Evaluation of a finger prompt variation in the treatment of pediatric feeding disorders
A quick finger prompt at the mouth can push bite acceptance past a plateau when escape extinction alone is not enough.
01Research in Context
What this study did
Rubio and team worked with three toddlers who refused most foods. Each child had a feeding disorder but no autism.
The kids already got escape extinction—meaning the spoon stayed at the lips until they took a bite. The researchers added a quick finger prompt: they gently pressed the corner of the child’s mouth to cue opening.
Sessions happened at an inpatient feeding clinic. Parents watched and gave thumbs-up ratings after each meal.
What they found
All three toddlers soon accepted 80-100 % of bites when the finger prompt was added. Two kids also kept crying and head-turning very low.
Parents scored the finger-prompt meals as “acceptable” and said they would use the trick at home.
How this fits with other research
Scott et al. (2024) pooled 266 cases and found that mixing escape plus non-escape parts gives the biggest gains. Rubio’s finger prompt is one clear way to add that extra piece.
Giallo et al. (2006) tried a high-probability sequence before bites; Carr et al. (2003) showed the sequence alone failed without escape extinction. Rubio keeps the required escape piece and simply layers on a shorter, easier finger cue.
Richman et al. (2001) taught parents to run escape extinction at home. Rubio moves the same idea back to clinic, swaps the prompt type, and still keeps parent approval high.
Why it matters
If a child is stuck at low acceptance even with non-removal of the spoon, you now have a low-effort next step. A one-second finger prompt at the lip can tip the scale without extra staff or toys. Try it during one lunch this week—measure bites accepted before and after—and you may see the same quick jump Rubio did.
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02At a glance
03Original abstract
Children with feeding disorders often engage in refusal behavior to escape or avoid eating. Escape extinction combined with reinforcement is a well-established intervention to treat food refusal. Physical guidance procedures (e.g., jaw prompt, finger prompt) have been shown to increase food acceptance and decrease inappropriate mealtime behavior when more commonly employed escape extinction (e.g., nonremoval of the spoon) procedures are ineffective. The finger prompt, however, has not been extensively evaluated as a treatment adjunct to target food refusal, thus necessitating further examination. The purpose of this prospective study was to assess a variation of a finger prompt procedure to treat food refusal and to assess caregivers' acceptability of the procedure. Three children age 1 to 4 years admitted to an intensive feeding disorders program and their caregivers participated. The finger prompt was effective in increasing bite acceptance across all participants and decreasing or maintaining low levels of inappropriate behavior for 2 participants. The procedure was also acceptable to all caregivers.
Journal of Applied Behavior Analysis, 2020 · doi:10.1002/jaba.658