A Retrospective Consecutive Controlled Case Series of Underspoon: A Modified-Bolus Placement to Address Behavior That Interfere With Swallowing.
Flip the spoon bowl-down to cut packing and boost safe swallowing in kids with feeding disorders.
01Research in Context
What this study did
Doctors looked back at old charts of kids who had trouble eating. They tried holding the spoon bowl-down, called underspoon, to see if food stayed in the mouth.
All kids had a feeding disorder and kept spitting or holding food in their cheeks. The team counted bites eaten and how often food came back out.
What they found
Kids ate more bites and spat less when the spoon was upside-down. Food also left the mouth cleaner after each swallow.
No extra steps like chasers or chin prompts were needed. Just the spoon flip made the change.
How this fits with other research
Amore et al. (2011) first tried a flipped spoon and cut packing in two kids. Takahashi et al. (2023) now show the same trick works for a bigger group.
Levin et al. (2014) and Taylor (2022) mixed several moves—redistribution, chasers, swallow help—to stop packing. The new study keeps it simple with only spoon angle.
Shalev et al. (2018) fixed liquid spitting with chin prompts or reclined seats. Takahashi et al. (2023) target solid food with the underspoon instead.
Why it matters
You can try underspoon placement today. Hold the spoon so the bowl faces the tongue and present the bite. Watch if the child swallows more and packs less. No new tools or drinks needed—just turn the spoon over.
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02At a glance
03Original abstract
Children diagnosed with pediatric feeding disorder (PFD) or avoidant/restrictive food intake disorder (ARFID) may present with comorbid oral-motor delays that often contribute to their failure to consume an adequate volume and/or variety of foods. Once the food enters the mouth, these children may exhibit additional problematic behavior such as expulsion and packing that further averts oral intake. Previous research has evaluated the impact of modified-bolus placement methods, including flipped spoon and NUK® brush, in comparison to upright spoon on expulsion and packing. Whether responses are due to performance or skill deficits, researchers hypothesize that modified-bolus placement may assist with reducing the response effort associated with swallowing. This retrospective consecutive controlled case series assessed the clinical application of an additional modified-bolus placement method, underspoon, to increase food consumption and decrease problematic behavior that interfere with mouth clean for children with PFD or ARFID.
Behavior modification, 2023 · doi:10.1177/01454455221129996