution to treat packing

Abstract

Children with feeding disorders may pack food when they lack the oral-motor skills, the motivation, or both to swallow. Presenting bites on the tongue with a Nuk brush, or redistribution, replacing packed food on the tongue, are two treatments whose relative efficacy is untested. In the current study, we compared the effects of (a) presenting on an upright spoon, (b) presenting on a Nuk, and (c) redistributing with a Nuk on two product measures of swallowing, which we refer to as 15-s and 30-s mouth clean, for three children with feeding disorders. Nuk presentation produced the highest levels of 15-s mouth clean relative to Nuk redistribution and uprightspoon presentation across participants. Levels of 30-s mouth clean were higher during Nuk presentation and Nuk redistribution relative to upright-spoon presentation for two participants. We discuss the oral-motor skills and motivational deficits that might account for the findings.

Further evaluation of modified‐bolus‐placement methods during initial treatment of pediatric feeding disorders

“…Although feeding behavior generally emerges in a predictable sequence, disruptions that impact swallowing can occur at any point in this process (Piazza et al, 2017). For example, children who have feeding disorders may hold food or liquid in the mouth, behavior referred to as packing (e.g., Gulotta, et al, 2005; Milnes et al, 2019). Other children with feeding disorders may propel, remove, or spill food or liquid out of the mouth, behavior referred to as expulsion (e.g., Wilkins et al, 2011).…”

“…Research has shown that modified‐bolus‐placement methods may reduce packing and expulsion, and increase mouth clean, which is a product measure of swallowing (Milnes et al, 2019; Volkert et al, 2019). The term utensil manipulation (Wilkins et al, 2014) has also been used to refer to modified‐bolus‐placement methods that occur with a spoon relative to a Nuk.…”

“…For example, one procedure consists of placing the bolus directly on the tongue with a flipped spoon, during which the feeder inserts a spoon into the mouth, turns it 180°, then drags the bowl of the spoon on the tongue to deposit the bite (e.g., Sharp et al, 2012; Stubbs et al, 2018). Alternatively, feeders might deposit bites with a Nuk brush, an approximately 13‐cm tool with a bristled rubber head that the feeder rolls on the tongue to deposit the bite (e.g., Milnes et al, 2019; Sharp et al, 2010). Both of these procedures differ from using an upright spoon to present and deposit a bite, which is the way most individuals use a spoon to eat (Milnes et al, 2019).…”

“…Alternatively, feeders might deposit bites with a Nuk brush, an approximately 13‐cm tool with a bristled rubber head that the feeder rolls on the tongue to deposit the bite (e.g., Milnes et al, 2019; Sharp et al, 2010). Both of these procedures differ from using an upright spoon to present and deposit a bite, which is the way most individuals use a spoon to eat (Milnes et al, 2019). Researchers have generally evaluated placing bites directly on the tongue with a flipped spoon or Nuk brush sequentially or after expulsion (e.g., Girolami et al, 2007) and packing (e.g., Milnes et al, 2019) emerge.…”

“…Both of these procedures differ from using an upright spoon to present and deposit a bite, which is the way most individuals use a spoon to eat (Milnes et al, 2019). Researchers have generally evaluated placing bites directly on the tongue with a flipped spoon or Nuk brush sequentially or after expulsion (e.g., Girolami et al, 2007) and packing (e.g., Milnes et al, 2019) emerge. For example, Milnes et al (2019) studied the relative efficacy of presenting bites on an upright spoon, placing bites on the tongue with a Nuk brush, and replacing packed food on the tongue with a Nuk brush.…”