Further evaluation of modified‐bolus‐placement methods during initial treatment of pediatric feeding disorders
Use the Nuk spoon first to cut spitting and improve swallowing when feeding treatment starts.
01Research in Context
What this study did
Five children with feeding disorders started treatment. Each child tried three ways to place food in the mouth.
The team used a Nuk spoon, an upright spoon, and a flipped spoon. They watched for food left in the mouth and how much the kids spit out.
Each child got all three methods in a rotation. The order changed across kids to rule out practice effects.
What they found
The Nuk spoon left the cleanest mouth. It also cut spitting the most.
Upright and flipped spoons let more food fall out. Kids swallowed better with the Nuk.
The Nuk method won for every child in the study.
How this fits with other research
Scotchie et al. (2023) extend this work. They show you can test bite size, texture, and prompt level before treatment starts. Their quick probe finds the best mix for each child.
Staddon et al. (2002) took the opposite road. They lowered food texture and also cut spitting. One study changes the spoon, the other changes the food. Both work, so you can pick the easier tweak.
Scott et al. (2024) zoom out. Their meta-analysis of 266 cases says escape plus non-escape extinction gives the biggest gains. Bolus placement is one move inside those larger packages.
Why it matters
Start feeding cases with the Nuk spoon. It is a low-cost, low-stress change that boosts swallowing from day one. Pair it with the multielement probe from Scotchie et al. (2023) to fine-tune texture and bite size. You will cut spitting faster and build momentum for the full extinction protocol shown in Scott et al. (2024).
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02At a glance
03Original abstract
Children with feeding disorders might pack or expel food when they lack the oral-motor skills, the motivation, or both, to swallow. Bolus placement directly on the tongue with a Nuk (e.g., Milnes et al., 2019) or flipped spoon (e.g., Sharp et al., 2010) is a treatment that researchers generally implement after such behavior emerges (e.g., Girolami et al., 2007). However, Wilkins et al. (2014) tested the relative efficacy of Nuk presentation and upright-spoon presentation during initial treatment of pediatric feeding disorders. In the current study, we compared the effects of (a) upright-spoon presentation; (b) Nuk presentation; and (c) flipped-spoon presentation on two product measures of swallowing: 15- and 30-s mouth clean, and expulsion during the initial treatment of feeding disorders with 5 children. We also monitored lip closure during bite presentation and following bolus placement. Nuk presentation produced the highest levels of mouth clean and the lowest rates of expels relative to upright-spoon presentation and flipped-spoon presentation. We discuss potential reasons why modified-bolus-placement methods improved feeding behavior and how measures of oral-motor skills might predict its necessity during initial treatment.
Journal of Applied Behavior Analysis, 2021 · doi:10.1002/jaba.748