A flipped spoon and chin prompt to increase mouth clean

We treated the liquid refusal of a 15-month-old girl using 2 antecedent manipulations: flipped spoon and chin prompt. Use of the chin prompt in the absence of the flipped spoon failed to produce increases in mouth clean (a product measure of swallowing). By contrast, modest increases in mouth clean resulted from the implementation of the flipped spoon alone. The greatest increases in mouth clean resulted from the combination of the 2 manipulations.     

Sequential treatment of a feeding problem using a pacifier and flipped spoon

Parents may be reluctant to treat the feeding disorder of a chronically ill child who exhibits distressed behavior during feeding. In this study, we identified a child with chronic medical problems and a feeding disorder who cried during feedings. We introduced treatment components sequentially to address parental concerns about crying. First, we used a pacifier to reduce crying, and then we used a flipped spoon to increase mouth clean. The results showed that a sequential approach to treatment can be effective for children with complex medical and behavioral problems.     

Development of oral motor behavior related to the skill assisted spoon feeding

Milestones in the typical development of eating skills are considered to be nippling (breast or bottle), eating from a spoon, drinking from a cup, biting and chewing.The purpose of this research was to study the development and consolidation of oral motor behavior related to the skill assisted spoon feeding in young infants. The present study longitudinally investigated the development of this skill in 39 healthy children from the start of spoon feeding until the skill was acquired. The Observation List Spoon Feeding with 7 observation items for oral motor behavior and 6 items for abnormal behavior was used. Results showed that infants between 4 and 8 months of age needed 5.7 weeks (SD 2.1), with a range of 8 weeks (from 2 to 10 weeks) to acquire this skill. No significant correlation (p = .109) between age at start spoon feeding and weeks needed to develop the skill was found. During this period oral motor behavior consolidated and abnormal behavior diminished.With this study it is shown that the period in weeks needed to acquire the oral motor behavior for the skill assisted spoon feeding is important in case of feeding problems.     

Development of the infant's ability to retrieve food through a slit

The main purpose of the present study is to explore infants' ability to comprehend task manipulation, and whether they can feed themselves with a spoon when food has to be retrieved through a slit in a lid placed over a plate. To access the food, the infant has to align the bowl of the spoon with the slit. The orientation of the slit is manipulated, and certain orientations require more elaborate modifications of the feeding action than others. The infants are observed at monthly intervals, from 12 to 17 months of age. The presence of the lid affects the behaviour of the infants at all ages. Some behaviours become more immature. The infants grasp the spoon with more primitive grasp configurations, they grasp the spoon less consistently at the top of the handle, and they orient the spoon less consistently, with its bowl facing upwards. These differences decrease with age. The infants also make attempts to adjust to the constraints of the task, mainly by inclining the spoon more vertically, and rotating the hand in such a way as to align the spoon with the orientation of the slit. These adjustments improve with age. Copyright © 2002 John Wiley & Sons, Ltd.     

Further evaluation of modified‐bolus‐placement methods during initial treatment of pediatric feeding disorders

Children with feeding disorders might pack or expel food when they lack the oral‐motor skills, the motivation, or both, to swallow. Bolus placement directly on the tongue with a Nuk (e.g., Milnes et al., 2019) or flipped spoon (e.g., Sharp et al., 2010) is a treatment that researchers generally implement after such behavior emerges (e.g., Girolami et al., 2007). However, Wilkins et al. (2014) tested the relative efficacy of Nuk presentation and upright‐spoon presentation during initial treatment of pediatric feeding disorders. In the current study, we compared the effects of (a) upright‐spoon presentation; (b) Nuk presentation; and (c) flipped‐spoon presentation on two product measures of swallowing: 15‐ and 30‐s mouth clean, and expulsion during the initial treatment of feeding disorders with 5 children. We also monitored lip closure during bite presentation and following bolus placement. Nuk presentation produced the highest levels of mouth clean and the lowest rates of expels relative to upright‐spoon presentation and flipped‐spoon presentation. We discuss potential reasons why modified‐bolus‐placement methods improved feeding behavior and how measures of oral‐motor skills might predict its necessity during initial treatment.     

Using a flipped spoon to decrease packing in children with feeding disorders

We evaluated the effects of redistribution and swallow facilitation with a flipped spoon on packing in 2 children with a feeding disorder. For both participants, packing decreased when we implemented the flipped spoon treatment package. Mechanisms responsible for behavior change and areas of future research are discussed.     

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.