Optimizing an Aversion Feeding Therapy Protocol for a Child with Food Protein-Induced Enterocolitis Syndrome (FPIES)

Abstract

This case study examines the difficulties of treating food aversion in a 9-month old child with a diagnosis of Food Protein-Induced Enterocolitis Syndrome (FPIES). Given the need to first identify a set of “safe foods” with which to work, the twin goals of doing food challenges and minimizing aversion are initially not complimentary, and require an approach outside the standard of care. The chosen plan encouraged flexibility and a positive relationship with feeding-related items, while only introducing one food item at a time. Mom and child accomplished goals surrounding food play easily. She has successfully introduced a wide variety of new foods in small quantities and is currently working on reducing dependence on breast milk. Therapists must be prepared to modify currently accepted interventions to accommodate and support the required medical intervention.

Assessing Feeding Difficulties in Children Presenting with Non-IgE-Mediated Gastrointestinal Food Allergies—A Commonly Reported Problem

“…This concurs with some of the retrospective data published by Meyer et al [ 10 ] in 2014; however, this study did not find more feeding difficulties in patients with rectal bleeding and bloating/flatus in children, compared to the retrospective study of 2014. Feeding difficulties have frequently been described in children with reflux and eosinophilic oesophagitis [ 11 , 12 ], and more recently, a higher prevalence of feeding difficulties was also reported in children with food protein induced enterocolitis syndrome, where the hallmark symptom is vomiting [ 18 , 19 ]. It has been hypothesised in children with underlying motility disorders (i.e., reflux and constipation) that repeated painful experiences (i.e., vomiting, pain on defecation) may alter the visceral sensory processing leading to increased sensory sensitivity, which in turn leads to a dysphoric feeding experience [ 20 ].…”

Food Selectivity in Children with Autism: Guidelines for Assessment and Clinical Interventions

“…This approach aims to “increase the range and volume of foods the child eats through play-based intervention” [ 85 ]. The approach, based on a systematic process of desensitization, is developed in six phases (visual tolerance, interaction, smell, touch, taste, and nutrition) and aims to guide the child through the exposition and experiences of a variety of foods and textures until he/she begins to interact, tasting a wider variety of foods [ 86 ]. Although it was not initially developed for individuals with autism, this approach is increasingly used to address the feeding difficulties experienced by children with ASD.…”

Sensory Snack Time: A School-Based Intervention Addressing Food Selectivity in Autistic Children

“…The approach has developed a six step eating hierarchy (visual tolerance, interaction, smell, touch, taste, and eating) as the protocol to advance the child forwards with exposure and experiences of a variety of foods and textures based on the child's response to each step (Toomey and Ross, 2011). The rationale behind the intervention is that a process of systematic desensitization, in the context of the six step hierarchy children begin to interact with and eat a wider variety of foods (Mattingly et al, 2015). Whilst not initially developed specifically for autistic individuals, it is increasingly being used to address feeding difficulties, such as restricted diet, experienced by children on the autism spectrum (Benson et al, 2013;Peterson et al, 2016).…”