Treating liquid expulsion in children with feeding disorders

Pediatric Tube Weaning: A Meta-Analysis of Factors Contributing to Success

Approximately 3-10% of children have severe feeding issues, and some require enteral/tube nutrition to grow and thrive. For many children, tube feeding is temporary, making efficacious interventions for tube weaning essential. We conducted a systematic review and meta-analysis of tube weaning treatments. Outcomes included percentage of participants completely weaned from the tube, and mean percentage of kilocalories consumed orally following treatment. Data were extracted from 42 studies, including cohort studies and single-subject research design studies. We evaluated moderators of treatment success, including treatment setting, use of behavioral approaches, use of hunger provocation, and use of a multidisciplinary approach. Results indicated that, after treatment, children received significantly more calories orally, and 67-69% of children were fully weaned. These analyses suggest that current interventions are generally effective; however, variability within treatments exist. Prospective randomized clinical trials are needed to understand effective components of weaning interventions.

A detailed examination of reporting procedural fidelity in the Journal of Applied Behavior Analysis

Few reviews on procedural fidelity-the degree to which procedures are implemented as designed-provide details to gauge the quality of fidelity reporting in behavior-analytic research. This review focused on experiments in the Journal of Applied Behavior Analysis (2006-2021) with "integrity" or "fidelity" in the abstract or body. When fidelity data were collected, the coders characterized measurement details (e.g., description of calculation, report of single or multiple values, frequency of fidelity checks, checklist use). The researchers found increasing trends in describing the calculation(s), reporting multiple values, and stating the frequency of measurement. Few studies described using a checklist. Most studies reported fidelity as a percentage, with high obtained values (M = 97%). When not collecting fidelity data was stated as a limitation, authors were unlikely to provide a rationale for the omission. We discuss recommendations for reporting procedural fidelity to increase the quality of and transparency in behavior-analytic research.

A Comparison of re-presentation and modified chin prompt to treat different topographies of liquid expulsion

Treatment of one behavior in the chain of consumption might be associated with the emergence of other problematic behaviors. For example, some children with feeding disorders expel liquid. Moreover, the form in which children expel liquid might vary and influence whether a treatment to reduce liquid expulsion will result in clinically meaningful outcomes. In the current investigation, we first identified topographies of liquid expulsion (e.g., forceful, run out) for each child. We then compared and evaluated the effects of 2 procedures, a modified chin prompt and re-presentation, on the liquid expulsion of 3 children with feeding disorders. For 2 participants, expulsion decreased to clinically meaningful levels with a modified chin prompt or re-presentation. However, for 1 participant, expulsion decreased to clinically meaningful levels only when we combined the modified chin prompt and re-presentation as part of a treatment package. We discuss possible mechanisms underlying the effects of a modified chin prompt and re-presentation, in addition to areas for future research.