Use of extinction and reinforcement to increase food consumption and reduce expulsion.

Two children with feeding disorders would not eat. They spit food out or pushed it away.

The team gave praise and toys for accepting bites. They also ignored refusal and kept the spoon at the lips. Later, they added a second step: any food that came back out was scooped up and offered again.

Acceptance went up once praise and extinction were in place.

When expelled bites were re-presented, spitting dropped and swallowing rose. The combo worked better than reinforcement plus extinction alone.

Najdowski et al. (2003) later showed escape extinction is the real engine; praise only softens crying. Their data say the re-presentation step in Coe et al. (1997) is extra escape extinction, not magic.

Scott et al. (2024) pooled 266 kids and found the same: mixing escape and non-escape extinction gives the biggest bite gains. The 1997 pair are inside that pool, so the meta-analysis backs them up.

Scotchie et al. (2023) take it further. They run quick probes first to see which bite size, texture, or spoon angle already cuts expulsion. You can use their probe results to decide when extra re-presentation is even needed.

You now have a clear chain: start with praise for acceptance, stay firm with extinction, and re-present any food that comes out. Run Scotchie’s five-minute probe first to see if a simple spoon flip does the job. If not, add re-presentation and watch swallowing rise while spitting fades.