Abstract
Treatment of highly selective or low overall eating by children may prevent the development of more complicated feeding difficulties, which can result in compromised health status and developmental concerns as well as the need for more intensive interventions. Caregiver-friendly intervention strategies that can be implemented with children in their community environments (e.g., in the child’s home or school) may reduce the need for tertiary care. A small but growing number of studies have found that certain behavioral procedures can be effective in the absence of escape extinction with children who have established eating patterns (i.e., inadequate intake, selectivity by food type). This article reviews these procedural variations within the behavioral pediatric feeding literature and provides a practical guide for individuals who develop behavioral interventions for children in community settings.
Similar content being viewed by others
References
Ahearn, W.H. (2003). Using simultaneous presentation to increase vegetable consumption in a mildly selective child with autism. Journal of Applied Behavior Analysis, 36, 361–365.
Ahearn, W.H., Kerwin, M.E., Eicher, P.S., Shantz, J., & Swearingin, W. (1996). An alternating treatments comparison of two intensive intervention for food refusal. Journal of Applied Behavior Analysis, 29, 321–332.
Babbitt, R.L., Hoch, T.A., & Coe, D.A. (1994). Behavioral feeding disorders. In D.N. Tuchman & R. Walter (Eds.), Pediatric feeding and swallowing disorders: Pathophysiology, diagnosis, and treatment (pp. 77–95). San Diego, CA: Singular Publishers.
Brown, J. F., Spencer, K., & Swift, S. (2002). A parent training programme for chronic food refusal: A case study. British Journal of Learning Disabilities, 30, 118–121.
Buckley, S.D., & Newchok, D.K. (2005). An evaluation of simultaneous presentation and differential reinforcement with response cost to reduce packing. Journal of Applied Behavior Analysis, 38, 405–409.
Burklow, K.A., Phelps, A.N., Schultz, J.R., McConnell, K., & Rudolph, C. (1998). Classifying complex pediatric feeding disorders. Journal of Pediatric Gastroenterology, 27, 143–147.
Christopherson, E. R., & Hall, C. L. (1978). Eating patterns and associated problems encountered in normal children. Issues in Comprehensive Pediatric Nursing, 3, 1–16.
Cooper, L.J., Wacker, D.P., Brown, K., McComas, J.J., Peck, S.M., Drew, J., et al. (1999). Use of a concurrent operants paradigm to evaluate positive reinforcers during treatment of food refusal. Behavior Modification, 23, 3–40.
Cooper, L.J., Wacker, D.P., McComas, J.J., Brown, K., Peck, S.M., Richman, D., et al. (1995). Use of component analyses to identify active variables in treatment packages for children with feeding disorders. Journal of Applied Behavior Analysis, 28, 139–153.
Fisher, W., Piazza, C. C., Bowman, L. G., Hagopian, L. P., Owens, J. C., & Slevin, I. (1992). A comparison of two approaches for identifying reinforcers for persons with severe and profound disabilities. Journal of Applied Behavior Analysis, 25, 491–498.
Kedesdy, J.H., & Budd, K.S. (1998). Childhood feeding disorders: Biobehavioral assessment and intervention. Baltimore: Paul H. Brookes.
Kerwin, M.E., Ahearn, W.H., Eicher, P.S., & Burd, D.M. (1995). The costs of eating: A behavioral economic food analysis of food refusal. Journal of Applied Behavior Analysis, 28, 245–260.
Kerwin, M.E., & Eicher, P.S. (2004). Behavioral intervention and prevention of feeding difficulties in infants and toddlers. Journal of Early and Intensive Behavior Intervention, 1, 129–140.
Lerman, D.C., Iwata, B.A., & Wallace, M.D.(1999). Side effects of extinction: Prevalence of bursting and aggression during the treatment of self-injurious behavior. Journal of Applied Behavior Analysis, 32, 1–8.
Levin, L., & Carr, E.G. (2001). Food selectivity and problem behavior in children with developmental disabilities: Analysis and intervention. Behavior Modification, 25, 443–470.
Luiselli, J.K., Ricciardi, J.N., & Gilligan, K. (2005). Liquid fading to establish milk consumption by a child with autism. Behavioral Interventions, 20, 155–163.
Munk, D.D., & Repp, A.C. (1994). Behavioral assessment of feeding problems of individuals with severe disabilities. Journal of Applied Behavior Analysis, 27, 241–250.
Najdowski, A. C., Wallace, M. D., Doney, J. K., & Ghezzi, P. M. (2003). Parental assessment and treatment of food selectivity in natural settings. Journal of Applied Behavior Analysis, 36, 383–386.
Palmer, S., & Horn, S. (1978). Feeding problems in children. In S. Palmer & S. Ekvall (Eds.), Pediatric nutrition in developmental disorders (pp. 107–129). Springfield, IL: Thomas.
Palmer, S., Thompson, R.J., & Linscheid, T.R. (1975). Applied behavior analysis in the treatment of childhood feeding problems. Developmental Medicine and Child Neurology, 17, 333–339.
Patel, M.R., Reed, G.K., Piazza, C.C., Bachmeyer, M. H., & Layer, S. (2005). An evaluation of a high-probability instructional sequence to increase acceptance of food and decrease inappropriate behavior in children with pediatric feeding disorders. Research in Developmental Disabilities, 27, 430–442.
Patel, M., Reed, G.K., Piazza, C.C., Mueller, M., Bachmeyer, M.H., & Layer, S.A. (2007). Use of a high-probability instructional sequence to increase compliance to feeding demands in the absence of escape extinction. Behavioral Interventions, 22, 305–310.
Piazza, C.C., & Carroll-Hernandez, T.A. Assessment and treatment of pediatric feeding disorders. In: Tremblay RE, Barr RG, Peters RDeV, eds. Encyclopedia on Early Childhood Development [online]. Montreal Quebec: Centre of Excellence for Early Childhood Development; 2004: 1–7. Available at: http://www.excellence-earlychildhood.ca/documents/Piazza-Carroll-HernandezANGxp.pdf. Accessed September 9, 2005.
Piazza, C.C., Fisher, W.W., Brown, K.A., Shore, B.A., Patel, M.R., Katz, R.M., et al. (2003). Functional analysis of inappropriate mealtime behaviors. Journal of Applied Behavior Analysis, 36, 187–204.
Piazza, C. C., Patel, M. R., Gulotta, C. S., Sevin, B. M., & Layer, S. A. (2003). On the relative contributions of positive reinforcement and escape extinction in the treatment of food refusal. Journal of Applied Behavior Analysis, 36, 309–324.
Piazza, C.C., Patel, M.R., Santana, C.M., Goh, H., Delia, M., & Lancaster, B.M. (2002). An evaluation of simultaneous sequential presentation of preferred and non-preferred food to treat food selectivity. Journal of Applied Behavior Analysis, 35, 259–270.
Reed, G.K., Piazza, C.C., Patel, M.R., Layer, S.A., Bachmeyer, M.H., Bethke, S.D., et al. (2004). On the relative contributions of noncontingent reinforcement and escape extinction in the treatment of food refusal. Journal of Applied Behavior Analysis, 37, 27–42.
Riordan, M.M., Iwata, B.A., Finney, J.W., Wohl, M.K., & Stanley, A.E. (1984). Behavioral assessment and treatment of chronic food refusal in handicapped children. Journal of Applied Behavior Analysis, 17, 327–341.
Riordan, M.M., Iwata, B.A., Wohl, M.K., & Finney, J.W. (1980). Behavioral treatment of food refusal and selectivity in developmentaly disabled children. Applied Research in Mental Retardation, 1, 95–112.
Singer, L.T., Song, L, Hill, B.P., & Jaffe, A.C. (1990). Stress and depression in mothers of failure-to-thrive children. Journal of Pediatric Psychology, 15, 711–720.
Tiger, J.H., & Hanley, G.P. (2006). Using reinforcer pairing and fading to increase the milk consumption of a preschool child. Journal of Applied Behavior Analysis, 39, 399–403.
Wilder, D.A., Normand, M., & Atwell, J. (2005). Noncontingent reinforcement as treatment for food refusal and associated self-injury. Journal of Applied Behavior Analysis, 38, 549–553.
Author information
Authors and Affiliations
Additional information
This review was completed by the author in partial fulfillment of obtaining a Ph.D. degree in School Psychology at the University of Iowa. The author expresses her appreciation to David P. Wacker for his helpful suggestions and comments on a previous version of this manuscript.
Rights and permissions
About this article
Cite this article
Bachmeyer, M.H. Treatment of Selective and Inadequate Food Intake in Children: A Review and Practical Guide. Behav Analysis Practice 2, 43–50 (2009). https://doi.org/10.1007/BF03391736
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03391736