Nutrition Interventions for Children with Special Health Care Needs

Chapter 9 - Behavior Issues Related to Feeding
addresses both dysfunctional family dynamics as well as implement a behavioral
feeding intervention. If nutritional status, failure-to-thrive, or other medical issues
are significantly problematic, inpatient treatment for the child may be indicated.
While feeding may initially be handled by an inter-disciplinary team of hospital
clinicians, the primary caregiver should ultimately receive direct practice in utilizing
new feeding patterns with the child prior to discharge (10).
Table 9-1: Typical Reinforcers for Eating or Food Refusal
Example Most likely to occur when… Least likely to occur when…
Reinforcer: Tangible
• getting a kiss
• getting a new toy
• distraction
• changing of
activities
• bandaid
• food/drink
• comfort item
• this is the most effective way
to ensure that the tangible
item will be provided
• the tangible item has been
provided in the past for this
behavior
• the tangible item is not readily
available
• something in the environment
leads the child to believe that
the item is about to become
less readily available
• the tangible item is
readily available
• the item has never
been provided after this
behavior
• there is an easier and
equally reliable way to
gain access to the item
Reinforcer: Internal – Generally, no pattern to occurrence or the pattern is relative to sleep or
medication schedule.
• facial grimace
• muscle contraction/
extension
• random selfinjurious
behavior
• behaviors designed
to access deep
pressure (in the
form of physical
assistance or
restraining)
• child is alone and no one is
likely to respond
• no pattern to occurrence
• in the midst of a preferred, low
demand, high attention activity
• high level of sensory input
• low level of sensory input
114 Nutrition Interventions for Children With Special Health Care Needs