Food Refusal Research Articles

Does food selectivity drive differences in dietary resemblance between children with intellectual disabilities and typical development?

Although children's dietary intake often resembles that of their parents', dietary resemblance has not been examined among children with intellectual disabilities (ID), where food selectivity is a common parental concern. We compared dietary resemblance in children with typical development (TD), ID, and ID and co-occurring autism (ID + A) in parent-child dyads, and examined whether child food selectivity mediated between-group differences. Dietary data from parents and their children (3–8 years, male = 61.8%, TD = 52.9%, ID = 18.6%, ID + A = 28.4%) were analyzed as mother-child (n = 100) and father-child (n = 70) dyads. Dietary resemblance was operationalized as the proportion of foods that were reported as eaten/not eaten by both parent and child in parent-completed Food Frequency Questionnaires. Food refusal rate was used to capture food selectivity (total foods children would not eat/total foods offered). Among mother-child dyads, dietary resemblance did not differ between children with ID compared to TD (P = 0.243). Among father-child dyads, dietary resemblance was 10% lower in children with ID than TD (66.4% vs. 74.1%, P = 0.032), and the difference was partially explained (mediated) by food refusal. Among mother-child dyads, dietary resemblance was 19% lower among children with ID + A than TD (61.5% vs. 75.6%, P = 0.001), and the difference was completely explained by food refusal. Among father-child dyads, dietary resemblance was 22% lower among children with ID + A than TD (57.9% vs. 74.1%, P < 0.001), and the difference was completely explained by food refusal. Subanalyses by food groups produced similar results. Compared to TD children, dietary resemblance was lower in children with ID + A, but not children with ID, and differences were explained by food selectivity. Our findings suggest parents of children with ID + A may have less influence over their child's dietary intake than parents of children with ID or TD.

In Vivo Effects of a GHR Synthesis Inhibitor during Prolonged Treatment in Dogs

Background: The activation of the growth hormone receptor (GHR) is a major determinant of body growth. Defective GHR signaling, as seen in human Laron dwarfism, resulted in low plasma IGF-1 concentrations and limited growth, but also marked absence in the development of breast cancer and type 2 diabetes. In vitro, we identified a small molecule (C#1) that inhibits the translation of GHR mRNA to receptor protein. Methods: Before its application in humans as a potential anticancer drug, C#1 was tested in animals to evaluate whether it could be administered to achieve a plasma concentration in vivo that inhibits cell proliferation in vitro without causing unwanted toxicity. To evaluate the efficacy and toxicity of C#1, a group of six intact female Beagle dogs was treated daily each morning for 90 days with an oral solution of C#1 in Soiae oleum emulgatum at a dose of 0.1 mg/kg body weight. During treatment, dogs were closely monitored clinically, and blood samples were taken to measure plasma C#1 concentrations, complete blood counts (CBC), clinical chemistry, and endocrinology. At the end of the treatment, dogs were euthanized for gross and histopathological analysis. An additional group of six female Beagle dogs was included for statistical reasons and only evaluated for efficacy during treatment for 30 days. Results: Daily administration of C#1 resulted in a constant mean plasma concentration of approximately 50 nmol/L. In both groups, two out of six dogs developed decreased appetite and food refusal after 4–5 weeks, and occasionally diarrhea. No significant effects in CBC or routine clinical chemistry were seen. Plasma IGF-1 concentrations, used as biomarkers for defective GHR signaling, significantly decreased by 31% over time. As plasma growth hormone (GH) concentrations decreased by 51% as well, no proof of GHR dysfunction could be established. The measured 43% decrease in plasma acylated/non-acylated ghrelin ratios will also lower plasma GH concentrations by reducing activation of the GH secretagogue receptor (GHSR). C#1 did not directly inhibit the GHSR in vivo, as shown in vitro. There were no significant effects on glucose, lipid, or folate/homocysteine metabolism. Conclusions: It is concluded that with daily dosing of 0.1 mg C#1/kg body weight, the induction of toxic effects prevented further increases in dosage. Due to the concomitant decrease in both IGF-1 and GH, in vivo inhibition of GHR could not be confirmed. Since the concept of specific inhibition of GHR synthesis by small molecules remains a promising strategy, searching for compounds similar to C#1 with lower toxicity should be worthwhile.

Level of support/commitment and behavior during mealtime and dental care negatively impact the dental caries prevalence in autistic individuals: cross-sectional study.

To verify whether factors associated with Autism Spectrum Disorder (ASD) would have impact on the dental-caries prevalence. All ASD-individuals receiving care in a specialized center with minimum of 4y old were recruited. Demographic, socioeconomic and behavioral characteristics, level of support/commitment (Childhood Autism Rating Scale), mealtime behavior (Brief Autism Mealtime Behavior Inventory) and medication use were answered by ASD-individual's parents. Behavior during dental care was evaluated from Frankl scale. Dental-caries prevalence was the primary outcome. Three examiners calibrated/trained collected the data. Chi-square test was used to compare the variables impact on the dental-caries prevalence. 61 ASD-individuals were potentially eligible, and the all parents/guardians consent to participate. Dental-caries prevalence was 42.9%, which was statistically associated with lower toothbrushing frequency, higher level of support/commitment, and worse behavior at meals and during in dental care. Dental-caries prevalence was approximately higher twice in ASD-individuals: (i) uncooperative with dental care when compared those cooperative (62% versus 32%, respectively); (ii) with severe level of support when compared to those with mild/moderate level (58% versus 28%, respectively); and (iii) with worse mealtime behavior when compared to those with better behavior (59% versus 28%, respectively). A medium statistical correlation was observed between support level and mealtime behavior (rS=0.39). The BAMBI component statistically associated with dental-caries prevalence was the food refusal (capture problem when a child rejects a presented food, crying, spitting out food). higher required level of support, worse mealtime behavior and uncooperative profile in dental care negatively affect the dental-caries prevalence. our findings provide evidence of the need of specialized, preventive and individualized dental care among ASD-individuals.

Combined Effect of Oro-Motor Stimulation and Aroma Therapy for Successful Feeding in Autism Spectrum Disorder: Case Report

In Autism Spectrum Disorder (ASD) children feeding problems can be categorized as behavioural feeding disorders including food refusal, choking, gagging, expulsion and sensory-based feeding problems such as textural aversions. The oral stimulation increases oral motor organization improve muscle contractility as a result increases oral intake. Sensory characteristics of food such as taste, texture and aroma have effects on food acceptance. We present a case of 3.3 year old male with ASD having feeding issues such as refusal to consume food and would spit when tried to feed him forcefully and accepting only liquids in small quantities as compared to earlier since 55 days. The outcome measure used was Sensory Profile (Dunn, 1999) and Pediatric Eating Assessment Tool (PediEAT). Combined oral motor stimulation and aroma therapy was provided to the child for developing successful feeding skill. Conclusion: From the above pilot study it may be concluded that combination of oro-motor stimulation and aroma therapy is an effective intervention in decreasing oral sensory issues and thus improving feeding skills in children with ASD.

Practices for introducing complementary foods in Taiwan: A nationwide survey from 2013 to 2016

Background/purposeIntroducing complementary foods to infants is a critical stage in their healthy growth and development process. In this study, we analyzed the feeding habits and choices of caregivers in Taiwan during this essential transition period. MethodsData from the 2013–2016 Nutrition and Health Survey in Taiwan were analyzed. Using a multistage stratified sampling technique, we collected data through questionnaires on the feeding practices, challenges, and information sources associated with complementary feeding. We also investigated the timing of introducing various foods. Certain feeding indicators recommended by the World Health Organization were modified and used for analysis. ResultsAmong 439 caregivers of infants aged 2–24 months, complementary feeding typically began at 5 months, and it primarily began with cereals and pureed foods. At 6–8 months of age, 98.29% of the infants received these foods. Only 48.39% of infants aged 6–24 months consumed eggs or flesh foods. Among the primary challenges for caregivers were concerns regarding infants’ adaptation to new foods (38.2%), refusal of foods by infants (37.1%), and uncertainty regarding which foods to introduce (11.4%). The main sources of information were friends and family (46.9%), the Internet (46.5%), and baby care books (35.6%). Notably, approximately 51% of the respondents used commercial baby foods. ConclusionIn Taiwan, although the majority of infants begin complementary feeding on time, the introduction of eggs and flesh foods is typically delayed. Given the growing reliance on the Internet in the modern age, accurate feeding information should be disseminated online.

Infantile anorexia: how to avoid diagnostic errors?

Food whims, some food refusals, food selectivity are issues for which parents often seek advice from a paediatrician. It is difficult to identify the reasons of the issues for just a few minutes of a visit. But the greatest challenges in the diagnosis arise when parents complain that they fail to feed both breastfed and non-breastfed young infants. Anorexia in young infants may be of a psychological and/or organic origin. The most complex and early forms often have a mixed etiology. A detailed history taking reveals cases of forced feeding, frequent changes of formula, and mother’s emotional instability. The article presents several clinical cases with different reasons for food refusals in children for which parents sought advice from a doctor. The first clinical case: a 11-year-old boy with complaints about lack of weight gain, as his weight did not exceed 6.8 kg, extremely slow growth rates. The child was diagnosed with moderate eosinophilic infiltration of the esophagus with eosinophils up to 10–12 per high-power field (hpf). Second clinical case: a 7-month-old girl M. with complaints about decreased appetite, food refusal, lack of interest in food and thirst, regurgitation during feeding. The examination showed eosinophilic infiltration of the duodenum up to 50 eosinophils per hpf. In the stomach there were up to 5 eosinophils per hpf. Third case: a boy Ya. with complaints about restlessness, more in the evening and at night, waking up frequently at night, regurgitation, hiccups, and periods of bloating. The article presents modern options for using specialized food products for this category of children according to the cause of anorexia.

Feeding-Related Early Signs of Autism Spectrum Disorder: A Narrative Review.

Feeding difficulties are prevalent among individuals with autism spectrum disorder (ASD). Nevertheless, the knowledge about the association between feeding-related early signs and child development remains limited. This review aimed to describe the signs and symptoms related to feeding during child development and to explore their relevance to the diagnosis of ASD. Specialists in nutrition and/or ASD conducted a search of MEDLINE, PsycINFO, and Web of Science databases. Although studies in typically developing children demonstrate age-related variations in hunger and satiety cues, the literature about early feeding indicators in ASD is scarce. Challenges such as shortened breastfeeding duration, difficulties in introducing solid foods, and atypical mealtime behaviors are frequently observed in children with ASD. The eating difficulties experienced during childhood raise concerns for caregivers who base their feeding practices on their perceptions of food acceptance or refusal. Considering the observed associations between feeding difficulties and ASD, the importance of recognizing feeding-related signs according to developmental milestones is emphasized to alert medical professionals that deviation in the formation of feeding habits and skills could indicate the need for ASD diagnostic investigation.

Family caregivers use a Hand-Under-Hand online course to improve the nutritional status of patients with severe dementia: A quasi-experimental study.

In Taiwan, over 90% of dementia patients received home care. Severe dementia-linked food refusal significantly affects nutrition, thereby straining caregivers. Family caregivers can reduce their burden by learning feeding and dementia nutrition online, thus preserving patient oral feeding. The study aim for family caregivers learn online Hand-Under-Hand (UH) techniques to ease feeding in severe dementia, enhancing nutrition and reducing their burden. In this quasi-experimental study, participants in the experimental group received 2-h UH courses online, while the control group received their usual care. The primary outcome indicators were abnormal eating behavior, nutritional status, and caregiver burden, with outcomes tracked at 0, 1, and 3 months. At the neurology outpatient clinic of a medical center in Taipei, 65 dyads-comprising patients with severe dementia and their caregivers-were randomly assigned to groups. The study participants comprised 36 female and 29 male caregivers, with an average age of 58.09 years. The patient group included 43 females and 22 males, with a mean age of 83.32 years. Patients in the experimental group exhibited reduced abnormal eating behavior, and caregiver burden was reduced at 1 and 3 months, patients demonstrated improved nutritional status by month 3. The accessibility and convenience of online courses enabled family caregivers to use UH feeding techniques to effectively improve the nutritional status and correct the abnormal eating behavior of patients with dementia, while also decreasing caregiver burden. Geriatr Gerontol Int 2024; ••: ••-••.

Preoperative fasting for elective surgery in children

This review investigated preoperative fasting in children who need elective surgical interventions. Fifty publications included in the abstract databases PubMed and elibrary for the period from 2017 to 2023 were reviewed. For the analysis, we used articles on the effect of preoperative fasting on indicators of the cardiovascular system and water and carbohydrate metabolism and assessed the course of the perioperative period depending on the duration of refusal of solid food and liquids before surgery. The article presents historical information that formed the basis for the modern paradigm of refusal of solid food and liquids in the preoperative period, especially the negative consequences of prolonged refusal of food in the preoperative period, indicating the main ones, namely, euglycemic ketosis and ketoacidosis, which are common in children. Hypoglycemia due to food refusal before surgery is rare and is not a serious problem in most patients, except in children in the first year of life. In most cases, it has been demonstrated that the time of preoperative fasting significantly exceeds the recommended intervals and amounts to more than 10 hours, and 75% of patients experience a strong feeling of hunger. Infusion of dextrose solutions has not been found to reduce feelings of hunger and thirst before surgery. An increase in preoperative fasting time is often associated with improper organization of the process (35.1%), an increase in surgical time (34.1%), and surgical plan changes (20.9%). It is noted that the optimal volume of liquid that a child can drink before surgery is 3 ml/kg. Data indicates that preoperative fasting can cause arterial hypotension after induction of anesthesia, at the stage of preparing the surgical field. It has been demonstrated that a residual gastric volume of 1.25 ml/kg is a risk factor for aspiration during the induction of anesthesia. There is currently no convincing evidence of the negative effect of preoperative fasting on treatment outcome; however, clearly, the time to abandon clear liquids before elective surgery in children should be minimal.

Intermittent fasting as a promising method of treatment of metabolically associated steatotic liver disease. Review

Metabolic‑associated steatotic liver disease (MASLD) is one of the most common diseases of the century. According to a recent meta‑analysis, its prevalence in the Western world is estimated at approximately 25% of the entire adult population. Currently, there is no single pharmacological treatment of MASLD approved by international guidelines. Therefore, changes in the lifestyle, diet and eating behavior remain the cornerstone of the treatment of MASLD. Recently, a lot of attention in the treatment of obesity and MASLD is paid to the so‑called intermittent fasting (IF) — a food regimen, the essence of which is to divide the day into periods of eating (food window) and complete refusal of food. Because chronic dysregulation of circadian rhythms may increase the risk of metabolic disease, time‑restricted diets, or dietary interventions, including IF, may maintain circadian rhythms and ameliorate metabolic disease. Acting on the main metabolic pathways, IF in patients with MASLD is able to restore metabolic flexibility, which is understood as the ability of the body to coordinate the sensation, exchange, storage and utilization of nutrients, as well as to choose adequate metabolic pathways to maintain energy homeostasis in accordance with the availability and demand for energy substrates. Several possible mechanisms of the influence of intermittent fasting on the pathogenesis of MASLD are known, in particular, energy switching to ATP generation processes, such as β‑oxidation; reduction of inflammation and oxidative stress; improvement of autophagy, sensitivity to insulin and composition of gut microbiota. Randomized controlled clinical trials demonstrated that depending on the type and duration of the diets, IF can lead to significant weight loss compared to hypocaloric or other diets, it affects almost all of the major metabolic drivers of MASLD, thus slowing the progression of liver disease and serving as an additional tool in the treatment of this pathology. Thus, intermittent fasting can become a promising, effective, and cheap treatment method with low side effects for a wide range of patients.

The effect of preoperative fasting on the water sectors of the body in the perioperative period in children

Introduction. Avoiding solid foods and liquids before surgery is a common practice in elective surgery in pediatric, however, there is a risk of dehydration.The objective was to assess the distribution of fluid across the water sectors of the body in children according to the duration of refusal of food and liquids before elective surgery.Materials and methods. A single-center prospective cohort study. 104 children were examined, the average age was 12.5 ± 3.7 years. Depending on the age, patients were divided into three groups: group I: 3–7 years old, group II: 7–12 years old and group III: 12–18 years old. In each group, taking into account the duration of preoperative refusal of food and fluid, there were two subgroups: subgroup I – less than 12 hours; subgroup II – more than 12 hours. The average fasting time was 13.3 ± 2.7 hours. The condition of the water sectors of the body was assessed 30 minutes before surgery, 30 minutes and 24 hours after surgery.Results. Before the operation, the distribution of fluid across the water sectors in groups I and II, depending on the duration of fasting, did not differ; in group III, when fasting for more than 12 hours, all indicators were significantly lower. 30 minutes and 24 hours after the intervention, an increase in the volume of total water and extracellular fluid was observed, however, significant changes were only in group III (p &lt; 0.05). In group III, when fasting for more than 12 hours before surgery, lower systolic BP values were observed (p &lt; 0.05).Conclusion. The duration of preoperative refusal of solid food and liquids in the range of 12–15 hours does not adversely affect the indicators of water metabolism and is not associated with arterial hypotension during the induction of anesthesia.

End-of-Life Care of Persons with Alzheimer's Disease and Other Dementias.

End-of-life (EOL) care has been a common option for patients with terminal medical conditions such as cancers. However, the utilization of EOL care in Alzheimer disease and other dementing conditions have become available relatively recently. As the end-stage dementia approaches, the clinicians and caregivers become faced with numerous clinical challenges-delirium, neuropbehavioral symptoms, the patient's inability to communicate pain and associated discomfort, food refusal, and so on. In addition to providing quality clinical care to the EOL patients, clinicians should pay special attention to their families, assuring that their loved ones will receive supportive measures to improve quality of life (QOL).

Platforming pickiness: the digitally mediated enactment of childhood avoidant eating

ABSTRACT Steve Woolgar has argued that science and technology studies is a prime place for studying the relationship between children and consumption [2012 “Ontological Child Consumption.” In Situating Child Consumption: Rethinking Values and Notions of Children, Childhood and Consumption, edited by B. Sandin, A. Sparrman, and J. Sjöberg, 33–51. Lund: Nordic Academic Press]. Yet this project remains largely unfulfilled, mirroring the broader absence of children as a serious object of study in the discipline. This extends to the analysis of childhood eating. So-called ‘picky’ eating, which I refer to as ‘avoidant’ eating, involves varying degrees of food refusal, often experienced by carers as highly distressing. In response, many parents are turning to digital platforms for support. This paper analyses how parents’ encounters with avoidant eating become entangled with digital platforms, centring on a digital autoethnography of the author’s own information seeking practices via Google search. Not only does the paper respond to the neglect of parent–child relations as a site for research within STS, it also demonstrates that the so-called ‘new social studies of childhood’ could benefit from further analysing the way in which parent–child relations are entangled with relations between people and things, including digital platforms.

High prevalence of response to PPI treatment in children and adolescents with eosinophilic esophagitis in southern Brazil.

Eosinophilic esophagitis is a newly recognized entity, in which there is significant evidence available that clearly demonstrates the positive impact of PPIs on reducing esophageal eosinophilia in individuals across different age groups, including children, adolescents, and adults. Multiple mechanisms have been proposed to explain how this treatment effect occurs. In Brazil, there seems to be a lack of studies that have prospectively assessed the clinical and therapeutic response rate in pediatric patients with EoE. The objective of this study was to prospectively evaluate the clinical and therapeutic response of pediatric patients with EoE in a medical center located in southern Brazil, by investigating the effectiveness of PPI treatment. This study is a clinical, prospective, open trial that took place in a pediatric hospital located in southern Brazil. The focus of the study was on patients diagnosed with Eosinophilic Esophagitis (EoE) who were given treatment using omeprazole/esomeprazole at a dosage of 1 mg.kg per dose, twice daily, for a period of 8-12 weeks. Following the treatment period, the patients underwent another endoscopy. Patients who exhibited 15 or less eosinophils in the biopsy conducted after the treatment were considered as responders. A total of 27 patients was evaluated (74.1% boys). The average age (± standard deviation) was 8 years (±4). Nineteen patients (70.3%) were considered as responders to PPI treatment: 6 patients-22.2%-exhibited a complete response (defined as having 5 or fewer eosinophil per high power field. Additionally, 13 patients-48.1%-demonstrated a partial response, characterized by eosinophil counts exceeding 5 but less than 15 eos/hpf. When comparing the responder and non-responder groups at presentation, a statistical difference was observed in the prevalence of food refusal as a presenting symptom. Food refusal was found to be more prevalent in the non-responder group (87.5% vs. 26.3%, P = 0.008). No differences were observed in terms of atopy history and endoscopic scores. Upon comparing the histological findings from the post-treatment endoscopy of the two groups, it was observed that PPI responders exhibited a greater tendency to decrease basal cell hyperplasia (P = 0.06) and intercellular edema (P = 0.08). In this group of pediatric patients with EoE in Southern Brazil most patients showed a high prevalence of histological, endoscopic, and clinical response to PPI treatment. PPIs showed efficacy in Brazilian patients with EoE, most of whom would probably not be able to adequately undergo other treatments. https://ensaiosclinicos.gov.br/rg/RBR-2ntbth9, identifier (U1111-1301-1842).

Dietary management of IgE and non-IgE-mediated food allergies in pediatric patients.

Food allergies (FA) consist of both IgE and non-IgE-mediated entities, with varying phenotypes and overlapping and different considerations for each specific disease presentation. In general, all FAs place children at increased risk for inadequate nutritional intake and negative impacts on their nutritional status, as well as negative impacts on the quality of life for the entire family. To minimize these untoward effects, a multidisciplinary approach should be taken, including consultation and management with a dietitian trained in the varying presentations of FA. Families should be instructed on label reading as a first line of nutritional management. During a nutrition consultation, the age of the child, growth, and nutritional status should be considered. Food refusal should be assessed and addressed. Families should be educated on avoidance and appropriate substitutions. In the case of cow's milk allergy, a suitable specialized formula should be suggested if the infant is not breastfed or if breast milk supply is not sufficient. Other mammalian milk should be avoided and careful consideration should be given before plant-based milk is used in young children. Specific food allergies may differ in terms of advice provided on the level of avoidance required, whether precautionary advisory labels should be avoided, and if a maternal avoidance of the allergen during breastfeeding should be advised. The role of immunonutrition on overall health should be discussed.

A prospective cohort study exploring the impact of tonsillectomy on feeding difficulties in children.

Paediatric feeding difficulties are common, affecting up to 25% of otherwise healthy children, symptoms include food refusal, gagging, choking, and excessive mealtime duration. These symptoms are commonly described in pre-operative discussions about tonsillectomy. This prospective study explores the impact of tonsillectomy on paediatric feeding difficulties. This prospective cohort study invited caregivers of children undergoing tonsillectomy to complete a PediEAT questionnaire about their children's feeding behaviours, pre and post-operatively. The study was completed in two phases with 9 questions administered in phase 1 and three additional questions added for phase 2. A free text comments box was also provided. Responses were graded from 0 to 5, where 0 is 'never a problem' and 5 is 'always a problem' with eating behaviours. The study was conducted at our institution, a tertiary paediatric ENT unit. Children aged between 6 months - 7 years undergoing tonsillectomy for any indication were invited to participate. Changes to the Pedi-EAT scores pre and post operatively were the main outcome measure. 102 participants were recruited between January 2020 and January 2022. The mean age of participants was 4.1 years, 87% had a concurrent adenoidectomy. The mean time to completion of post-operative questionnaire was 23 weeks after surgery. 9 of the 12 questions showed a statistically significant improvement in post-operative scores using a paired student t-test (p < 0.05). The most significant improvements related to 'gets tired from eating and is not able to finish' (1.49 pre-op, 0.91 post op, p < 0.01) and 'eats food that needs to be chewed' (1.4 pre-op, 0.72 post-op, p < 0.01). 13% of participants only underwent tonsillectomy and this group also showed a statistically significant improvement in fatigue during eating (p < 0.05). Symptoms of fatigue during eating and avoidance of food requiring mastication are most likely to improve following tonsillectomy in children.

An evaluation of training components necessary to teach staff members to conduct an intensive pediatric feeding intervention

AbstractIn applied behavior analysis, parents or other caregivers are often trained to implement an intervention after the intervention has been demonstrated effective when implemented by professionals. However, training novice staff members to conduct specific behavioral interventions has received less attention. This is particularly true in the context of training staff to implement interventions to treat food refusal. In the current study, we implemented three levels of training to evaluate the level of intensity required to train staff members (i.e., behavior technicians, Registered Behavior Technicians®, and Board‐Certified Behavior Analysts®) to implement a feeding protocol with a role play partner. Only one participant met the mastery criteria following the first training phase, which included written instructions and video modeling. Following 72 h of exposure to the instructional materials, we provided participants an opportunity to ask clarifying questions about the procedure (second training phase). Only one participant met mastery in this phase. Three other participants required in vivo feedback and modeling (third training phase) to master the protocol. We discuss clinical implications and future research directions.

Evaluation of two physical guidance procedures in the treatment of pediatric feeding disorder.

Children with pediatric feeding disorder may refuse to consume an adequate variety and/or volume of food to maintain expected growth. They can consume food but may actively or passively refuse, resulting in escape or avoidance of eating. Behavioral interventions like positive reinforcement with escape extinction can increase consumption. However, sometimes these interventions are insufficient, especially in treating passive refusal. In these cases, physical guidance may be used to prompt an open mouth to deposit food. Research indicates open-mouth prompts are effective and rated as acceptable. This study replicated an existing physical guidance procedure, the finger prompt, and compared its efficacy and acceptability with that of a spoon prompt. This study extended research by defining and measuring passive refusal as a dependent variable and assessing social validity among different stakeholders and times. Both prompts were effective in treating food refusal, and caregivers rated the finger prompt as more preferred.

On the efficacy and efficiency of treating pediatric feeding disorder.

Inappropriate mealtime behavior (IMB) is a type of feeding challenge within the broader class of food refusal. The purpose of this study was to critically analyze the efficacy of interventions for the treatment of IMB through a meta-analysis of research using single-case experimental designs. We examined the extent to which different interventions resulted in decreases in IMB while also producing increases in food acceptance. This meta-analysis was also used to examine the efficiency of different interventions in achieving clinical significance. We identified 38 studies involving 266 cases in which IMB was treated with a behavioral intervention. The results indicated interventions that combined escape extinction and non-escape extinction had greater effect sizes for both reducing IMB and increasing food acceptance than either escape extinction alone or non-escape extinction alone. However, interventions that included escape extinction were slightly less efficient at decreasing IMB than were interventions that did not include escape extinction. We discuss the implications of these findings and provide recommendations for future research.

The relationship between the severity of intellectual and developmental disabilities (IDDs) in adults with IDDs and eating and drinking problems and nutritional status.

Adults with intellectual and developmental disabilities (IDDs) experience eating, drinking and swallowing problems, such as chewing problems, choking, gagging, coughing during eating, aspiration and rumination syndrome, which may lead to poor nutritional status. This study aimed to determine the relationship between IDD levels, eating, drinking and swallowing problems and nutritional status in adults with IDDs. The sample consisted of 71 participants (37 men and 34 women) with a mean age of 22.5±7years (range 18-60years). Professionals classified intellectual disability as mild, moderate or severe. The Screening Tool of Feeding Problems scale was applied to the caregivers of adults with IDDs to identify eating, drinking and swallowing problems. Dietary intake was assessed using a 24-h dietary recall and a food and nutrition photograph catalogue. The researchers measured body weight, height and middle upper arm circumference. Body mass index was calculated. Four body mass index categories were determined: underweight (<18.5kg/m2 ), normal weight (18.5-24.9kg/m2 ), overweight (25.0-29.9kg/m2 ) and obese (≥30kg/m2 ). Chi-squared tests were used to detect the relationship between IDD levels and eating and drinking problems, and analysis of variance tests were conducted to detect the relationship between IDD levels with anthropometric measurements and dietary intake. Participants had mild (42.3%; n=30), moderate (29.6%; n=21) or severe IDD (28.2%; n=20). They were underweight (12.7%; n=9), normal weight (59.2%; n=42) or overweight and/or obese (28.2%; n=20). Participants with severe IDD had significantly higher Screening Tool of Feeding Problems 'nutrition-related behaviour' and 'eating and drinking skill deficit problem' sub-scale scores than those with mild IDD. However, the groups had no significant difference in 'food refusal and selectivity' sub-scale scores. Participants with severe IDD also had anorexia prevalence similar to those with mild IDD. The groups did not significantly differ in anthropometric measurements, daily energy intake and macronutrient and micronutrient intake. While adults with severe IDD had more eating and drinking skill deficits (e.g. chewing problems and independent eating difficulties) and nutrition-related behaviour problems than those with mild IDD, the eating, drinking and swallowing problems, which may critically affect their food intake, were similar to adults with mild IDD. The anthropometric measurements and energy and nutrient intakes of adults with severe IDD were not significantly different from those with mild IDD consistently. Findings indicate that nutritional deficiencies and nutritional behaviour problems may be avoidable in adults with IDDs.