Nutrition Interventions for Children with Special Health Care Needs

Chapter 9 - Behavior Issues Related to Feeding
and helps maintain the child’s interest in the process. Only after reinforcing
easy behaviors, does work begin on the targeted behaviors. Sometimes the
only behavior the child can exhibit without displaying distress is to look at the
food or to touch a small piece of food. This is then referred to as a previously
mastered behavior. The next subskill that the child needs to master is referred
to as the targeted behavior.
4. The next step is to elicit the targeted behavior from the child through modeling
and a least-to-most prompting paradigm. This entails giving the least
amount of assistance required to gain the targeted response. Demonstrating,
tapping the item, touching the child’s elbow, guiding the child’s hand, or using
hand-over-hand modeling are all different levels of prompting. The therapist
must be careful not to provide attention or a delay in the completion of the
behavior, otherwise, she risks reinforcing avoidance through escape or contingent
attention.
Examples of interventions for specific behavior challenges are described below.
Internal Events: avoiding the development of food refusal when
pain or discomfort accompanies feeding.
In the first example, baby Jonathan refused food because of pain triggers.
Without behavioral intervention, attention or escape may end up maintaining or
strengthening this behavior even if the medical conditions causing the pain are
resolved. Rather than waiting for entrenched food refusal to develop, treatment
could have been started at the first refusal of food during a feeding, the first episode
of pulling away. With careful data collection and analysis of the data, a behaviorist
would have determined the antecedents, cues, frequency, latency and duration of
pain episodes. Steps would have been taken to identify medications, positions, times,
settings, and duration of feeds that decreased the frequency of pain episodes.
The feeding could have been structured to maximize the likelihood that pain would
have occurred primarily when the child was off the nipple. When a pain episode did
occur during a feeding, pain management strategies could have been implemented
that did not include escape from the nipple. Examples of pain management strategies
include changes in positioning, in the rate of flow from the nipple, and movement
during feeding. Increasing the social and sensory reinforcers available during a
feeding would have helped to maintain the nippling behavior. In combination, these
strategies often reduce or eliminate the development of food refusal behaviors while
the reflux is treated or the child outgrows it.
110 Nutrition Interventions for Children With Special Health Care Needs