Shaping Oral Feeding in a Gastronomy Tube–Dependent Child in Natural Settings

Abstract

A 3-year-old medically fragile girl who refused to eat after prolonged and frequent hospitalizations was started on a feeding program in the home and school settings. She exhibited food aversions and received all nourishment via a gastronomy tube. Preevaluation observations of her feeding behavior revealed that she refused all presented drinks and foods. Treatment was two-fold. First, food acceptance was followed by social praise and access to preferred toy play, and second, food refusal and disruptive behaviors were ignored. Gagging, vomiting, and crying occurred periodically during initial feedings. In addition, there were medical complications during the course of treatment necessitating continuous modifications of the program. Results of a multiple-phase design showed marked increases in the amount of food consumed at home, which then generalized to the school setting.

A Critical Review of Line Graphs in Behavior Analytic Journals

“…Time series line graphs must have a unit of time on the horizontal axis (Robbins 2005). Examples of units of time range from seconds (e.g., Preston 1994) and minutes (e.g., Norborg et al 1983) to hours (e.g., Ramirez 1997) and days (e.g., Gutentag and Hammer 2000). Twenty-eight percent of line graphs in behavioral journals maintained a time unit label.…”

Functional Assessment and Behavioural Intervention for Eating Difficulties in Children with Autism: A study Conducted in the Natural Environment Using Parents and ABA Tutors as Therapists

“…Some studies have examined the use of treatment in the natural setting, giving the advantage of allowing these variables to be assessed directly. Gutentag and Hammer (2000) conducted treatment of a three year old girl with food aversion, receiving all nutrition via a gastronomy tube, in the child's home and school; treatment was conducted by parents and teachers. Social praise and access to preferred toy play were provided for food acceptance and food refusal and disruptive behaviours were ignored.…”

Jump start exit criterion: Exploring a new model of service delivery for the treatment of childhood feeding problems

“…The effectiveness of the inpatient setting has been described in several studies that have involved samples of children with severe feeding problems, notably food refusal and dependence upon tube feedings (Babbitt, Hoch, Coe, Cataldo, Kelly, Stackhouse, et al, 1994;Blackman & Nelson, 1987;Foy, Czyewski, Phillips, Ligon, Baldwin, & Klish, 1997); however, inpatient treatment may not be necessary or appropriate to address all feeding problems. While the effectiveness of outpatient treatment has been demonstrated (Gutentag & Hammer, 2000;Werle, Murphy, & Budd, 1993), outpatient treatment may not be appropriate when the caregivers are unable to implement the treatment plan (Linscheid et al, 2003). Recently, the efficacy of day treatment, in which the children receive intensive treatment (e.g., multiple sessions per day for multiple days) without the need for hospitalization has been demonstrated for feeding problems (Cohen, Piazza, & Riski, 2006;Williams, Riegel, Gibbons, & Field, 2007).…”