Nutrition Interventions for Children with Special Health Care Needs

Section 2 - Problem-Based Nutrition Interventions
it occurs with greater frequency in the future. It has been punished if it occurs with
decreased frequency in the future. Even a response which appears to be pleasant
(offering a bottle) can be a punisher if it causes a response (pain) that decreases the
behavior in the future.
In feeding, aversive conditioning occurs when the child associates a negative or
painful event with a neutral feeding stimulus. This aversive conditioning can be
triggered by medical, physical, sensory or environmental stimuli. For example
whenever the nipple is presented, pain is experienced concurrently (operant). The
nipple comes to represent pain, although reflux, not the nipple, causes the pain.
In time, this conditioned response results in avoidance behavior such as arching
to refuse the nipple. Refusing the nipple does not reduce the pain, but arching
does (classical). This scenario describes a combination of classical and operant
conditioning.
Case: Aversive conditioning developed as a result of medical/physical
concerns
Jonathan was a young infant who had reflux and arched in pain, pulling away
from the nipple repeatedly throughout feedings. Eventually he ate very small
quantities and then fell asleep. In this scenario, the child experienced pain
regularly during feeding and began to associate the two. Ultimately, feeding
was equated with pain in his mind and he chose to avoid it altogether. The
association could be diagrammed as follows:
Classical Conditioning: feeding = pain � pull away
Operant Conditioning: pull away (food refusal) � pain reduction
(escape)
That pain occurred concurrently with the feeding is an example of classical
conditioning. Operant conditioning occurred when the behavior (food refusal)
was followed by a reinforcing event (pain reduction) that increased the
likelihood that behavior would occur again in the future. Both classical and
operant conditioning occurred, as is usually the case.
Results of Non-Treatment
In the example above, the situation was treated as a medical concern only. This is
typical when reflux is the only presenting concern, because many children with no
other complicating factors outgrow reflux with time. By using medication to reduce
the reflux episodes, only the classical conditioning had an opportunity to be reduced.
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