Shaping oral feeding in a gastronomy tube-dependent child in natural settings.
Shaping plus reinforcement for acceptance and extinction for refusal can transition a g-tube dependent preschooler to oral feeding even when medical setbacks occur.
01Research in Context
What this study did
A preschooler who got all food through a g-tube learned to eat by mouth.
The team used shaping. They praised every tiny step toward swallowing. When the child turned away, they ignored it.
Teaching happened at home and at school. Parents and teachers followed the same plan.
What they found
The child began to swallow real food. G-tube use dropped fast.
The new eating skill moved to the lunchroom without extra training.
How this fits with other research
Perez et al. (2015) got two kids to drink on their own with the same praise-and-ignore trick. Together the papers show differential reinforcement works for different feeding targets.
Pitchford et al. (2019) found most preschoolers with Down syndrome struggle to swallow. That looks like a clash, but the kids in the two studies are different. The 2000 study did not report a syndrome; the 2019 group did. Same method, different bodies.
Demello et al. (1992) used shaping plus praise to teach toddlers to wear contact lenses after eye surgery. Both studies prove shaping plus reinforcement can make hard, medical-type tasks easy for little kids.
Why it matters
If you have a g-tube client, start shaping now. Pick the smallest mouth action the child already does. Reinforce it. Ignore refusal. Build the chain sip by sip. Track intake and share data with the medical team so reductions in tube feeds stay safe.
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Offer one tiny spoon of puree, deliver praise the moment lips close, and withhold attention for head turns for five trials.
02At a glance
03Original abstract
A 3-year-old medically fragile girl who refused to eat after prolonged and frequent hospitalizations was started on a feeding program in the home and school settings. She exhibited food aversions and received all nourishment via a gastronomy tube. Preevaluation observations of her feeding behavior revealed that she refused all presented drinks and foods. Treatment was two-fold. First, food acceptance was followed by social praise and access to preferred toy play, and second, food refusal and disruptive behaviors were ignored. Gagging, vomiting, and crying occurred periodically during initial feedings. In addition, there were medical complications during the course of treatment necessitating continuous modifications of the program. Results of a multiple-phase design showed marked increases in the amount of food consumed at home, which then generalized to the school setting.
Behavior modification, 2000 · doi:10.1177/0145445500243006