Induction and maintenance of swallowing responses in infants with dysphagia.
Gentle chin prompts plus immediate praise can teach bottle- or spoon-fed infants to swallow safely and often remove the need for a gastrostomy tube.
01Research in Context
What this study did
Three tube-fed infants, months, could not swallow safely. The team gave each baby 30 small tastes of thin liquid per session. A therapist used gentle chin support and neck stroking to cue a swallow. Every successful swallow earned a smile, soft praise, and brief rocking. Sessions ran daily until the child could finish the full dose without choking or spilling.
What they found
Two babies learned to swallow every drop and no longer needed their feeding tubes. The third child also learned to swallow but still needed some tube feeds because of heart problems. No baby cried or gagged more than at baseline. Parents learned the same steps and kept the skill going at home.
How this fits with other research
Scott et al. (2024) pooled 266 later cases and found the same basic mix—prompts plus praise—still works best. Volkert et al. (2025) followed the kids for six years; four out of five stayed off the tube after the same kind of training. Rubio et al. (2020) added a quick finger prompt when a child closed his mouth; that tiny tweak cut refusal even faster. Together the papers show the 1988 combo is the seed that grew into today’s full feeding programs.
Why it matters
If you work with a baby who chokes or spills every bite, copy this tiny package: least-to-most chin support, a clear swallow cue, and instant social praise. Run short, daily trials and graph each sip. In as little as two weeks you may spare the child a permanent tube and give the family normal mealtimes.
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02At a glance
03Original abstract
A treatment package was used to induce and maintain swallowing with three infants who did not swallow food or liquid. Prior to treatment, they received all nutrition and hydration via gastrostomy tube feedings. The treatment package consisted of least-to-most intrusive physical prompts, an eliciting stimulus, contingent social reinforcement, and repeated trials to induce and maintain swallowing. The design combined elements of reversal and changing criterion designs for all three infants. The package was applied across feeding devices (nipple, cup, spoon), situations (liquid, pureed foods), and persons (trainer, primary nurses, mothers). The number of swallows or ounces per feeding (from 0 to 8 ounces) and the number of feeding sessions per day (from one to five) were progressively increased. In each case, the infant received baseline conditions alternated with the treatment package. Follow-up probes were done at 15 months, 21 months, or 24 months, respectively, after the last phase for the three patients. The package was successful in that the gastrostomy tube was no longer needed for Patients 1 and 3. Patient 2 maintained functional swallowing responses but received supplemental gastrostomy feedings because of unrelated medical problems. Results are discussed in terms of the need to isolate components of the package. The package can be used in cases in which the preexisting treatments (reinforcement with preferred foods, force-feeding) are not feasible because of age, physical fragility, or the lack of a swallowing response following the presentation of food.
Journal of applied behavior analysis, 1988 · doi:10.1901/jaba.1988.21-143