Feeding Behaviors and Pediatric Disorders

Future Research Directions

• Research on pediatric feeding disorders should focus on how they impact long-term health, especially in relation to chronic medical conditions
• Understanding the influence of sensory processing differences, food aversions, and environmental factors on feeding behavior

Chronic Medical Problems

• Chronic gastrointestinal illnesses like gastroesophageal reflux disease (GERD) can contribute to feeding disorders

Associating Feeding with Discomfort

• Children may develop aversions to specific textures, tastes, or smells due to past experiences with pain or discomfort associated with eating

Developmental Emphasis

• Oral-motor development is crucial for evaluating feeding disorders, as it influences sucking, chewing, and swallowing abilities

Oral-Motor Dysfunction

• Oral-motor dysfunction can include difficulties with lip closure, tongue movement, jaw coordination, and overall muscle control within the mouth

Etiology of Feeding Disorders

• The etiology of feeding disorders is diverse and complex, involving a combination of biological, environmental, and psychological factors

Caregiver Reports

• Caregivers of chronically hospitalized children often report difficulties with their child's feeding, reflecting the potential impact of medical interventions on feeding behaviors

Determining Chewing Skills

• Videofluoroscopic swallowing study can help investigators assess a child's chewing skills by visualizing the movement of food through the mouth and throat

Feeding Uniqueness

• Feeding behavior is unique because it involves a complex interplay of sensory, motor, and motivational factors, as well as environmental influences

Specialized Beak

• Crossbills are birds known for their unique beak structure adapted for efficiently extracting seeds from pinecones

Physiological Changes in Hibernation

• Black bears undergo a physiological shift, reducing their metabolic rate and body temperature during hibernation

Reactions to Poor Growth

• Professionals in the United States often suggest calorie-dense formulas or supplements to address a poorly growing child's nutritional needs

Adapting Foraging Behaviors

• Organisms need to adapt their foraging behaviors to manage unpredictable food availability to ensure survival and proper nutrition

Food Motivation

• Organisms experiencing changes in food availability often exhibit increased food motivation to compensate for potential shortages

Adaptations for Food Availability

• Some organisms develop adaptations to cope with unpredictable changes in food availability, such as storing food or altering their foraging strategies

Misconceptions Regarding Feeding Behaviors

• One misconception about poorly growing children is that they simply lack sufficient food motivation, which is not always the case

Negative Impacts of Feeding Disorders

• Beyond nutritional deficiencies, feeding disorders can negatively impact children's social-emotional development, self-esteem, and overall quality of life

Etiology Nature

• Feeding disorders' etiology is multifaceted and influenced by various factors acting in a complex interplay, rather than solely arising from a single cause

Caregiver Impact

• Feeding disorders can place a heavy emotional and psychological burden on caregivers, impacting their well-being and relationships with their children

Behavior Extinction

• Extinguishing a behavior associated with feeding disorders, such as escape behavior (leaving the table), might lead to an increase in other problematic behaviors aimed at avoiding food

Behavior-Analytic Approaches

• More research is needed to fully apply behavior-analytic approaches to address feeding disorders in children, especially regarding preventing the emergence of new problem behaviors

Acceptance of Target Foods

• Studies have shown that acceptance of target foods during training for feeding disorders increases gradually, demonstrating the importance of sustained intervention

Common Misconception

• A common misconception about families dealing with feeding disorders is that they are not willing to work with their children. This is often not true and a lack of knowledge about available resources can contribute to this misunderstanding

Inadequate Caloric Intake

• Inadequate caloric intake due to feeding disorders before age 5 can potentially lead to long-term nutritional deficiencies, developmental delays, and health complications

Gradual Food Type Change

• Food chaining involves gradually changing food types to reduce food refusal, starting with a highly preferred food and gradually introducing new ones

Treatment Focus

• The focus of empirical support in the treatment of feeding difficulties for young children is on increasing acceptance of a variety of foods

Addressing Mealtime Behavior

• Functional analysis is cited as a useful method for addressing inappropriate mealtime behavior by identifying underlying contributing factors

Food Refusal Management

• Non-food reinforcement is suggested as an instructional strategy for managing food refusal, providing rewards for desired behaviors unrelated to food

Mouth Cleaning Enhancement

• Oral-motor exercises are one intervention used to enhance mouth cleaning in children, promoting better oral hygiene and reducing food retention

Condition Assessed Alongside Food Selectivity

• Adipsia (lack of thirst) is assessed alongside food selectivity in some studies, exploring its potential impact on overall fluid consumption and hydration

Adipsia Treatment

• Fluid loading is used to address adipsia in children by providing them with adequate fluids to prevent dehydration

Applied Behavior Analysis Journal

• Journal of Applied Behavior Analysis is known for publishing articles on applied behavior analysis related to feeding disorders

Treatment for Feeding Refusal

• Positive reinforcement was explored as a treatment for feeding refusal in children, rewarding desired behaviors related to food consumption

Reducing Packing Behavior

• Escape extinction was used to reduce packing (avoiding food) in children with severe food refusal, eliminating the reinforcement of escaping eating situations

Treating Total Liquid Refusal

• Contingency management was used to treat total liquid refusal, linking desired behaviors to rewarding outcomes

Therapy Characteristic

• The therapies mentioned in the content often involve behaviorally based strategies based on principles of reinforcement and shaping

Escape Extinction Intent

• The intent of using escape extinction in treatment is to reduce the reinforcement of behaviors aimed at avoiding food by preventing escape from eating situations

Neural Network Pattern Recognition

• Computer vision involves neural network pattern recognition, allowing analysis of visual information related to feeding behaviors

Food Refusal Analysis

• Behavioral economic analysis of food refusal assesses the value of food for a child, understanding their preferences and motivations

Research Design for Bias Mitigation

• Randomized controlled trials are highlighted for understanding systematic biases in treatment comparisons, allowing for more robust and reliable findings

Defining Acceptance

• Acceptance is defined as the child using a utensil or his fingers to put the entire bite of food in his mouth within 8 seconds of presentation.
• Observers do not score acceptance if the bite is placed into the mouth during re-presentation.
• Observers only register acceptance if the entire bite of food is placed in the mouth.
• For the study, the bite presented was one piece of food measuring 0.6 × 0.6 × 0.6 centimeters.
• The feeder restricted the operant by only presenting one bite at a time.

Measuring Expulsion

• Expulsion is when food or liquid exits the mouth after being presented.
• Liquids are defined as a pea-sized piece or larger visible outside the lips after it passes the plane of the lips.
• Solids are defined as a pea-sized piece or larger visible outside the lips after the entire bolus of food passes the plane of the lips.
• Observers scored the frequency of expulsion and presented the data as expulsions per bite.

Differential Reinforcement

• Researchers have used differential reinforcement in several ways for treatment.
• This includes:
  • Immediate (Patel, Piazza, Martinez, Volkert, & Santana, 2002)
  • Delayed (Kern & Marder, 1996; Riordan et al., 1984) reinforcement,
  • use of stimuli selected arbitrarily (Kern & Marder, 1996; Casey, Cooper-Brown, Wacker, & Rankin, 2006),
  • systematic preference assessments (Buckley, Strunck, & Newchok, 2005),
  • tokens that the child could exchange for meal discontinuation (Kahng, Boscoe, & Byrne, 2003).
• Peterson, Volkert, and Zeleny (2015) used differential reinforcement for two children with a feeding disorder to increase self-drinking from a cup.
• The researchers conducted a multiple-stimulus-without-replacement assessment before each session and used the three most preferred stimuli as reinforcement for self-drinking.
• The researchers increased the amount of liquid in the cup after the child’s self-drinking with the smaller amount increased with differential reinforcement.
• Sehgal, Prakash, Gupta, Mohan, & Anand (1990) used simultaneous presentation of different vegetable options for a child with autism.
• Stark et al. (1994) used differential reinforcement to increase vegetable consumption in a mildly selective child with autism.

Analyzing Factors

• The complexity of feeding disorders necessitates refining functional analysis procedures.
• This is to properly analyze the characteristics of the feeding environment and identify what stimuli are acting as reinforcement such as escape.
• Studies on fading suggest that the properties of stimuli can be manipulated.
• This involves altering the properties of stimuli associated with high levels of acceptance and low levels of inappropriate mealtime behavior to produce appropriate feeding.
• Researchers need to determine antecedent variables a priori.
• Most children display some forms of appropriate behavior.
• Researchers need to identify these behaviors and use this information to prescribe an effective feeding intervention.

Additional Notes

• Behavior analysts have evaluated procedures to reduce expulsion and packing.
• Ahearn, Kerwin, Eicher, Shantz, & Swearingin (1996) used two intensive interventions for food refusal:
  • an escape contingency
  • a token economy.
• Kahng, Tarbox, & Wilke (2001) implemented a token economy to increase food acceptance.
• Munk & Repp's (1994) work focused on the behavioral assessment of feeding problems in individuals with severe disabilities.
• Najdowski, Wallace, Doney, and Ghezzi (2003) conducted parent assessments and treatments for food selectivity in natural settings.
• Najdowski et al. (2008) used a caregiver-conducted experimental functional analysis to target inappropriate mealtime behavior.
• Najdowski et al. (2010) focused on a home-based parent training approach to treat food selectivity.
• Palmer & Horn (1978) researched feeding problems in children.
• Pangborn, Borrero, & Borrero (2013) focused on training caregivers to implement pediatric feeding protocols.
• Patel, Piazza, Kelley, Ochsner, & Santana (2001) experimented with a fading procedure to increase fluid consumption in children with feeding problems.
• Patel, Piazza, Layer, Coleman, & Swartzwelder (2005) evaluated food textures to decrease packing and increase oral intake in children with pediatric feeding disorders.
• Patel, Piazza, Martinez, Volkert, & Santana (2002) focused on increasing acceptance for bites/drinks.
• Peck, Richman, et al. (1995) focused on increasing the variety of foods consumed by blending nonpreferred foods into preferred foods.
• Penrod, Gardella, & Fernand (2012) investigated a progressive high-probability instructional sequence along with low-probability demand fading to treat food selectivity.
• Peterson, Piazza, Ibañez, & Fisher (2019) conducted a randomized controlled trial to assess the efficacy of an applied behavior analysis intervention for food selectivity in children with autism spectrum disorder.
• Peterson, Piazza, & Volkert (2016) compared a modified sequential oral sensory approach to an applied behavior analytic approach in treating food selectivity in children with autism spectrum disorders.
• Peterson, Volkert, & Zeleny (2015) examined strategies to improve self-drinking for children with feeding disorders.
• Piazza, Anderson, & Fisher (1993) researched teaching self-feeding skills to patients with Rett syndrome.
• Piazza & Carroll-Hernandez (2004) provided information about the assessment and treatment of pediatric feeding disorders.
• Piazza, Fisher, Brown, Shore, Patel, Katz, et al. (2003) focused on the functional analysis of inappropriate mealtime behaviors.
• Piazza, Patel, Gulotta, Sevin, & Layer (2003) examined factors contributing to the treatment of pediatric feeding disorders.

Behavior-Analytic Approach to Feeding Disorders

• Oral-motor dysfunction in children may contribute to eating disorders.
• Speech or occupational therapists can identify and evaluate oral-motor dysfunction.
• Caregivers often provide immediate attention, removal of the spoon, or preferred items when children refuse food, shaping their behaviors.
• Differential Reinforcement of Alternative Behavior (DRA) is a proven intervention for decreasing food refusal and increasing acceptance.
• High-probability instructions followed by desired behavior can increase acceptance.
• Simultaneous presentation of desired food and non-preferred food can help increase consumption.
• Escape extinction can reduce inappropriate eating behaviors and increase acceptance.
• Redistribution is used to reduce packing by removing food from the mouth and encouraging chewing.
• Chasers help reduce packing by offering an immediately accepted food or liquid after the target food.
• Fading is a technique to gradually increase acceptance of target foods.
• Feeding disorders can impact a child’s physical, mental, and social development, leading to medical complications.
• Impact of feeding disorders can be significant on families, causing stress, depression, and financial burdens.
• The etiology (causation) of feeding disorders is complex with several possible reasons including:
  • Learned behaviors (escape and avoidance)
  • Oral-motor skill deficits
  • A combination of factors

Impact on Development and Families

• Children with feeding disorders are at risk for medical complications as insufficient calorie intake and poor nutrition can be dangerous before age 5 during rapid brain development.
• Feeding disorders can isolate children socially, hindering participation in events.
• Families of children with feeding disorders can experience caregiver stress, depression, and high financial costs.

Explore the unique behaviors associated with feeding across species and understand the complexities of pediatric feeding disorders. This quiz delves into how organisms adapt their feeding mechanisms and the multifactorial influences on feeding difficulties in children. It highlights the impact of oral-motor dysfunction and environmental factors.