Further examination of behavior during extinction‐based treatment of pediatric food refusal

Engler et al. (2023) looked back at 60 kids who got extinction-based feeding therapy. They counted how many kids showed side effects like bursts, crying, or yelling.

The team used clinic charts to track each child’s first two weeks of treatment. They wanted real-world numbers, not lab data.

Fewer than one in three kids had a burst or big emotional spike. Side effects were not the norm.

When bursts did happen, they were short and did not stop the therapy from working.

Woods et al. (2019) first warned that bursts could occur, but their sample was small. Engler’s larger chart review shows the risk is lower than many feared.

Phipps et al. (2022) added that child unhappiness fades faster when you give non-contingent bites of preferred food. Engler agrees: most kids calm quickly even without extra tweaks.

Haney et al. (2022) tracked relapse (resurgence and renewal) in almost half of cases. Engler fills the other side of the picture: initial bursts are rare, but later relapse is common—plan for both.

You can start escape extinction for feeding refusal without waiting for a perfect “burst plan.” Expect some crying, but know it hits only a minority of kids and passes fast. Pair the procedure with dense reinforcement from day one (Phipps et al., 2022) and watch for relapse signs later (Haney et al., 2022). This balanced view keeps caregivers on board and treatment moving.