Intensive, Manual‐based Intervention for Pediatric Feeding Disorders

Abstract

Results from this pilot study corroborate evidence from single-subject and nonrandomized studies on the positive effects of behavioral intervention. Findings support the feasibility and preliminary efficacy of this manual-based approach to intervention. These results warrant a large-scale randomized trial to test the safety and efficacy of this intervention.

Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

“…Medical monitoring (e.g., hydration status, weight) is necessary during tube weaning, which can result in weight loss due to inadequate nutrient intake. 28 In a recent randomized controlled trial (RCT) of 1- to 6-year-olds with ARFID (n = 20, 9 of whom were reliant on tube feeds), a 5-day manualized behavioral intervention significantly increased grams consumed at each meal, increased bite acceptance, and reduced mealtime disruptive behaviors, compared to a no-treatment wait-list control condition. 28 Moreover, a meta-analysis of 11 of studies (only two of which were RCTs) evaluating day or inpatient programs for increasing dietary volume in children with ARFID—most of whom had significant co-occurring medical problems—demonstrated an overall 71% success rate, with a range of 43–100%, in weaning those on tube feeds.…”

“…22 In studies using tube weaning as the primary intervention, success rates ranged from 81.4% to 100%. 29,30,31 However, while the studies involving behavioral intervention without tube weaning reported weight stabilization or gain, 30,32,33,28 those evaluating tube weaning resulted in weight loss. 29,30,31,34,35 In other words, although tube weaning is often successful in eliminating tube dependence, it should only be undertaken when the patient is able to tolerate at least a small amount of short-term weight loss and there is a clear plan for replacing tube calories with oral intake.…”

Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents

“…Tube feeding can be a life-saving treatment strategy in the setting of acute malnutrition, but, in most cases, should be considered a temporary measure to support the ultimate treatment goal of obtaining adequate nutrition through oral intake. Once patients have gained to a healthy weight and can take in at least some nutrition by mouth, weaning off tube feeds is typically done under close supervision in an inpatient (24) or day treatment (25) setting.…”

Assessment and treatment of eating disorders in children and adolescents

“…A pilot trial found support for an intensive, manual-based behavioural feeding intervention compared with waiting list for children with chronic food refusal and dependence on enteral feeding or oral nutritional formula supplementation 34. In general, treatment is individualised on the basis of the main feeding or eating difficulty and the factors contributing to aetiology.…”