Abstract:
Upon continued feeding difficulties, a child may require a feeding tube to meet their nutritional needs. Prolonged tube feeding, or tube dependency, has multiple negative outcomes, including medical complications, disrupted oral-motor development, social exclusion, and healthcare costs. Behavioural interventions are well-established treatment approaches for paediatric feeding disorders. However, few studies are conducted outside of controlled settings and there is little focus on the longer-term nutritional and social outcomes. In addition, assessment results and treatment decision-making are rarely reported. This thesis aimed to evaluate a home-based behavioural assessment and treatment model for nine children with tube dependency. First, we developed a caregiver-informed antecedent-based assessment model to evaluate the effect of manipulations to food or liquid properties (e.g., volume, texture), on food consumption. Second, we implemented treatments informed by the assessment, and tested a treatment decision-making model to evaluate increasingly more restrictive treatment components in a stepwise fashion. Caregivers participated during experimenter-led sessions, and then implemented their child’s treatment protocol following training. We measured behavioural, nutritional, and social outcomes until the child’s treatment goal was achieved, then during follow-up visits conducted up to 12 months following treatment. For seven of nine children, the current assessment and treatment model achieved sustained improvements in the consumption of varied foods and reductions in tube feeding. Surprisingly, antecedent- or reinforcement-based treatments were effective for most children in the absence of escape extinction. By the final follow-up, six children had ceased tube feeding. Caregivers and health professionals provided strong ratings of satisfaction with treatment goals, procedures, and outcomes.
