Conceptualizing Food Preferences as Rich-to-Lean and Lean-to-Rich Transitions: A Translational Analysis

Principal Investigator: Carrie Borrero

The purpose of this study is to determine if a children's food preferences following treatment for pediatric food refusal continue to impact mealtimes. During meals, typically multiple foods are presented, and this often includes both preferred and nonpreferred foods. In some cases, in clinical practice, we have observed that, even after a successful treatment package has been established, some children take longer to consume non-preferred foods within the context of a meal. In addition, we sometimes observe that children continue to refuse during mealtimes when nonpreferred foods are presented. The presentation of a variety of foods could be conceptualized as transitions within mealtimes (e.g., getting a bite of a preferred food followed by a bite of a non-preferred food). Research on transitions has shown that responding may differ depending on the type of transition that occurs (e.g., preferred activity to nonpreferred activity, preferred to preferred). These transitions could include rich-to-lean transitions, lean-to-rich, rich-to-rich (with rich being preferred and lean being nonpreferred), to name a few. We would like to review mealtime data using the children's individual treatment plan to assess whether or not such transitions occurred during the meal, and if the children's mealtime behavior differed depending on the type of transition.

From a clinical perspective, treatment packages are implemented to address food refusal with patients on the feeding unit. In addition, preference assessments to identify preferred and nonpreferred foods are conducted as part of the typical assessment phase of an admission. Following the evaluation of an effective treatment and a preference assessment, 15-20 participants will be selected from former patients in the feeding program, between January 2011-December 2014. One of the study team members will select 10 consecutive meals for each participant and evaluate the order of foods presented and any child behavior that occurred following bite presentation (delays to acceptance, inappropriate mealtime behavior, aggression or self-injury). These child responses and food selections are recorded as part of clinical practice on the unit. When the study team member has selected 10 meals, all identifying information will be removed prior to data analysis and no link to the identifying information will remain. This is a descriptive study evaluating child behavior during typical meals (clinical practice) following the presentation of preferred and nonpreferred foods.