A systematic review of physical guidance procedures as an open‐mouth prompt to increase acceptance for children with pediatric feeding disorders

This article reviews behavioral treatments of pediatric feeding disorders using physical guidance procedures as an open‐mouth prompt (i.e., jaw prompt, finger prompt, Nuk prompt, side deposit) to increase food acceptance. We identified 9 articles containing 35 systematic evaluations. We coded participant and study characteristics and assessed the experimental rigor, quality, and outcomes of each evaluation. Of the high‐quality research present, the finger prompt variation and side deposit reliably increased acceptance. We found mixed results on the efficacy of the jaw prompt, although it was the most widely researched procedure. Further, authors reported interobserver agreement for 100% of the participants, procedural integrity for 60%, social validity for 80%, fading for 5%, and follow‐up for 55%. Based on the invasive nature of physical guidance, we provide recommendations for researchers and clinicians to increase the quality of their treatment evaluations. We discuss limitations, implications for practice, and future research.     

Sucking patterns are not predictive of further feeding development in healthy preterm infants

Preterm infants are at risk of experiencing difficulties in their feeding development. For a possible early identification of these, we examined the association between sucking patterns, assisted spoon feeding, and chewing skills in 40 healthy preterm infants, and the role of experience in the acquisition of these skills in a prospective longitudinal study. Sucking patterns were evaluated at 34, 37, and 44 weeks postmenstrual age (PMA), assisted spoon feeding was evaluated at 6, 9, and 12 months PMA, and chewing was evaluated at 9, 12, and 24 months PMA. Sucking patterns were rated using the Neonatal Oral Motor Assessment Scale, assisted spoon feeding was rated using the Observation List Spoon Feeding, and chewing was evaluated using the Mastication Observation and Evaluation Instrument.All infants showed progression in their oral motor skills during the study period, but not all demonstrated a stable progression of skills. Quality of sucking patterns was not associated with skill level achievement of assisted spoon feeding or with chewing. Length of experience in sucking was significantly associated with duration of supplemental tube feeding but not with the quality of the sucking pattern. Length of chewing experience was significantly associated with chewing abilities at 9 and 12 months PMA. No clinical characteristics were sufficiently predictive of oral motor skill development. Results show that sucking patterns are not predictive of subsequent feeding development in healthy preterm infants. The food consistency offered and the length of feeding experience influenced the acquisition and quality of oral motor skills differently.     

‘Please don’t put the whole dang thing out there!’: A discursive analysis of internet discussions around infant feeding

The promotion of breastfeeding is an important focus of intervention for professionals working to improve infant health outcomes. Literature in this area focuses largely on ‘choices’ and ‘barriers to breastfeeding’. It is our argument, however, that women's cultural context plays a key role in infant feeding ‘choices’. In this article, we explore contested representations of infant feeding and infant feeding choices in public debates conducted on a large British parenting website. To sample dominant representations of infant feeding circulating in UK culture, two threads were chosen from the debating board of a busy online parenting community (105 and 99 individual posts, respectively). Participants on the threads were largely women. A feminist informed Foucauldian discourse analysis was used to deconstruct the intersecting constructions of gender, childhood and motherhood implicit in public discussions about infant feeding choices. We identify dominant constructions of women who breastfeed or bottle feed, social representations of both forms of infant feeding, and explore the relationship between constructions of infant feeding choices and constructions of ‘good’ or ‘bad’ motherhood. This analysis functions to trouble the individualist assumptions underpinning the notion of infant feeding ‘choices’, considering the cultural context within which British mothers ‘choose’ how to feed their babies.     

Escape as reinforcement and escape extinction in the treatment of feeding problems

Given the effectiveness of putative escape extinction as treatment for feeding problems, it is surprising that little is known about the effects of escape as reinforcement for appropriate eating during treatment. In the current investigation, we examined the effectiveness of escape as reinforcement for mouth clean (a product measure of swallowing), escape as reinforcement for mouth clean plus escape extinction (EE), and EE alone as treatment for the food refusal of 5 children. Results were similar to those of previous studies, in that reinforcement alone did not result in increases in mouth clean or decreases in inappropriate behavior (e.g., Piazza, Patel, Gulotta, Sevin, & Layer, 2003). Increases in mouth clean and decreases in inappropriate behavior occurred when the therapist implemented EE independent of the presence or absence of reinforcement. Results are discussed in terms of the role of negative reinforcement in the etiology and treatment of feeding problems.     

Chin prompt plus re-presentation as treatment for expulsion in children with feeding disorders

Expulsion (spitting out food) is a problem behavior observed in many children with feeding disorders. In the current investigation, we identified 4 children diagnosed with a feeding disorder who exhibited high rates of expulsion. Treatment with re-presentation (placing expelled liquids or solids back into the child's mouth) was not effective in reducing expulsion. Therefore, we added a chin-prompt procedure (the feeder applied gentle upward pressure to the child's chin and lower lip) for the initial presentation and the re-presentation. Chin prompt plus re-presentation resulted in low rates of expulsion for all 4 children. The results are discussed in terms of the potential underlying mechanisms behind the effectiveness of the chin-prompt procedure.     

Coping with rising food costs in a closed economy: feeding behavior and nocturnal hypothermia in pigeons.

The pigeon's response to increasing fixed-ratio schedules in a 24-hr closed economy is marked by changes in feeding behavior during the daily light phase and by changes in body temperature during the dark phase. The time course of these responses to increasing behavioral cost of obtaining food is very different. Feeding is most affected immediately, within the first day of exposure to moderate fixed ratios. The number of times the pigeons produce the food hopper each day decreases, and the rate at which they eat from the food hopper (grams per minute) when it is available increases, as the fixed ratio is raised. Body temperature is affected later, falling to progressively lower resting levels during the dark phase as body weight drops at the higher fixed ratios when food intake is reduced. The changes in feeding and in body temperature that occur as the fixed-ratio schedule increases seem to reduce daily energy expenditures, within the constraints imposed by the experiment. The ascending and descending limbs of the bitonic function obtained when total daily operant responding is plotted as a function of fixed-ratio schedule in the closed economy is possibly related to the occurrence of thermoregulatory strategies for energy conservation. The energetic analysis of performances in the closed economy requires consideration of a variety of energetic strategies available to the species being studied.     

Procurement time as a determinant of meal frequency and meal duration.

Foraging involves the expenditure of both time and effort in the acquisition of food; animals typically modify their meal patterns so as to reduce these expenditures or costs. The contribution of time, as compared with effort, to the overall cost perceived by an animal is not known. We investigated the effect of foraging time as a cost independent of effort by measuring the meal patterns of rats living in a laboratory foraging simulation in which they earned all their daily intake. They pressed a bar once to initiate an interval (procurement interval) leading to the presentation of a large cup of food from which they could eat a meal of any size. As the length of the interval increased from 1 s to 46 hr, meal frequency decreased regularly. Meal size increased in a compensatory fashion, and total daily intake was conserved through an interval of 23 hr. The changes in meal frequency occurred because of changes in the rat's latency to bar press after each meal. The functions relating meal frequency and size to the procurement interval were of the same shape as those seen when cost is the completion of a bar-press requirement, which entails the expenditure of both effort and time. When the bar-press requirement was increased to 10, meal frequency was reduced, but time and effort did not appear to simply add together in the rat's perception of cost. These data reveal that time is preceived to be a cost by rats foraging in this laboratory environment. These results suggest that the time parameters of foraging are different from those of consumption.