A Comparison of Two Physical Guidance Procedures in the Treatment of Pediatric Food Refusal

Principal Investigator: Carrie Borrero

Escape prevention procedures implemented in the treatment of food refusal may vary across clinical settings. An evidence base exists for at least one form of physical guidance that is commonly implemented in the treatment of food refusal. The jaw prompt (i.e., application of slight pressure to the mandibular junction with the thumb and fingers), when used in combination with nonremoval of the spoon, has been shown to be an effective physical guidance procedure. A variation of physical guidance known as the finger prompt (i.e., therapist placement of index finger inside the child's mouth between gumline and cheek) is commonly implemented in the treatment of food refusal, but lacks rigorous support in the literature. In the previous 6 months on the feeding unit, this procedure has been used with over 25% of patients.

This is a review of de-identified clinical data (de-identified post-discharge and prior to forming a research database). Data collected during therapist-conducted meals will be analyzed by the PI and study team to determine the efficacy of the finger prompt relative to the jaw prompt. The PI and the study team will review graphic representations of the comparison of prompts (jaw vs. finger) in the clinical database (accessible to all feeding unit staff) and the PI and study team will de-identify clinical data for all identified participants. The graphic representations and data are on the shared drive (clinical database) with the records for patients, and after the patients are identified, further analysis of their data will be conducted. Graphs are saved in the clinical database under the patient name and the files for graphs are saved with initials, which will be removed after the initial identification of participants, and there will be no link to the original identifying information. After the initial identification, the PI and study team will only view and save de-identified data.

Data will be analyzed for 4-10 children admitted to an intensive feeding program for the assessment and treatment of food refusal. The jaw prompt and finger prompt are used commonly for clinical purposes on the unit, and records will be reviewed to identify patients for whom both procedures were used. Individuals for whom a valid single subject research design was implemented will be included. Changes in the children's acceptance (e.g., placement of a bite of food in the child's mouth within 5-10 s of its presentation) and refusal (e.g., head turns, mouth covers, or disruptions) of food following systematic introduction and withdrawal of the physical guidance procedures will provide and index of treatment effectiveness.

Results of the analyses may empirically validate the implementation of the finger prompt in clinical settings. Potential side effects of the procedures and treatment of preferences will be discussed.