An alternating treatments comparison of two intensive interventions for food refusal.

The team compared two escape-extinction ways to end food refusal.

One way was physical guidance: the feeder gently closed the child’s jaw after the spoon touched the tongue.

The other way was nonremoval of spoon: the spoon stayed at the lips until the child opened.

Each meal alternated the two methods so the child served as his own control.

Both methods pushed food acceptance above 80 percent.

Physical guidance won on the side effects: fewer screams, shorter meals, and parents liked it more.

Firth et al. (2001) ran the same match-up five years later and got the same winner, so the edge for physical guidance is holding up.

Rubio et al. (2021) pooled many studies and found finger prompts and side deposit work best; the jaw prompt used here showed mixed results across papers. The difference is tiny—H et al. used jaw prompt inside a full package, not alone.

Davis et al. (2023) later showed you can sometimes skip escape extinction entirely and just alternate how foods are presented. Their kids ate more with sequential bites, proving escape-based force is not the only path.

Kirkwood et al. (2021) added another layer: when food refusal is fueled by both escape and attention, you must reinforce and extinguish both functions. Pure escape plans like the ones here may fall short for those kids.

You now have a ranked menu: try physical guidance first if you need escape extinction—it is faster and parents prefer it. If the child has social functions or you want a lighter touch, fold in antecedent swaps or function-based reinforcement before you clamp jaws.