Feeding Data Analysis and Behavior

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

How does the opportunity to engage in expulsion relate to a clinician's assessment in mealtime behavior?

It affects how clinicians calculate rates of expulsion based on the number of bites available to the child.

What is the difference between calculating expulsions per bite and expulsions per opportunity?

Expulsions per bite is used when the opportunity to expel is fixed, while expulsions per opportunity is used when the opportunity to expel varies.

What actions are classified as inappropriate mealtime behavior according to the researchers?

Behaviors that disrupt feeding involving external body parts, such as the head, hands, arms, and legs.

What is the significance of 'mouth clean’ in evaluating swallowing difficulties?

'Mouth clean' is a product measure indicating that no food larger than a pea is left in the mouth, making it a reliable measure of swallowing. Signup and view all the answers

How did observers in Kadey et al. (2013) determine if a child's mouth was clean?

They checked the child's mouth 30 seconds after a bite was taken to ensure no food was left, unless it was due to expulsion. Signup and view all the answers

What is the importance of distinguishing between mouth clean and packing behaviors?

This distinction helps in understanding the underlying issues of mealtime behavior and assessing eating difficulties. Signup and view all the answers

Why might swallowing be considered difficult to measure reliably in clinical settings?

Swallowing involves complex physiological processes that can vary greatly among individuals, making it hard to quantify. Signup and view all the answers

What alternative behaviors might interfere with feeding, apart from expulsions and packing?

Physiological behaviors such as coughing, gagging, and vomiting can interfere with feeding. Signup and view all the answers

What are some chronic medical conditions that can affect a child's digestive system?

Conditions include congenital defects of the gastrointestinal tract, delayed gastric emptying, food allergies, and gastroesophageal reflux disease. Signup and view all the answers

How did Volkert et al. (2014) define mastication in their research?

Mastication was defined as chewing food with pieces no larger than $0.2 imes 0.2$ centimeters in a liquid medium. Signup and view all the answers

What limitation is noted in the definition of chewing provided in the text?

The definition does not differentiate between rotary chews and immature chewing patterns like munching. Signup and view all the answers

What role does nausea play in the development of food aversions in children?

Nausea, when paired with eating, can lead to the development of aversions to certain tastes after only a few experiences. Signup and view all the answers

What is one major medical problem associated with aspiration due to oral-motor dysfunction?

Pneumonia. Signup and view all the answers

Estimate the prevalence of feeding disorders in children with chronic medical problems.

Feeding disorders are estimated to occur in 40–70% of children with chronic medical conditions. Signup and view all the answers

What role do caregivers typically play when a child exhibits refusal behavior during meals?

They may coax, remove the spoon, or use threats to encourage feeding. Signup and view all the answers

What could sufferer experiences in children with gastroesophageal reflux disease lead to?

Children may associate eating with pain due to excess acid erupting into the esophagus. Signup and view all the answers

Who typically performs evaluations for oral-motor dysfunction in children?

A swallow specialist, usually an occupational or speech therapist. Signup and view all the answers

What is an important feature of the mastication check used by researchers?

Observers determined whether the child had masticated rather than simply swallowed the bite. Signup and view all the answers

What are two possible consequences caregivers may provide in response to inappropriate mealtime behavior?

<ol> <li>Providing escape from the meal, 2) Coaxing or reprimanding the child.</li> </ol> Signup and view all the answers

What is the effect of food aversion development mentioned in the text?

Food aversions may develop rapidly and can generalize to other foods, making them treatment-resistant. Signup and view all the answers

How does a dietitian contribute to the care of a child with feeding disorders?

They calculate the child's caloric, hydrational, and nutritional needs. Signup and view all the answers

What dietary considerations might a child with a glycogen storage disorder need?

Monitoring of blood sugar levels and a diet that restricts simple sugars. Signup and view all the answers

What might the results of an interdisciplinary evaluation for feeding disorders indicate?

The need for medical treatment, consistency or texture manipulations, or a special diet. Signup and view all the answers

What is one potential serious effect of drops in blood sugar levels in children?

Seizures, coma, or even death. Signup and view all the answers

What was the primary goal of the behavioral intervention for the children with cystic fibrosis?

The primary goal was to increase caloric intake and weight gain. Signup and view all the answers

What variables were used to measure the effectiveness of the behavioral intervention?

Calories consumed and weight gain were the dependent variables used. Signup and view all the answers

What components were included in the multicomponent behavioral intervention?

It included caregiver praise, a star chart, and access to privileges for appropriate feeding behavior. Signup and view all the answers

How many calories did the intervention group consume daily after the behavioral intervention?

The intervention group increased their caloric intake to 1,032 calories per day. Signup and view all the answers

What was the mean weight gain for the behavioral intervention group compared to the control group?

The mean weight gain was 1.7 kilograms for the intervention group, while the control group had 0 kilograms. Signup and view all the answers

What notable follow-up results were maintained by the participants of the intervention?

Participants maintained higher levels of caloric intake relative to baseline at 3- and 6-month follow-ups. Signup and view all the answers

Which three interventions were noted as not incorporating behavior-analytic principles?

Non-nutritive sucking, oral stimulation, and oral support did not incorporate behavior-analytic principles. Signup and view all the answers

What does the term 'differential reinforcement' refer to in the context of the interventions mentioned?

Differential reinforcement refers to reinforcing desired behaviors while withholding reinforcement for undesired behaviors. Signup and view all the answers

What treatment method was used to address feeding refusal in Groff et al. (2014)?

Syringe fading was used as a treatment for feeding refusal. Signup and view all the answers

In what study did Kirkwood et al. (in press) compare function-based and nonfunction-based extinction?

Kirkwood et al. compared function- and nonfunction-based extinction in the context of inappropriate mealtime behavior. Signup and view all the answers

What innovative method was used by Hadley et al. (2015) for the detection of swallowing problems?

Neural network pattern recognition was used for automated detection of swallow. Signup and view all the answers

What approach did Levin et al. (2014) employ to reduce packing in children with autism spectrum disorders?

Levin et al. utilized a multi-component treatment approach. Signup and view all the answers

Which treatment design did Hagopian et al. (1996) implement for total liquid refusal?

They implemented backward chaining and fading as a treatment design. Signup and view all the answers

What was the primary goal of the food redistribution strategy proposed by Gulotta et al. (2005)?

The primary goal was to reduce packing in children with severe food refusal. Signup and view all the answers

What are the implications of using escape as reinforcement in treating feeding problems according to LaRue et al. (2011)?

Using escape as reinforcement implies that allowing children to escape from challenging eating situations can help reduce feeding issues. Signup and view all the answers

Which fading technique did Groff et al. (2011) apply to help with cup drinking in a child with intestinal failure?

They applied spoon-to-cup fading as a technique. Signup and view all the answers

Study Notes

Expulsion, Acceptance, and Mouth Clean

Clinicians should pay attention to how the opportunity to engage in expulsion affects data presentation when analyzing feeding data.
Expulsions per bite can be calculated when the opportunity to expel is fixed, such as a fixed number of bites offered.
Expulsions per opportunity can be calculated when the opportunity to expel is variable, such as during re-presentation.
Mouth clean is a product measure of swallowing that is often used due to the difficulty of reliably measuring swallowing directly.
In Kadey et al. (2013), observers scored "mouth clean" when there was no food larger than a pea in the child's mouth, unless the absence of food was the result of expulsion.
The feeder in Kadey et al. checked the child's mouth 30 seconds after the bite entered the mouth by saying, "Show me."
The mouth check provided the opportunity to score mouth clean or pack.

###Inappropriate Mealtime Behavior

Inappropriate mealtime behavior can involve numerous behaviors that disrupt feeding.
Some researchers categorize inappropriate mealtime behavior into broader categories that include:
- External body part behaviors: behaviors a child emits with their head, hands, arms, and legs that prevents solids, liquids, or both from entering the mouth.
- Mouth behaviors: behaviors the child emits with their mouth, like expulsion and packing.
- Behaviors with a putative physiological basis: Behaviors like coughing, gagging, and vomiting.
Volkert et al. (2014) included a measure of mastication, defined as food with pieces no larger than 0.2 × 0.2 centimeters in a liquid medium at the mastication check.

Oral-Motor Dysfunction

Oral-motor dysfunction may be associated with aspiration and can present medical problems such as pneumonia.
A swallow specialist, typically an occupational or speech therapist, can determine if oral-motor dysfunction may be causing or contributing to a child's feeding disorder and whether the child is a safe oral feeder.
Oral-motor dysfunction may be caused by chronic medical problems that affect the digestive system, such as congenital defects, delayed gastric emptying, food allergies, GERD, malabsorption, and metabolic disorders.

Caregiver Responses to Feeding Behavior

Caregivers may respond to refusal of food with:
- Escape (spoon removal, meal termination)
- Attention (coaxing, reprimands, concern)
- Tangible items (preferred toys or food)

Interventions

Behavior-analytic interventions are generally considered to be the most empirically supported interventions for increasing acceptance, decreasing inappropriate mealtime behavior, and reducing expulsion.
Researchers have used behavioral interventions to address feeding challenges related to:
- Increasing acceptance of solids
- Increasing acceptance of liquids
- Decreasing self-injurious behavior
- Decreasing expulsion

Interventions Supported By Research

Interventions supported by research include:
- Non-nutritive sucking
- Oral stimulation
- Oral Support
- Stimulus fading
- Simultaneous presentation without escape extinction
- Differential reinforcement
- Response cost
- Noncontingent reinforcement

Evaluation

Interdisciplinary evaluation may reveal a need for medical treatment, consistency/texture modifications, special diets, and/or a combination of these interventions.
A dietitian can determine a child's caloric, hydration, and nutritional needs and whether they require diet modification.

Limitations

One limitation of the definition of inappropriate mealtime behavior discussed is that “it did not differentiate rotary chews from an immature chewing pattern such as munching" (Volkert et al., 2013).

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers key concepts related to the analysis of feeding data, including the impact of expulsion opportunities and measures of mouth cleanliness. It references the methodology in Kadey et al. (2013) for observing eating behaviors. Important aspects of inappropriate mealtime behavior are also touched upon for a comprehensive understanding.