Using behavioural intervention to support the advancement of oral feeding skills in tube-dependent children

Abstract

Children with tube dependency rely on an external tube to meet their daily nutritional requirements. Though a feeding tube can be imperative in supporting a child to grow, develop, and thrive, tube dependency can become a barrier for a child and their whānau once it is no longer medically necessary. Tube dependency can impede the development of a child’s independence, participation in daily rituals (i.e., mealtimes), and bonding with family, friends and peers. Ergo, acquiring and advancing oral feeding skills are paramount in supporting tube-dependent children to have a higher quality of life. Implementing therapeutic interventions underpinned by behaviour analytic principles has shown great success within the feeding literature. The research is predominantly conducted in highly controlled clinical settings and is implemented by trained therapists. Further research is needed into implementing intervention within the home setting, focusing on ongoing caregiver implementation. Two child participants were recruited for this study. Before the current study, both participants took part in a two-week home-based intensive. During the intensive period, a senior behaviour analyst implemented a behavioural intervention plan that established initial eating and drinking skills, which caregivers were trained to implement. Upon concluding the two-week intensive, both participants transitioned into the current study. The focus of this study was to advance oral feeding skills in accordance with whānau selected feeding goals. Individualised behavioural treatment packages were implemented by caregivers with ongoing researcher support, initially in the home setting and then generalised to the kindergarten setting for one participant. The results indicated that the treatment package successfully advanced oral feeding skills for both participants. However, prolonged illness for both participants and hospitalisation for one significantly impacted oral feeding skill building. This resulted in one participant's early discharge from the current study. Data and observations at follow-up indicated that oral feeding skills can be re-established after periods of sickness. The limitations and implications of the current findings and suggested direction for future research are discussed below.