1. Please Eat! Evidence and Practice Applications of Interventions to Treat Food Selectivity in Young Children Julie Bugeau, OTS Spalding University January 23, 2015 juliebugeau@gmail.com

2. Objectives What is food selectivity? What causes food selectivity? Why is this important to OT? What does the research say? What does clinical practice say? Moving forward

4. What is Food Selectivity? Avoids an entire food group Avoids all foods with a certain texture Avoids all solid foods and will only drink liquids Eats 5 or fewer foods Avoids all foods of a certain type

5. What Causes Food Selectivity? SENSORYBEHAVIORAL PHYSICAL or MEDICAL

6. Why Does This Matter to OT? Feeding as occupation/co-occupation Prevalence of feeding disorders in children Child development Stress on family Importance of early intervention

7. Level IIA Fieldwork 63% of children on caseload with feeding problems Diagnoses Developmental delay  42% Autism  33% Sensory processing deficits  25%

8. Level IIA Fieldwork Treatments Oral-motor exercises/activities Food chaining SOS Play Sensory integration strategies Parent education

9. Research Process What evidence is available? In the home or in a clinic? What about parental involvement? What do I see in practice? Oral motor? Behavioral? Sensory? Diagnoses?

10. Research Process (continued) Databases: Google Scholar, AJOT, OT Search, Academic Search Premier Articles within the last eight years assessing: oral support, food selectivity in ASD, outcomes of intense interdisciplinary feeding programs, treatments based on operant conditioning, relation between nutritional adequacy and ASD, caregiver perspectives, how OTs teach caregivers, food chaining, sensory integration vs. operant conditioning Diagnoses: premature birth, ASD, developmental delays, reflux Outcome measures: oral intake, bite acceptance, #refusal behaviors, # presentations, YAQ*, CEBI-Children’s Eating Behavior Inventory YAQ: Youth/Adolescent Food Frequency Questionnaire

11. What Does the Evidence Say? Behavioral interventions can be effective Most commonly researched Effective, usually as part of a treatment package for children w/variety of feeding problems Increased variety and amount of foods accepted, decreased inappropriate behaviors, decreased caregiver stress Escape extinction Differential attention Non-contingent reinforcement Taste exposure

12. What Does the Evidence Say? (continued) Sensory integration is not shown to improve feeding outcomes 1 study Challenges in studying SI Food chaining may be effective in increasing Very little research One component of an individualized treatment protocol Effective as an adjunct in the treatment of children with food selectivity More easily implemented in the home setting than some other treatments

13. What does the Research Show? (continued) Role of the parent/caregiver is important Stress of food selectivity in a child on the family unit and mealtime routines OTs are not doing enough to explicitly teach caregivers strategies Parents must be compliant to implement strategies at home Therapy usually directed by feeding therapist and in a clinical setting Children with a more limited food repertoire had inadequate intakes of a great number of nutrients

14. What This Means for OT… Treat the child and the family Provide strategies for the parents to implement in the home Clinical judgment to address oral-motor, sensory, and behavioral components Reach out to other disciplines Research!

15. Thank you! What questions do you have? Julie Bugeau, OTS juliebugeau@gmail.com