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Cópia de Fishbein2006
Cópia de Fishbein2006
ABSTRACT: Food chaining has been developed as a At our institution, we have established an alter-
systematic method for the treatment of children with native therapy for aversive feeding disorder that
extreme food selectivity. Food chaining is an individual- includes home-based therapy with the advantage of
ized, nonthreatening, home-based feeding program convenience and familiarity. The intervention,
designed to expand food repertoire by emphasizing similar incorporating sensory integration and behavioral
features between accepted and targeted food items. This modification techniques, includes food chaining
chart review illustrates the efficacy of food chaining in (Fraker, Walbert, Cox 2004 copyright) and allows for
treating aversive feeding disorders. expansion of food repertoire by emphasizing similar
features (taste, texture, temperature) between
accepted food items and new/targeted food items. In
this model, the parent or guardian assumes the
primary feeding role.8,9
Figure 1. Example of food chain: French fries to chicken pot pie. Accepted food item: French fries. Targeted food item:
chicken pot pie. New food items: listed in sequence.
food items and that were rejected previously or tions without sustained improvement. All subjects
never attempted, are introduced. Food chain were enrolled in the feeding program for at least 3
branching and expansion allows for the addition of months. Six of 10 children carried other diagnoses.
food targets to meet the child’s current needs. The Four of 10 children required supplemental gastros-
endpoint of therapy occurs when parent and child no tomy/jejunostomy feedings. At the onset of feeding
longer rely upon the intervention of the feeding intervention, subject #2 was consuming only animal
therapist to achieve feeding goals. crackers and juice, subject #5 was consuming only
Correspondence between study participants and water, and subject #9 was consuming only carbon-
feeding team members occurred through clinic vis- ated beverages. The median intervention during the
its, telephone calls, voice mail, electronic mail, and 3-month interval occurred for 1.25 hours/week
videotape. The investigation commenced at the ini- (range, 0.5–2 hours/week; Table 1).
tiation of the feeding program and was completed 3 All children were able to increase their food
months later. Subject demographics included age, repertoire over 3 months (p ⬍ .05, paired t-test). The
gender, diagnoses other than aversive feeding dis- median number of accepted foods at onset was 5
orders, nutrition status, gastrostomy/jejunostomy (range, 1–10). The median number of new/target
tube status (present or absent), and intervention foods at 3 months was 20.5 (range, 8 –129); see
duration per week (correspondence time). The study Figure 2). Supplemental feeding status did not
was approved by the Springfield Committee for change after intervention.
Research Involving Human Subjects.
Discussion
Behavioral modification techniques are integral
Statistical Analysis to the treatment of feeding disorders in children. In
A paired t-test involving the number of new/ this chart review, the efficacy of food chaining, an
targeted food items accepted from 0 to 3 months was intervention designed to expand food repertoire
used to determine the outcome of the intervention. through behavioral modification, was demonstrated.
The children were nonuniform with regard to nutri-
tion status or medical condition, but all had extreme
Results food selectivity. A majority of subjects had failed
Ten children (6 male, 4 female) with age median previous feeding therapy. Despite these prior fail-
of 3 years (range, 1–14 years) were studied. Eight of ures, all subjects involved in this individual feeding
10 subjects had experienced prior feeding interven- program that includes food chaining were able to
Table 1
Patient demographics and length of interventions per week
expand their diets successfully. The manner of inter- include feeding therapist availability (at least 1/2
vention/communication modality also was tailored hour per week for several consecutive months, and
to meet subject necessity and convenience. Despite perhaps longer), feeding therapist expertise (thera-
these variations, all subjects had sufficient access pist must be familiar with behavioral modification
and time allotment to therapy to achieve adequate and its role in food chaining), and sufficiently moti-
progress with their feeding program. Traditional vated and compliant parent or guardian. The goals
feeding programs involve prolonged hospitalization, of a feeding program should be realistic and estab-
with feeding therapy provided primarily by a lished by parent, therapist, and child. If imple-
trained therapist. In contrast, our program is home mented properly and in this manner, food chaining
based and allows for an expanded role in feeding may be a useful adjunct in the treatment of children
therapy by parents. with feeding aversion.
The demands of a successful feeding program
have been illustrated in these cases. Prerequisites References
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Figure 2. Accepted food items at 0 and 3 months after food 9. Fishbein M, Cox S, Walbert L, Fraker C. Feeding disorders in
chaining. children: a little taste. Nutrition and the MD. 2003;29:1–5.