Using a Chaser to Decrease Packing in Children With Feeding Disorders

Abstract

Packing is a problematic mealtime behavior that is characterized by pocketing or holding solids or liquids in the mouth without swallowing. In the current study, we examined the effects of a chaser, a liquid or solid consistently accepted and swallowed by the child, to decrease packing of solid foods in 3 children with feeding disorders. During the chaser procedure, the therapist presented the chaser immediately for 2 children or 15 s after each bite presentation for 1 child. The chaser was effective in decreasing packing for all 3 children. The results are discussed in terms of the clinical importance of the findings and directions for future research.

Pocketing of food in cheeks during eating in an adolescent with CHARGE syndrome

“…2,3 This eating behaviour has previously been described in children with autism. 3 Feeding and swallowing problems are seen in many (>70%) infants with CHARGE syndrome, and of these, the majority have to be tube fed at some point.…”

“…Pocketing of food in cheeks or food packing has been described in the current literature as holding accepted food in the mouth without swallowing. 2,3 This eating behaviour has previously been described in children with autism. 3 Feeding and swallowing problems are seen in many (>70%) infants with CHARGE syndrome, and of these, the majority have to be tube fed at some point.…”

“…Chaser use, food re-distribution and manipulation of food textures have been described in the literature as beneficial ways to reduce food pocketing in children with autism. 2,3 This is the first case to document food pocketing in an individual with CHARGE syndrome. It is important that feeding team therapy members and clinicians are aware of such eating behaviours in individuals with CHARGE syndrome, in addition to the already well-established physical features and symptoms of the syndrome.…”

A Practical Approach to Classifying and Managing Feeding Difficulties

“…44 These problems require more complex treatment, such as hunger inducement, 42 oral motor desensitization, and a gradual nonthreatening exposure to food, 58 and in almost all instances should be referred to specialists competent in these approaches. Specialized techniques proven to be effective by behavioral therapists include distraction to avoid gagging, 49 use of a chaser to overcome "pocketing" (food retained in the cheeks), 72 following the mouth of the child with the spoon, or guiding the child physically to accept food. 73 Recently, medications to suppress visceral hyperalgesia have helped establish normal feeding in tube-fed children.…”

Simultaneous Presentation to Decrease Packing in a Child With a Feeding Disorder

“…Packing is problematic for several reasons, such as increased meal duration, decreased caloric intake, and increased risk for aspiration (Gulotta et al, 2005). Several treatments have been evaluated and found to be effective at decreasing packing when reinforcement procedures are not effective, including redistribution of packed food (Gulotta et al, 2005;Sevin, Gulotta, Sierp, Rosica, & Miller, 2002), using chasers (Vaz, Piazza, Stewart, Volkert, & Groff, 2012), and reducing texture (Patel, Piazza, Layer, Coleman, & Swartzwelder, 2005). Yet, there are limitations worth noting with these procedures.…”