Nutrition Interventions for Children with Special Health Care Needs

Chapter 9 - Behavior Issues Related to Feeding
Collecting Data for a Functional Assessment
A functional assessment is a data-driven approach that is based on the response of
the child to variables in the environment. These variables include, but are not limited
to attention, escape, tangible items, environmental structures, timing and pacing,
individuals present, and internal events such as pain or reflux. It is a methodical
approach that identifies what the child is trying to achieve through the behavior,
and builds an intervention around that information. Data is collected in an ongoing
manner to carefully chart progress, and adjustments are made based on the data
collected. Strategies are individualized to the needs and abilities of the family
while remaining technically accurate. This approach presupposes that the primary
caregivers are both able and willing to follow through with recommendations. It is a
goal-oriented, time-limited, and cost-effective approach for the right population (5).
Taking a comprehensive history and conducting a complete and thorough
developmental and sensory evaluation are essential components of a functional
assessment for feeding dysfunction. It is important to listen carefully to parents as
they describe what mealtimes look like and how they differ from each other and
from mealtimes in the past. It is also necessary to observe one or more feedings to
gather data on the observed behaviors and interactions. This is called a structured
observation. During these observations, which are typically videotaped, a team
often utilizes a simple ABC chart to collect information on the function of the
target behavior (6,7). A sample chart is provided as Table 9-2. The “A” stands for
antecedent and refers to what occurred immediately before the target behavior.
The “B” stands for the behavior, carefully and objectively defined. The “C” stands
for consequence and refers to what occurred immediately after the target behavior.
Using Charlotte as an example, behavior can be charted as follows:
Antecedent Behavior Consequence
Mom puts the food on
Charlotte’s tray
Charlotte turns her head
(food refusal)
Mom presents spoon Charlotte turns her head
(food refusal)
Mom points to some food on
the tray and says, “Yummy!”
Charlotte turns her head
(food refusal)
This pattern repeats itself with minor variations about 6 times.
Mom points to the food Charlotte takes a bite (food
acceptance)
Mom holds up the spoon and
says, “Take a bite, honey”
(attention)
Mom leans forward and turns
Charlotte’s chin, looks her in
the eye and says, “Take a bite,
honey.” (attention)
Mom leans forward, turns
Charlotte’s chin, looks her in the
eye, and says, “Come on, you can
do it! It’s easy!” (attention)
Mom turns from Charlotte
to reload spoon (removal of
attention)
108 Nutrition Interventions for Children With Special Health Care Needs