A Stepwise Evaluation of Pairing and Shaping for Children With Autism and Feeding Difficulties

From the Editor

Maternal feeding practices during the first year and their impact on infants’ acceptance of complementary food

Breastfeeding and experience with variety early in weaning increase infants’ acceptance of new foods for up to two months

Feeding difficulties, resulting from refusal to eat certain foods, are a frequent complaint in pediatric clinical practice. In many instances the initial situation is not necessarily serious but ongoing issues around feeding may lead to the adoption of inappropriate feeding practices that can have long lasting consequences. An extremely selective food choice, or picky eating, has been linked to sensory reactivity difficulties. In the general population it is estimated that between 5-10% of children experience sensory reactivity issues. Understanding how this can affect participation in feeding and mealtime is critical. This article presents a case report of a 22-month year old girl with selective food choices and feeding refusal. Occupational Therapy intervention based on Ayres Sensory Integration®, in the context of collaboration with the child’s pediatrician, was used to address the sensory issues underlying this child’s feeding and mealtime participation difficulties. From the results of the assessment, the following hypothesis were made; a) over-reactivity to oral and tactile sensory input was affecting acceptance of new foods and textures, b) vestibular processing difficulties and tactile over-reactivity were impacting this child´s ability to regulate level of alertness and the ability to stay sitting at the table during appropriate periods of time. Following the Occupational Therapy intervention this child showed improved feeding and mealtime participation and was also able to adequately sit at the table for the duration of the meal.

Feeding difficulties, resulting from refusal to eat certain foods, are a frequent complaint in pediatric clinical practice. In many instances the initial situation is not necessarily serious but ongoing issues around feeding may lead to the adoption of inappropriate feeding practices that can have long lasting consequences. An extremely selective food choice, or picky eating, has been linked to sensory reactivity difficulties. In the general population it is estimated that between 5-10% of children experience sensory reactivity issues. Understanding how this can affect participation in feeding and mealtime is critical. This article presents a case report of a 22-month year old girl with selective food choices and feeding refusal. Occupational Therapy intervention based on Ayres Sensory Integration®, in the context of collaboration with the child’s pediatrician, was used to address the sensory issues underlying this child’s feeding and mealtime participation difficulties. From the results of the assessment, the following hypothesis were made; a) over-reactivity to oral and tactile sensory input was affecting acceptance of new foods and textures, b) vestibular processing difficulties and tactile over-reactivity were impacting this child´s ability to regulate level of alertness and the ability to stay sitting at the table during appropriate periods of time. Following the Occupational Therapy intervention this child showed improved feeding and mealtime participation and was also able to adequately sit at the table for the duration of the meal.

Feeding difficulties, resulting from refusal to eat certain foods, are a frequent complaint in pediatric clinical practice. In many instances the initial situation is not necessarily serious but ongoing issues around feeding may lead to the adoption of inappropriate feeding practices that can have long lasting consequences. An extremely selective food choice, or picky eating, has been linked to sensory reactivity difficulties. In the general population it is estimated that between 5-10% of children experience sensory reactivity issues. Understanding how this can affect participation in feeding and mealtime is critical. This article presents a case report of a 22-month year old girl with selective food choices and feeding refusal. Occupational Therapy intervention based on Ayres Sensory Integration®, in the context of collaboration with the child’s pediatrician, was used to address the sensory issues underlying this child’s feeding and mealtime participation difficulties. From the results of the assessment, the following hypothesis were made; a) over-reactivity to oral and tactile sensory input was affecting acceptance of new foods and textures, b) vestibular processing difficulties and tactile over-reactivity were impacting this child´s ability to regulate level of alertness and the ability to stay sitting at the table during appropriate periods of time. Following the Occupational Therapy intervention this child showed improved feeding and mealtime participation and was also able to adequately sit at the table for the duration of the meal.

Infant temperament and feeding history predict infants' responses to novel foods

Early feeding practices may influence the acceptance of new foods and contribute to the development of feeding difficulties later in childhood. The aim of this systematic review was to evaluate the association of breastfeeding duration, timing of complementary feeding introduction, and feeding techniques with feeding difficulties or their subtypes, namely picky or fussy eating, food refusal, and food neophobia, in children older than 1 year of age. Guidance from the Cochrane Collaboration and the Centre for Reviews and Dissemination was followed. MEDLINE, Embase, and PsycINFO databases were searched up to December 2019. Additionally, references from included articles were screened. Interventional and observational studies were eligible. Of the 3653 records obtained after the search strategy was applied, 21 observational studies (cohort, case-control, cross-sectional), many with important methodological limitations, and 1 randomized controlled trial were included. Three authors extracted data independently. Results were synthesized narratively. Twelve observational studies assessed the association of breastfeeding duration with parent-reported feeding difficulties. Longer duration of breastfeeding tended to be associated with fewer childhood feeding problems in the majority of studies, but the differences were often small and not significant. Eight observational studies that examined the timing of complementary feeding introduction in relation to parent-reported feeding difficulties showed inconsistent results. Baby-led weaning, as compared with spoon-feeding, was significantly associated with less fussiness at age 12 to 36 months in 1 of 5 studies. This review showed no strong evidence to support the hypothesis that early feeding practices contribute significantly to specific parent-reported feeding difficulties in children older than 1 year of age. Additional methodologically rigorous studies are needed to confirm these findings. PROSPERO registration number CRD42018115792.

Parent-child mealtime interactions associated with toddlers' refusals of novel and familiar foods

ObjectivesAvoidant restrictive food intake disorder (ARFID) is a ‘disordered eating’ condition introduced in the DSM-IV (Manual of American Psychiatric Association) in 2013. The currently available literature suggests that the awareness...

Intrinsic and extrinsic influences on children's acceptance of new foods

Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by limited variety and/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with diverse psychiatric and somatic symptoms and therefore consult various pediatric subspecialties. Large-scale studies mapping coexisting conditions are, however, lacking. To characterize the health care needs of youth with ARFID. This cohort study used the Child and Adolescent Twin Study in Sweden (CATSS), in combination with inpatient and specialized outpatient clinical diagnoses from the Swedish National Patient Register. Data were collected from July 2004 to April 2020, and data were analyzed from September 2022 to February 2024. Using a composite measure derived from parent or guardian reports and register data, children with the broad ARFID phenotype occurring between the ages of 6 to 12 years were identified, as well as children without ARFID. From more than 1000 diagnostic International Classification of Diseases (ICD) codes, mental and somatic conditions within or across ICD chapters, the number of distinct per-person diagnoses, and inpatient treatment days between participants' birth and 18th birthdays were specified (90 outcomes). Hazard ratios (HRs) and incidence rate ratios (IRRs) were calculated. Of 30 795 CATSS participants, a total of 616 children (2.0%) with the broad ARFID phenotype occurring between the ages of 6 to 12 years were identified, and 30 179 children without ARFID were identified. Of 616 children with ARFID, 241 children were female (39.1%). Relative risks of neurodevelopmental, gastrointestinal, endocrine or metabolic, respiratory, neurological, and allergic disorders were substantially increased in children with ARFID (eg, autism: HR, 9.7; 95% CI, 7.5-12.5; intellectual disability: HR, 10.3; 95% CI, 7.6-13.9; gastroesophageal reflux disease: HR, 6.7; 95% CI, 4.6-9.9; pituitary conditions: HR, 5.6; 95% CI, 2.7-11.3; chronic lower respiratory diseases: HR, 4.9; 95% CI, 2.4-10.1; and epilepsy: HR, 5.8; 95% CI, 4.1-8.2). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had significantly more distinct mental diagnoses (IRR, 4.7; 95% CI, 4.0-5.4) and longer hospital stays (IRR, 5.5; 95% CI, 1.7-17.6) compared with children without ARFID. Children with ARFID were diagnosed with a mental condition earlier than children without ARFID. No sex-specific differences emerged. This cohort study yields the broadest and most detailed evidence of coexisting mental and somatic conditions in the largest sample of children with ARFID to date. Findings suggest a complex pattern of health needs in youth with ARFID, underscoring the critical importance of attention to the illness across all pediatric specialties.

Effectiveness of teacher modeling to encourage food acceptance in preschool children

Background:Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder, characterized by limited variety and/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with a range of psychiatric and somatic symptoms, and therefore consult various pediatric subspecialties; large-scale studies mapping comorbidities are however lacking. To characterize health care needs of people with ARFID, we systematically investigated ARFID-related mental and somatic conditions in 616 children with ARFID and >30,000 children without ARFID.Methods:In a Swedish twin cohort, we identified the ARFID phenotype in 6–12-year-old children based on parent-reports and register data. From >1,000 diagnostic ICD-codes, we specified mental and somatic conditions within/across ICD-chapters, number of distinct per-person diagnoses, and inpatient treatment days between birth and 18th birthday (90 outcomes). Hazard ratios (HR) and incidence rate ratios (IRR) were calculated.Findings:Relative risks of neurodevelopmental, gastrointestinal, endocrine/metabolic, respiratory, neurological, and allergic disorders were substantially increased in ARFID (e.g., autism HR[CI95%]=9.7[7.5–12.5], intellectual disability 10.3[7.6–13.9], gastroesophageal reflux disease 6.7[4.6–9.9], pituitary conditions 5.6[2.7–11.3], chronic lower respiratory diseases 4.9[2.4–10.1], epilepsy 5.8[4.1–8.2]). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had a significantly higher number of distinct mental diagnoses (IRR[CI95%]=4.7[4.0–5.4]) and longer duration of hospitalizations (IRR[CI95%]=5.5[1.7–17.6]) compared with children without ARFID. Children with ARFID were diagnosed earlier with a mental condition than children without ARFID. No sex-specific differences emerged.Interpretation:This study yields the broadest and most detailed evidence of co-existing mental and somatic conditions in the largest sample of children with ARFID to date. Findings suggest a complex pattern of health needs in youth with ARFID, underscoring the critical importance of attention to the illness across all pediatric specialties.Funding:Fredrik and Ingrid Thurings Foundation, Mental Health Foundation.

Large amounts of money, time and effort are devoted to sensory and consumer research in food and beverage companies in an attempt to maximize the chances of new products succeeding in the marketplace. Many new products fail due to lack of consumer interest. Answers to what causes this and what can be done about it are complex and remain unclear. This wide-ranging reference collates important information about all aspects of this in one volume for the first time. It provides comprehensive, state-of-art coverage of essential concepts, methods and applications related to the study of consumer evaluation, acceptance and adoption of new foods and beverages. Combining knowledge and expertise from multiple disciplines that study food sensory evaluation and consumer behaviour, it covers advanced methods including analytical, instrumental and human characterization of flavour, aspects of food processing and special research applications of knowledge and methods related to consumers’ evaluation of new food products. Researchers and professionals working in food science and chemistry are sure to find this an interesting read.