Please Eat!Evidence and Practice Applications of Interventions to Treat Food Selectivity

in Young ChildrenJulie Bugeau, OTS

Spalding UniversityJanuary 23, 2015

juliebugeau@gmail.com

Objectives

• What is food selectivity?

• What causes food selectivity?

• Why is this important to OT?

• What does the research say?

• What does clinical practice say?

• Moving forward

What is Food Selectivity?

• Avoids an entire food group

• Avoids all foods with a certain texture

• Avoids all solid foods and will only drink liquids

• Eats 5 or fewer foods

• Avoids all foods of a certain type

What Causes Food Selectivity?

SENSORYBEHAVIORA

LPHYSICAL or

MEDICAL

Why Does This Matter to OT?

• Feeding as occupation/co-occupation

• Prevalence of feeding disorders in children

• Child development

• Stress on family

• Importance of early intervention

Level IIA Fieldwork

• 63% of children on caseload with feeding problems

• Diagnoses• Developmental delay 42%• Autism 33%• Sensory processing deficits 25%

Level IIA Fieldwork

• Treatments

• Oral-motor exercises/activities

• Food chaining

• SOS

• Play

• Sensory integration strategies

• Parent education

Research Process

What evidence is available?

In the home or

in a clinic?

What about

parental involveme

nt?

What do I see in

practice?

Oral motor?

Behavioral?

Sensory?

Diagnoses?

Research Process(continued)

• Databases: Google Scholar, AJOT, OT Search, Academic Search Premier

• Articles within the last eight years assessing: oral support, food selectivity in ASD, outcomes of intense interdisciplinary feeding programs, treatments based on operant conditioning, relation between nutritional adequacy and ASD, caregiver perspectives, how OTs teach caregivers, food chaining, sensory integration vs. operant conditioning

• Diagnoses: premature birth, ASD, developmental delays, reflux

• Outcome measures: oral intake, bite acceptance, #refusal behaviors, # presentations, YAQ*, CEBI-Children’s Eating Behavior Inventory

YAQ: Youth/Adolescent Food Frequency Questionnaire

What Does the Evidence Say? • Behavioral interventions can be

effective• Most commonly researched

• Effective, usually as part of a treatment package for children w/variety of feeding problems

• Increased variety and amount of foods accepted, decreased inappropriate behaviors, decreased caregiver stress

Escape extinction

Differential attention

Non-contingent reinforcement

Taste exposure

What Does the Evidence Say? (continued)

• Sensory integration is not shown to improve feeding outcomes• 1 study

• Challenges in studying SI

• Food chaining may be effective in increasing • Very little research

• One component of an individualized treatment protocol

• Effective as an adjunct in the treatment of children with food selectivity

• More easily implemented in the home setting than some other treatments

What does the Research Show? (continued)

• Role of the parent/caregiver is important

• Stress of food selectivity in a child on the family unit and mealtime routines

• OTs are not doing enough to explicitly teach caregivers strategies

• Parents must be compliant to implement strategies at home

• Therapy usually directed by feeding therapist and in a clinical setting

• Children with a more limited food repertoire had inadequate intakes of a great number of nutrients

What This Means for OT…

• Treat the child and the family

• Provide strategies for the parents to implement in the home

• Clinical judgment to address oral-motor, sensory, and behavioral components

• Reach out to other disciplines

• Research!

Thank you!What questions do you have?

Julie Bugeau, OTSjuliebugeau@gmail.com