Using Food Redistribution to Reduce Packing in Children With Severe Food Refusal

Abstract

Positive- and negative-reinforcement-based procedures typically have targeted acceptance for children with severe food refusal; however, these procedures do not always result in successful swallowing. Once acceptance is achieved, some children expel the food repeatedly or pack (hold or pocket) it in their mouths for extended periods of time. This study evaluated the effects of using food redistribution with a bristled massaging toothbrush to reduce packing and increase consumption in 4 children with severe feeding disorders. Packing was reduced for all children. In addition, latency to clean mouth (the duration of time from acceptance to food no longer being present in the child's mouth in the absence of expulsion) for 2 children decreased when the food-redistribution procedure was used. Results are discussed in terms of the potential operant functions of the food-redistribution procedure.

Pediatric Feeding Disorders: A Quantitative Synthesis of Treatment Outcomes

“…Typical consumption involves a number of successive steps: bringing a bite to the lips, accepting food into the mouth, chewing and forming a bolus, and swallowing (Gulotta et al 2005). When this process is interrupted, problems may arise at different points along this chain of consumption, which further complicates the diagnostic and intervention picture (Riordan et al 1980;Sevin et al 2002).…”

“…For example, some children display disruptive behaviors (e.g., head turning, batting at the spoon) that interfere with accepting a bite into the mouth, while other children fail to consume an adequate volume of food due to packing or expelling bites. In addition, treatment resolving refusal at one point along the chain of consumption (e.g., acceptance) can lead to a collateral increase in topographies of food refusal further down the chain (e.g., expulsions, packing) after a child is accepting bites without difficulty (Gulotta et al 2005). This presents a unique challenge for caregivers and professionals addressing feeding concerns, with the goal of an intervention often shifting over time.…”

Further Manipulations in Response Effort or Magnitude of an Aversive Consequence to Increase Self-Feeding in Children with Feeding Disorders

“…We hypothesized that Mickey would avoid the flipped spoon due to his prior history, and the results showed that we could use this procedure to shift responding from being fed to self-feeding. Investigators have hypothesized that swallow facilitation is effective via promotion of skill acquisition (i.e., placement of the bolus on the tongue and stimulation of the swallow response), alteration of motivation (i.e., avoidance of the procedure; Volkert, Vaz, Piazza, Frese, & Barnett, 2011), or both (Gulotta, Piazza, Patel, & Layer, 2005). The results from the current investigation suggest that Ezra and Mickey may have been motivated to avoid the swallow-facilitation procedure as their responding shifted to self-feeding when given the choice to self-feed one bite or to be fed one bite when swallow facilitation was a component of treatment.…”

Assessing Preferences of Individuals With Developmental Disabilities: A Survey of Current Practices

“…Behavior analysts have applied principles of reinforcement to teach individuals with developmental disabilities language skills (e.g., Bourret, Vollmer, & Rapp, 2004), social interaction skills (e.g., Krantz & McClannahan, 1998), play skills (e.g., MacDonald, Sacramone, Mansfield, Wiltz, & Ahearn, 2009), community safety skills (Page, Iwata, & Neef, 1976), personal hygiene skills (e.g., Swain, Allard, & Holborn, 1982), and vocational skills (e.g., Lattimore, Parsons, & Reid, 2006). In addition, techniques based upon the principles of behavior have proven invaluable in the assessment and treatment of problem behaviors such as self-injury (e.g., Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994, aggression (e.g., DeLeon, Fisher, Herman, & Crosland, 2000), stereotypy (e.g., Ahearn, Clark, MacDonald, & Chung, 2007), noncompliance (e.g., Mace et al, 1988), food refusal (e.g., Gulotta, Piazza, Patel, & Layer, (2005), and property destruction (e.g., Fisher, Adelinis, Thompson, Worsdell, & Zarcone, 1998). Programs designed to teach new skills and reduce problem behavior differ along several dimensions, but all require the identification of effective reinforcers and the effective application of principles of reinforcement.…”