Mealtime Skill Independence: from Pouch-to-Spoon Fading to Using Chopsticks

Abstract

Compared to solids, less paediatric feeding research has targeted liquids, medication, and teaching independence skills (e.g., fork, chopsticks). No research to our knowledge has reported transitioning from spout squeeze ‘baby food’ pouches, increasing finger-feeding, and teaching steps in scooping, sipping, and biting off portions. We detail a clinical case and depict data teaching comprehensive mealtime independence using multi-element and multiple-baseline designs. A 3-year-old male with paediatric feeding disorder, avoidant/restrictive food intake disorder (ARFID), and autism spectrum disorder (level 3) had only one independent skill (yogurt pouch via spout). He did not finger-feed, self-spoon-feed, self-drink, or cup-drink. He participated in a home-based intensive 2-week behaviour-analytic treatment programme. We conducted an assessment comparing novel pouch transition apparatuses, then used pouch-to-spoon fading to teach spoon self-feeding. We taught independence in finger-feeding, open-cup drinking, and four methods of medication administration, then open-cup bolus sipping, self-scooping, biting off portions, fork, and chopsticks (11 skills). He met 100% of goals. Caregivers reported high social validity and relevant culturally significant information, and gains generalised and maintained in follow-up.