Liquid to Baby Food Fading in the Treatment of Food Refusal

Abstract

In the current investigation, we identified two young children who consistently consumed liquids, but not baby food, after treatment with positive reinforcement for mouth clean (an indirect measure of swallowing) and physical guidance with re‐presentation of food. We examined the effects of an 11‐step stimulus fading procedure that involved gradually altering the concentration of liquid by adding baby food to the liquid. High levels of mouth clean were maintained in both children throughout fading, and increased mouth clean during probes of 100% baby food was obtained after conducting all 11 fading steps with one child and 6 of 11 fading steps with the second child. Negative vocalizations decreased during probes of 100% baby food after conducting the remaining fading steps with the second child. Gram intake of 100% baby food increased with both children after we completed all fading steps. Copyright © 2013 John Wiley & Sons, Ltd.

Blending as a treatment for feeding disorders: A review of the literature

“…Authors identified 43% ( n = 6) of participants as having a developmental disability, 21% ( n = 3) of participants as having a diagnosis of autism spectrum disorder (ASD), and 35% ( n = 5) of participants as typically developing or otherwise did not report a specific disability. Of children without disabilities, 80% ( n = 4) received clinical services for feeding disorders or presented significant health issues (e.g., failure to thrive; Bachmeyer, Gulotta, & Piazza, 2013).…”

“…The nature of selectivity varied widely and included children with severe feeding disorders who ate a narrow range of textures (e.g., Eckman et al, 2008; Shore, Babbitt, Williams, Coe, & Snyder, 1998), children who consumed a narrow range of solid foods (e.g., Luiselli, Ricardi, & Gilligan, 2005), and children who refused a specific item (e.g., milk; Tiger & Hanley, 2006). Authors reported that 36% ( n = 5) of participants presented with physical conditions related to feeding, which included unspecified “complex gastrointestinal problems” (Mueller, Piazza, Patel, Kelley, & Pruitt, 2004, p. 161), food allergies (e.g., Food Protein Induced Enterocolitis Syndrome; Holland, 2015), and oral motor restrictions (e.g., limited tongue movement and gastroesophageal reflux disease; Bachmeyer et al, 2013). Authors did not report physical conditions with the potential to inhibit feeding in the remaining participants (64%; n = 9).…”

“…Eckman et al (2008) also measured a positive, consumption‐related behavior (i.e., chewing). Studies also featured measures of inappropriate mealtime behaviors including expulsions (20%; n = 2), gags (10%; n = 1), and generic problem behavior (20%; n = 2; e.g., negative vocalizations; Bachmeyer et al, 2013; Holland, 2015).…”

“…behaviors including expulsions (20%; n ¼ 2), gags (10%; n ¼ 1), and generic problem behavior (20%; n ¼ 2; e.g., negative vocalizations; Bachmeyer et al, 2013;Holland, 2015).…”

“…Notwithstanding the limited evidence, practitioners may opt to use blending due to its convenience and conceptual consistency with other interventions used in behavioral treatment (e.g., fading during intervention conditions improved upon several baseline treatment packages, several of which included escape extinction (e.g., Bachmeyer et al, 2013;Holland, 2015;Mueller et al, 2004;Shore et al, 1998). Due to the quality of the research, blending cannot be unequivocally recommended to practitioners as an evidence-based practice.…”