Infant food refusal and parental social support

The purpose of this study was to examine the relations between various aspects of social support and maternal and infant outcome variables in a group of families having infants showing food refusal compared to a control group. In the case of early food refusal, the results indicated that access to emotional support and satisfaction with support were related to maternal psychosomatic health. The relationships were interpreted as showing that social support has moderating effects on negative outcomes of food refusal.     

Interactions between mothers and infants showing food refusal

This study examined the interactional patterns of mothers and their infants who showed food refusal (N = 24) and of mothers and infants in a control group (N = 24) during feeding and play. The observations revealed significant group differences in both infant and maternal behavior. Infants in the case group rejected food more often and showed less clear communication signals than control infants, and mothers of case infants were less sensitive, less cooperative, and had more verbal teaching/control behavior than the control group. These differences pertained to both feeding and play situations. The findings have implications for the development of appropriate and efficient intervention strategies for infants showing food refusal.     

Use of a multicomponent treatment for food refusal

We examined the use of a multicomponent treatment for food refusal exhibited by a 5-year-old boy who had been diagnosed with mild to moderate mental retardation. Treatment consisted of access to highly preferred tangible items, which were removed contingent on problem behavior or not accepting a bite, and differential reinforcement of alternative behavior. Treatment resulted in an increase in food acceptance to 100% of bite offers and near-zero rates of problem behavior. In addition, the participant's caregivers were successfully trained to implement the treatment.     

Noncontingent reinforcement as treatment for food refusal and associated self-injury

We examined the use of noncontingent reinforcement to decrease self-injury and increase bite acceptance in a child who exhibited food refusal. First, a brief functional analysis suggested that self-injury was maintained by escape from food presentation. Next, we evaluated an intervention that involved noncontingent access to a video during feeding sessions. Results of the intervention showed a decrease in self-injury and an increase in bite acceptance.     

Using food redistribution to reduce packing in children with severe food refusal

Positive- and negative-reinforcement-based procedures typically have targeted acceptance for children with severe food refusal; however, these procedures do not always result in successful swallowing. Once acceptance is achieved, some children expel the food repeatedly or pack (hold or pocket) it in their mouths for extended periods of time. This study evaluated the effects of using food redistribution with a bristled massaging toothbrush to reduce packing and increase consumption in 4 children with severe feeding disorders. Packing was reduced for all children. In addition, latency to clean mouth (the duration of time from acceptance to food no longer being present in the child's mouth in the absence of expulsion) for 2 children decreased when the food-redistribution procedure was used. Results are discussed in terms of the potential operant functions of the food-redistribution procedure.     

Analysis of response covariationamong multiple topographies of food refusal

This study examined the effects of sequentially introducing treatment across multiple topographies of food refusal. Treatment with nonremoval of the spoon produced an increase in food acceptance and a decrease in disruption, but expulsion of food increased. When expulsion was treated, packing of food increased. Finally, when packing was treated, all refusal behaviors remained low, and acceptance continued to occur at high and stable levels.     

Infant characteristics and anger reduction

Konrad Lorenz first suggested in 1943 that certain physical and behavioral characteristics common to infants (babyishness) serve as cues to attract adult attention and care as well as to decrease the likelihood of aggression. The present study was designed to determine whether the visual stimuli of a baby's face alone are sufficient to reduce anger. The subjects were 60 female students between 18 and 30 years of age. Anger was evoked by setting unsolvable tasks and by noise and maintained by adequate instructions and by continuing noise. Three procedures of measurement (heart rate, retrospective self-report, and interpretation of facial affect by two observers) were designed to show the reactions of the subjects viewing photos of babies and adults. We found a slight increase in heart rate to be an expression of happiness and a massive acceleration to be an expression of anger. The self-report measures and interpretation of facial affect supported the hypothesis that there is a more positive response to infants than to adults, and to cute babies also a more positive one than to less attractive infants. We found weak evidence that babyishness reduces anger. As a consequence of the length of the experiment, subjects who should not be aroused became angry. Thus, it was possible to register a reduction of anger as reaction to cute infants.     

Examining extinction bursts in the treatment of pediatric food refusal

Escape extinction has been shown to be highly effective in the treatment of food refusal; however, unpleasant side effects such as extinction bursts may accompany extinction procedures. Bursting has been reported to occur in 24% to 39% of all cases for which extinction was used as a component during treatment of problem behavior. Although commonly used in treatments, the occurrence of extinction bursts in the treatment of pediatric food refusal has not been studied. This study measured the frequency of bursting in 10 children for whom escape extinction was used to treat food refusal. Results showed that extinction bursts were observed in 30% of the children included in the study, although they were relatively brief and resolved quickly. Considerations for using escape extinction in interventions will be discussed.     

A comparison of two multicomponent treatment packages for food refusal

Food refusal is a severe feeding problem in which children refuse to eat all or most foods, which can be treated effectively using multicomponent intervention packages. This study compared two multicomponent treatment packages on food and drink consumption, inappropriate mealtime behavior, and total intake in a child with food refusal. Bite and drink consumption was consistently higher; inappropriate mealtime behavior was consistently lower; and total intake was greater when differential reinforcement of alternative behavior and escape extinction treatment were implemented compared to response cost, escape extinction, and differential reinforcement of alternative behavior.     

Comparison of bite-presentation methods in the treatment of food refusal

The current study examined the rate of expulsions and mouth cleans across 3 presentation methods (upright spoon, flipped spoon, Nuk brush) for a 3-year-old girl with a feeding disorder. The participant expelled all bites presented on an upright spoon. Results showed reduced rates of expulsions and increased mouth cleans during the flipped spoon and Nuk brush presentation methods.     

Treatment of chronic food refusal in a young developmentally disabled child

Chronic food refusal is a common problem among young children with developmental disabilities. Children with chronic food refusal may require supplemental tube feedings or parental feedings. A multicomponent treatment package consisting of escape–avoidance extinction, shaping and positive reinforcement was effective in establishing a normal oral feeding pattern with a 1.5 years old developmentally disabled child who was fed by gastrostomic tube. Treatment effects generalized to the home setting and were maintained during follow‐up. After treatment, tube‐feeding was discontinued. Copyright © 1999 John Wiley & Sons, Ltd.     

Trauma-Informed Care for Infant and Early Childhood Abuse

ABSTRACT

Trauma-informed care for those who experienced early childhood maltreatment is being developed to meet the needs of infant, toddler, and preschool victims of child abuse and neglect. This age group experiences a disproportionate amount of abuse, and the resultant toxic stress during this rapid developmental stage is more damaging than it is in later years. The concept of trauma-informed care in general is presented, followed by a focus on trauma care for early childhood abuse. Trauma-informed care for younger children is united by common principles and is seen as developmental, relational, sensory oriented, and evidence based in nature. Dissemination of knowledge about this unique population to every system that encounters survivors of any age has begun, although it must be broadened and increased. Evidence-based treatment programs for young children are available and effective but limited, especially for age 0–2. Home visiting programs for mothers and babies are effective and cost efficient. Major funding by U.S. Department of Health and Human Services to each state has significant potential for success because it targets mother-child attachment and care, as well as the disproportionate amount of damage resulting from early childhood abuse. Infants and preschoolers are in some ways comparable to children with disabilities due to their developmental limitations. The nature of this population requires a more rigorous and proactive awareness and identification process because these children are physically dependent on surrounding adults. Addressing child abuse in the first years of life offers an excellent opportunity to assist the most vulnerable victims and effectively reduce the impact to families and communities in the ensuing years.     

Spoon distance fading with and without escape extinction as treatment for food refusal

Little is known about the characteristics of meals that serve as motivating operations (MOs) for escape behavior. In the current investigation, we showed that the distance at which a therapist held a spoon from a child's lips served as an MO for escape behavior. Based on these results, we implemented spoon distance fading, compared fading with and without escape extinction (EE), and compared fading plus EE to EE alone. Initially, inappropriate mealtime behavior decreased during fading, but this effect was not maintained as fading progressed. Inappropriate mealtime behavior was lower initially when we combined fading and EE relative to EE alone, but acceptance increased more rapidly with EE than with fading plus EE. These results suggest that a number of mealtime characteristics might function as MOs for escape behavior and that analyses of MOs may be useful for developing treatments for food refusal.     

Comparison of upright and flipped spoon presentations to guide treatment of food refusal

The current study examined the effects of bite placement with a flipped versus upright spoon on expulsion and mouth clean (product measure of swallowing) in the treatment of 3 children diagnosed with a pediatric feeding disorder and oral-motor deficits. For all 3 participants, extinction in the form of nonremoval of the spoon led to improvements in inappropriate mealtime behavior and acceptance of bites; however, re-presentation did not reduce expulsion or improve mouth clean. Results showed a lower level of expulsion and higher percentage of mouth clean during flipped spoon presentations and re-presentations for all participants. Findings from follow-up analyses supported transitioning back to an upright spoon in all 3 cases, although the time required for this to occur differed across participants.     

Use of the high-probability instructional sequence and escape extinction in a child with food refusal

We used the high-probability (high-p) instructional sequence with and without escape extinction in the treatment of food refusal. Acceptance increased and refusal decreased only with the introduction of escape extinction. These results raise important questions about the high-p sequence in the treatment of food refusal.     

An evaluation of two differential reinforcement procedures with escape extinction to treat food refusal

Consumption of solids and liquids occurs as a chain of behaviors that may include accepting, swallowing, and retaining the food or drink. In the current investigation, we evaluated the relative effectiveness of differential reinforcement of the first behavior in the chain (acceptance) versus differential reinforcement for the terminal behavior in the chain (mouth clean). Three children who had been diagnosed with a feeding disorder participated. Acceptance remained at zero when differential reinforcement contingencies were implemented for acceptance or mouth clean. Acceptance and mouth clean increased for all 3 participants once escape extinction was added to the differential reinforcement procedures, independent of whether reinforcement was provided for acceptance or for mouth clean. Maintenance was observed in 2 children when escape extinction was removed from the treatment package. The mechanism by which consumption increased is discussed in relation to positive and negative reinforcement contingencies.     

Goodness-of-fit in family context: Infant temperament, marital quality, and early coparenting behavior

This study examined the contributions of infant temperament and marital relationship quality to the quality of the early coparenting relationship for couples parenting 3.5-month-old infants. Marital quality was assessed observationally during the third trimester of pregnancy. When infants were 3.5 months old, infant temperamental characteristics (fussiness and unadaptability) were rated by parents and observers and coparenting behavior was assessed observationally in play and child care contexts. Results indicated that associations between infant temperament and coparenting behavior depended on marital quality: couples with high marital quality showed more optimal coparenting behavior when faced with a challenging infant, whereas couples with low marital quality showed less optimal coparenting behavior when caring for a challenging infant.     

On the relative contributions of noncontingent reinforcement and escape extinction in the treatment of food refusal

In the current investigation, we evaluated the relative effects of noncontingent reinforcement (NCR), escape extinction, and a combination of NCR and escape extinction as treatment for the feeding problems exhibited by 4 children. For each participant, consumption increased only when escape extinction was implemented, independent of whether NCR was present or absent. These results were consistent with prior research suggesting that positive reinforcement alone is insufficient for increasing consumption, and that escape extinction often is necessary to increase and maintain food acceptance. However, NCR appeared to decrease inappropriate behavior for some participants.