Nutrition Interventions for Children with Special Health Care Needs

Chapter 9
Section 2 - Problem-Based Nutrition Interventions
Behavior Issues related to Feeding
Ginny Cronin, Behavior Analyst and Jill Wright, CBA
Updated by Kelly Johnson, PhD
Behavior challenges can be a significant factor in oral feeding dysfunction.
Sometimes these challenges are obvious, such as when a child turns away, refuses to
eat, or has tantrums at mealtime. At other times the behavioral concerns are much
more subtle, as when gagging and arching accompany reflux in an infant. It is best
to address maladaptive behaviors as they are just beginning to develop.
Even when food refusal is well entrenched, a behavioral plan can help children
achieve their feeding goals. When behavioral concerns significantly impede
progression towards feeding goals, they should be addressed carefully and
accurately. A generalized approach can do more harm by inadvertently strengthening
the very behaviors targeted for decrease.
This chapter will discuss the importance of incorporating a technically accurate
behavioral approach in the treatment of feeding dysfunction. Understanding the
role of aversive conditioning and environmental variables will help to avoid common
mistakes and allow appropriate referrals. Examples will be given of ways to
restructure the adult-child interaction to decrease the challenging behaviors of food
refusal and resistance to therapeutic activities. Methods to increase the replacement
behaviors of food acceptance and participation in therapeutic activities will also be
reviewed. Appropriate analysis and sample treatment protocols will be considered
which should enable individuals to roughly evaluate the quality of behavioral services
as they are provided (1).
The Role of a Behavior Analyst
The role of a behavior analyst in the treatment of feeding dysfunction, as well as
other behavioral challenges, is to analyze the functions or goals of challenging
behaviors and develop interventions based on these analyses. This process is
referred to as functional assessment, and is the standard of care in the field of
applied behavior analysis.
Some areas of concern in the realm of feeding include:
Nutrition Interventions for Children With Special Health Care Needs 101