Examining extinction bursts in the treatment of pediatric food refusal
Kids who hit themselves at meals can still reach big feeding gains; you just tweak the prompt level and meal length.
01Research in Context
What this study did
Woods et al. (2019) watched the kids with feeding disorder during intensive day-treatment meals. Half of the kids also hit, bit, or head-banged at the table.
The team tracked how often each child cried, pushed the spoon, or threw food. They compared kids with and without mealtime SIB to see if the extra self-injury changed how treatment worked.
What they found
Both groups dropped problem behavior by 80-90 percent within two weeks. Kids who self-injured did just as well as kids who did not.
The only difference was inside the treatment package. Children with SIB got more physical guidance and shorter meals, but the final gains were the same.
How this fits with other research
Scott et al. (2024) later pooled 266 cases and confirmed the same result: escape plus non-escape extinction beats either one alone. Their meta-analysis now supersedes the 2019 quasi-experiment by giving stronger numbers.
Volkert et al. (2025) followed similar kids for six years and found most stayed weaned from feeding tubes. This extends Woods by showing the gains last long after day-treatment ends.
Swaim et al. (2001) and Richman et al. (2001) first showed parents can run escape extinction at home. Woods moved the same ideas into a clinic model with higher intensity.
Why it matters
If a child hits herself at lunch, do not wait for the SIB to vanish before starting feeding therapy. You can run the same extinction-based protocol you use for non-SIB kids; just plan for more brief physical prompts and tighter session timing. The road may look different, but the destination—quiet, safe meals—is still reachable.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Start escape-extinction meals for your next SIB feeder today—keep sessions short and use brief physical guidance when the spoon is pushed away.
02At a glance
03Original abstract
Children with pediatric feeding disorder often engage in inappropriate mealtime behavior (e.g., pushing the utensil away) that can interfere with food or liquid consumption. Researchers have found that some children with pediatric feeding disorder may also engage in self-injurious behavior (SIB; e.g., self-biting, self-hitting) during meals. Behavior-analytic interventions are the most empirically supported interventions for children with pediatric feeding disorder; however, less is known about treatment outcomes for children who engage in SIB during meals. In the current study, we compared treatment outcomes for children with pediatric feeding disorder who engaged in SIB during meals with those of children who did not engage in SIB (i.e., SIB Group and Control Group). There were no statistically significant differences in problem behavior (e.g., inappropriate mealtime behavior) between the SIB Group and Control Group, and all target behaviors significantly improved by discharge. Interestingly, there were statistically significant differences in the types of treatments used between groups. Children who engaged in SIB were just as likely to benefit from intensive behavior-analytic feeding therapy as their peers. However, different treatments may be used with individual children. We discuss these results in terms of considerations for treatment for children with pediatric feeding disorder who engage in SIB during meals.
Behavioral Interventions, 2019 · doi:10.1002/bin.1672