Development of Medication Administration Protocols for In-Home Pediatric Feeding Cases

Abstract

Medication administration can be a significant issue in pediatric populations, and especially with patients with developmental disabilities and comorbid feeding disorders. Research has focused largely on consumption of solids rather than medication and liquids in pediatric feeding programs, with most studies being conducted within specialized hospital settings in the United States. No studies to our knowledge have detailed treatment evaluations for medication administration in pediatric feeding except for a few studies on pill swallowing. We report results of treatment protocols for medication administration using empirically-supported treatments in a short-term intensive home-based behavior-analytic program in Australia. Two males with autism spectrum and pediatric feeding disorders participated. We used a multiple baseline single-case experimental design for medication administration conducted concurrently with a treatment evaluation for solid foods. Consumption increased in number (9; supplements, laxatives, pain relievers), flavors (8; chocolate, blackcurrent and apple, strawberry, lemon-lime, orange, chocolate-vanilla, cherry, apple), forms (4; thin and thick liquids, chewables, gummies), and delivery methods (5; finger-fed, spoon, cup, medicine spoon, medicine cup) within the first treatment session. For one participant, we taught open cup drinking for a variety of liquids (milk, juices, medications). For both participants, we taught self-feeding with utensils for thick liquid medications. Treatment results were similar for solids and participants increased food variety to over 160 across food groups. All goals were met including training parents to maintain gains at home.

Avoidant/restrictive food intake disorder (ARFID) in New Zealand and Australia: a scoping review

“…Interobserver agreement, and caregiver satisfaction 2 M (2.5y) M(2y) Asian Australian South American Australian Short (< 10 days), intensive in-home treatment resulted in increased food consumption 100%, and decreased negative mealtime behaviours for two developmentally normal toddlers. At 3-year follow-up treatment gains were maintained Burton (Melbourne, Australia) [ 58 ] J Can Acad Child Adolesc Psychiatry Clinical cases, ARFID, ASD Application of Family Based Treatment (FBT) + Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) Paediatric psychology FBT + UP-C/A Treatment goals (no objective outcome measures used) 2 F (6y) F (11y) Not stated Application of FBT + UP-c/A for ARFID with comorbid ASD appeared to contribute towards increased oral intake and food variety, and reduced reliance on NGT feeding Taylor (Australia) [ 45 ] Behav Change Clinical case, ARFID, ASD Effectiveness of move-on treatment component Paediatric feeding Behaviour-analytic treatment Measures of consumption of food across food preference groups, procedural integrity, interobserver agreement, social acceptability, and caregiver satisfaction 1 F (5y) Asian Australian Move-on component added to treatment package resulted in increased consumption and decreased time to consume foods Taylor 2022 (Australia) [ 46 ] Behav Modif Clinical case, ARFID, ASD Medication administration in children with feeding disorders Paediatric feeding Behaviour-analytic treatment Behaviour frequency, latency duration, procedural integrity, interobserver agreement, social validity and treatment acceptability 1 1 M (5y) M (8Y) East Asian Australian South Asian Australian Both participants demonstrated 100% increase in medication consumption with reduced inappropria...…”

“…A focus on eating disorders (5 studies [27][28][29][30][31]), psychiatry (4 studies [32][33][34][35]), and paediatrics (4 studies [36][37][38][39]) commonly featured. In addition, journals relating to adolescence [40]; gastroenterology [41]; learning and motivation [42]; behaviour change [43][44][45][46]; speech, language, and hearing [47]; disability [48]; and autism and developmental disorders [49] were used to disseminate ARFID research among others, with the journal often being closely relating to the setting in which the sample was investigated.…”

Incorporating social validity into practice: Treatment progression across pediatric feeding skill domains

“…Well‐established empirically‐supported treatments included DA, contingent access (CA), and nonremoval (NR) and re‐presentation (RE) (Kerwin, 1999; Volkert & Piazza, 2012). Conditions were conducted similar to Taylor (2022). In CA, edibles provided changed as food variety expanded and preferences changed.…”

“…This intervention requires competency in comprehensive intakes (e.g., swallow safety, consultation with other disciplines), estimating service intensity, determining targets and textures, prioritizing goals and progression over time, and conducting training and generalization (Piazza et al, 2020;Taylor & Taylor, 2023;Williams & Seiverling, 2022). Developing medication administration protocols requires multidisciplinary coordination (Taylor, 2022).…”

Avoidant-restrictive food intake disorder and autism: epidemiology, etiology, complications, treatment, and outcome

“…Autistic children with ARFID may experience issues in oral-motor development that may contribute to their feeding difficulties [33]. These children may benefit from special feeding techniques [33], medication administration techniques [34], and from learning to swallow solid food with a liquid chaser [35].…”