Preliminary comparison of redistribution at different intervals to reduce packing in children with avoidant/restrictive food intake disorder.

Abstract

Packing (holding food in the mouth) is a problematic mealtime behavior displayed by children with feeding disorders that may cause prolonged meal durations and decreased caloric intake (Gulotta et al., 2005). Placement of the bolus directly on the tongue using flipped-spoon or Nuk presentation and redistribution of packed food have support as treatments to reduce packing. In our clinic's typical treatment progression, we often first conduct an assessment comparing methods to place the bolus on the tongue (e.g., upright to flipped-spoon or Nuk presentation) if packing emerges. If packing persists, we then add redistribution. The intervals researchers have evaluated most often are redistribution 15 or 30 s after bite deposit. We aimed to determine whether implementing redistribution at both 15 s and 30 s was more effective than implementing redistribution only at 30 s to reduce packing for three children with severe oral-motorskill deficits. We compared the effects of flipped-spoon presentation for Jacob and Nuk presentation for Mary combined with 15-and 30-s redistribution versus 30-s redistribution. For Whitney, we compared upright-spoon presentation to the two redistribution conditions. The results of this preliminary study showed that the 15-and 30-s redistribution procedure produced marginal reductions in packing for Jacob and Whitney and lower levels of packing for Mary.

A Retrospective Consecutive Controlled Case Series of Underspoon: A Modified-Bolus Placement to Address Behavior That Interfere With Swallowing

“…Kai's open-mouth posture and poor lip closure suggested that he would benefit from modified-bolus placement for removing the bolus from the spoon (e.g., Bloomfield et al, 2021;Stubbs et al, 2018). Of note, when exposed to underspoon, the participants did not require physical prompting (e.g., chin prompt).…”

“…Kai and Mila, who had moderate oral-motor delays, experienced fewer sessions with underspoon prior to successfully returning to upright spoon than the remainder of the participants with severe oral-motor delays. Kai’s open-mouth posture and poor lip closure suggested that he would benefit from modified-bolus placement for removing the bolus from the spoon (e.g., Bloomfield et al, 2021; Stubbs et al, 2018). Of note, when exposed to underspoon, the participants did not require physical prompting (e.g., chin prompt).…”

Behavior Analytic Feeding Interventions: Current State of the Literature

“…Redistribution was included in 6 of 15 studies published subsequent to Sevin et al's (2002) study, making it the most researched intervention for packing. In the most recent study, researchers compared two redistribution interventions, in one intervention, clinicians implemented redistribution at both 15 and 30 seconds and in the other intervention, clinicians implement redistribution only after 30 seconds (Bloomfield et al, 2021). They found implementing redistribution more often resulted in greater reduction in packing.…”

“…The authors stated “In our clinic’s typical treatment progression, we often first conduct an assessment comparing methods to place the bolus on the tongue (e.g., upright to flipped-spoon or Nuk presentation) if packing emerges. If packing persists, we then add redistribution” ( Bloomfield et al, 2021 , p. 1).…”