Parent feeding practices in infants and toddlers referred to a hospital-based feeding program in the United States.

While considerable research exists on parent feeding practices for infants and toddlers, past research has not focused on children with feeding problems. The goal of this study was to identify parent feeding practices in a sample of infants (n = 178) and toddlers (n = 221) referred to a hospital-based feeding clinic and then examine how these parent feeding practices were correlated with specific feeding problems. Parents completed surveys to report child demographics, feeding problems, and use of 54 feeding practices. Forty-eight (88.8%) of 54 practices were utilized more often for toddlers than for infants. Exploratory factor analysis with the 54 practices and the full sample (n = 399) produced the 16-item Baby Parent Mealtime Action Scale (BPMAS) with three dimensions: Multiple Food Offers, Use of Cereal/Pureed Foods, Use of Toys/TV. Controlling for demographics, hierarchical regression examined how each BPMAS dimension was associated with five feeding problems (underweight, tube feeding, texture problems, limited diet, mealtime disruption). Multiple Food Offers (e.g., daily offering of vegetables, offering foods from the family meal) was the dimension most correlated with fewer feeding problems such as tube feeding (ß = -0.220, p < 0.001), texture rejection (ß = -0.361, p < 0.001), and limited diet variety (ß = -0.175, p < 0.001), but also with more mealtime disruption (ß = 0.231, p < 0.001). Use of Toys/TV was correlated with more mealtime disruption (ß = 0.260, p < 0.001). In addition to demonstrating a correlation between parent feeding practices and feeding problems, this study also found adding cereal/pureed foods to be common and while the dimension, Use of Cereal/Pureed Foods, was not significantly correlated with any specific feeding problem, this dimension provides an expanded understanding of cereal usage.

Parent Attribution for Child Eating Scale (PACES). Psychometric characteristics and associations with child and parent variables.

Parent participation in interventions for their children's feeding problems may depend on parent attributions for the origins of these problems, but no measure is available to identify these parent perceptions. The purpose of the present paper was to develop a new Parent Attribution for Child Eating Scale (PACES), then to examine how parent perceptions measured by the PACES were associated with child variables and parent feeding practices. Participants included parents of 393 children from a hospital feeding clinic (68.2% boys; mean age = 55.4 months). Parents completed surveys to report children's demographic, medical, and feeding variables, three-point ratings for possible origins of these feeding problems, and their own use of nine child-feeding practices. Exploratory factor analysis of the parent ratings produced the 21-item PACES with four dimensions: Permissive Parenting, Medical Treatments, Oral Problems, and Vomiting Fear. The PACES showed acceptable goodness-of-fit, internal reliability, test-retest reliability, and support for its validity with expected correlations with child and parent variables. Multiple regression revealed that nine child variables (age, body mass index, gender, autism, gastrointestinal problems, neurological problems, oral motor problems, texture feeding problems, diet variety) explained 19-41% of the variance in the four PACES attributions, with oral motor problems significantly correlated with all of them (negatively with Permissive Parenting, positively with the other three), suggesting that its occurrence in combination with other child variables guides parent explanations for children's feeding problems. Multiple regression also found that Many Food Choices was the only parent feeding practice significantly correlated with all four PACES attributions (positively with Permissive Parenting, negatively with the other three), suggesting that it may be parents' primary response to attributions they develop for their children's feeding problems.

The oral behavior screener: a brief caregiver-completed measure of oral behaviors.

INTRODUCTION: To date, there are no caregiver-reported screening measures of oral behaviors related to feeding. The goal of this study was to develop such a measure. METHOD: Caregivers of 803 children referred to a feeding clinic and 188 comparison children reported their children's frequency of nine oral behaviors. These data were used to develop an Oral Behavior Screener (OBS). Both the psychometrics of the OBS and the relations between the OBS and child demographics were examined. RESULTS: As expected, the clinical sample demonstrated more deficits in oral behaviors than the comparison sample. We also found special needs status and age were linked to the OBS summary score. DISCUSSION: The OBS is a brief screener that can be used by clinicians to examine the need for further assessment, possible targets for intervention, oral behaviors often associated with feeding problems.

Parent mealtime actions that mediate associations between children's fussy-eating and their weight and diet.

The present study evaluated parent mealtime actions that mediate associations between children's fussy-eating and their weight and diet. Participants included 236 feeding-clinic children in three diagnostic groups: 50 with autism, 84 with other special needs, and 102 without special needs. Children's weight was measured as body mass index percentile (BMI%), with only 26.4% of the present sample found to be underweight (BMI% less than 10). Parents reported children's diet variety as the number of 139 common foods accepted, children's FUSSINESS with the Child Eating Behavior Questionnaire, and their own use of four actions from the Parent Mealtime Action Scale: POSITIVE PERSUASION, INSISTENCE ON EATING, SNACK MODELING, SPECIAL MEALS. Multiple regression found that only SPECIAL MEALS explained variance in children's BMI% and diet variety. For children without special needs, mediation analysis revealed that variance in children's BMI% explained by FUSSINESS was accounted for entirely by the parent's preparation of SPECIAL MEALS. For all diagnostic groups, mediation analyses revealed that variance in children's diet variety explained by FUSSINESS was accounted for by the parent's use of SPECIAL MEALS. We conclude that although the parent's use of SPECIAL MEALS may improve BMI% in fussy-eating clinic children, it may also perpetuate their limited diet variety.

Teaching chewing: a structured approach.

OBJECTIVE: A structured intervention was used to teach chewing to two children with special needs. Neither child had a history of chewing or eating high-textured food. METHOD: The intervention combined oral-motor and behavior components to teach chewing. A multiple baseline design was used to evaluate treatment effectiveness. RESULTS: Both children improved their chewing skills while increasing the texture of foods eaten and the variety of foods eaten. CONCLUSION: This structured intervention could be used to teach chewing to a range of children who did not acquire this skill during normal development.

Reducing tube feeds and tongue thrust: combining an oral-motor and behavioral approach to feeding.

OBJECTIVE: A treatment package combining oral-motor and behavioral interventions was implemented for a 6-year-old girl with Down syndrome referred to an intensive day treatment feeding program for gastrostomy tube dependence and food refusal. The participant exhibited a tongue thrust, resulting in the expulsion of all foods presented. METHOD: An oral-motor procedure was used to reduce the tongue thrust and allow the food to be swallowed. This procedure was paired with positive reinforcement and escape prevention to increase oral consumption of liquids and solids. A multiple-probe design was used to evaluate treatment effectiveness. RESULTS: By the end of treatment, tube feedings were eliminated and tongue thrust was significantly reduced. CONCLUSION: This intervention demonstrated the successful combination of oral-motor and behavioral components in the treatment of a severe feeding problem. It could serve as a model for the development of future interventions.

Lewis rats are more sensitive than Fischer rats to successive negative contrast, but less sensitive to the anxiolytic and appetite-stimulating effects of chlordiazepoxide.

Lewis rats show greater anticipatory contrast effects than Fischer 344 rats. Specifically, relative to Fischer rats, Lewis rats exhibit greater avoidance of a saccharin cue when it predicts the future availability of a preferred sucrose reward [Grigson, P.S., Freet, C.S. The suppressive effects of sucrose and cocaine, but not lithium chloride, are greater in Lewis than in Fischer rats: evidence for the reward comparison hypothesis. Behav Neurosci 2000;114:353-363.]. Experiment 1 was designed to determine whether Lewis rats also would demonstrate greater contrast in another paradigm, successive negative contrast (SNC). The results demonstrated a tendency for greater SNC in Lewis rats and then slower recovery from the unexpected loss of reward relative to the Fischer rats. Pretreatment with the anxiolytic agent, chlordiazepoxide (CDP), effectively eliminated contrast in the Fischer rats, but served to prolong recovery from contrast in the Lewis rats. Finally, the results of Experiment 2 demonstrated that Fischer rats, but not Lewis rats, increase consumption of a 0.1 M sucrose solution following pretreatment with CDP. Together, the results show that, while both Lewis and Fischer rats demonstrate SNC, the effect is more sustained in the Lewis rats and these rats are insensitive to both the anxiolytic and the appetite-stimulating effects of CDP.

Practice does make perfect. A longitudinal look at repeated taste exposure.

Previous research has found that 10-15 exposures to a novel food found can increase liking and consumption. This research has been, however, largely limited cross-sectional studies in which participants are offered only one or a few novel foods. The goal of the current study uses a small clinical sample to demonstrate the number of exposures required for consumption of novel foods decreases as a greater number of foods are added to the diet. Evidence that fewer exposures are needed over time may make interventions based upon repeated exposure more acceptable to parents and clinicians.

Combining repeated taste exposure and escape prevention: an intervention for the treatment of extreme food selectivity.

Repeated taste exposure has been used to introduce novel foods in several settings, but none of these efforts have targeted clinical populations. This study describes an intervention that combines repeated taste exposure and escape prevention in the treatment of extreme food selectivity in two children with autism. Future applications of repeated taste exposure are discussed.