Nutrition Interventions for Children with Special Health Care Needs

Section 2 - Problem-Based Nutrition Interventions
Tangible Maintained Behavior: changing the timing.
Ben was given a clean cloth diaper as a comfort item after each episode of reflux or
other anxiety. His mother was taught to make the cloth available additionally as a
reinforcer for allowing touch to his mouth and oral stimulation activities. In this way
the reinforcing properties of the cloth were transferred to other therapeutic activities.
Ben learned to tolerate many of the subskills he would need to progress to oral
feeding in the future when his medical condition was resolved. We avoided allowing
him to develop an escape response to touch to his mouth (1).
Attention-Maintained Behavior: providing attention for food approach
and ignoring food refusal.
For Charlotte, attention was more pleasant than food. Refusing food had become a
powerful way to gain attention. One appropriate response to this difficulty is to use
contingent attention accurately. Contingent attention is powerful. It involves paying
attention to the behaviors targeted for increase, and ignoring the behaviors targeted
for decrease (1).
In Charlotte’s situation, the therapist or parent would be directed to avert their eyes
and stop talking until Charlotte displayed some type of approach response to food.
This response might be defined initially as looking at the food or touching the food.
Her most preferred foods would be used at first to make this approach response
an easy one. Enthusiastic and specific praise would occur immediately upon the
occurrence of the behavior. “Charlotte! You touched the bread! Good for you!” The
therapist (or parent) would continue to talk to her and would touch her (if she found
touch pleasant) as long as she continued to interact with the food. Over time, the
required response would change based on the task analysis of the target behavior.
Attention would be delivered only when she picked up the food, smelled it, licked
it, or held it in her mouth. These types of carefully graduated changes are called
shaping techniques. Eventually, only swallowing would be reinforced (3).
Modeling would be utilized to prompt each new targeted behavior. Hand-over-hand
prompting or some lesser degree of prompting would be utilized if Charlotte did not
exhibit the targeted behavior independently. Such prompting would be appropriate
only if it was determined that the target behavior was an appropriately small change
and that prompting it was unlikely to trigger significant anxiety. Adding a tangible
reinforcer to the contingency, such as access to a preferred toy for brief intervals,
can strengthen the effects of contingent attention (3).
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