Figure 1 - uploaded by Mark Fishbein
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Example of food chain: French fries to chicken pot pie. Accepted food item: French fries. Targeted food item: chicken pot pie. New food items: listed in sequence.
Source publication
Food chaining has been developed as a systematic method for the treatment of children with extreme food selectivity. Food chaining is an individualized, non-threatening, home-based feeding program designed to expand food repertoire by emphasizing similar features between accepted and targeted food items. This chart review illustrates the efficacy o...
Context in source publication
Context 1
... subjects underwent initial assessment by a multidisciplinary feeding team including a pediatric gastroenterologist, dietitian, speech language pathologist (feeding therapist), and behavioral psychologist. Each subject was identified with extreme food selectivity and designated for a feeding program that included food chaining ( Figure 1). The individualized treatment protocol was designed by the dietitian, speech language pathologist, and behavioral psychologist. ...
Citations
... K was introduced to the concept of 'food chaining', which is a strategic approach aimed at helping K try new foods and overcome her fear of foods whilst considering her unique food preferences (Fishbein et al., 2006). This involved creating links or 'chains' between foods she already consumed and new foods that supported her health. ...
Cognitive Behavioural Therapy for Avoidant and Restrictive Food Intake Disorder (CBT-AR; ARIFD) is a psychological treatment that targets many of the core symptoms of ARFID. Although a growing literature supports the efficacy of behavioural interventions for paediatric feeding and eating disorders, including ARFID, the applicability of these methods to adults remains undetermined. Telehealth delivery of CBT-AR in adults with autism has yet to be tested. With this study, we conduct a preliminary evaluation of CBT-AR delivered virtually to a 26-year-old white British female, with mixed ARFID and elevated autistic traits. She attended 23 remote CBT-AR sessions facilitated through a dedicated telehealth platform. Adjustments were made to accommodate her lived experience of neurodiversity. Using a pre-post treatment design, changes on measures of subjective goal attainment, eating-related and general psychosocial impairment, general anxiety, and depression were evaluated. Following treatment, the participant had made significant progress towards personally meaningful goals, with improvements observed in nutritional intake, general well-being, and reductions in eating-related psychosocial impairment and general anxiety. The results offer preliminary insights into acceptability and efficacy of virtual CBT-AR for neurodiverse individuals.
... As a general rule, it is suggested to implement feeding patterns that discourage aversive feeding practices 5 and promote a gradual transition from more accepted foods to those less preferred by resembling their color, volume, or texture. 18,41,42 When food selectivity is severe, behavioral therapy and sensory desensitization may be key tools in feeding and the overall well-being of children. 41,43,44 Behavioral feeding strategies may be effective even in eating disorders of organic origin. ...
It has been estimated that between 25% and 40% of healthy children show symptoms of feeding difficulties (FDs) during their growth and development; many times, these are not adequately diagnosed. The objective of this study was to conduct a narrative review that collected the available information on feeding difficulties. Assessment and management algorithms were developed based on the bibliographic evidence. Most feeding problems in young children (feeding selectivity, loss of appetite, fear of feeding) are often concurrent, and a clinical risk assessment is necessary to plan an individualized intervention. Having standardized definitions and common terms to address these difficulties in an appropriate and multidisciplinary manner is one of the ways to optimize their treatment. The involvement of different health care providers and parents is critical to address feeding difficulties.
... These food similarities are used to create 'food chains' or links between the foods that are considered acceptable to the child and the new ones. Based on this approach, anxiety level will be contained, enabling children to become more familiar with the new foods that will be included in their diet later on (30)(31)(32) . ...
... Bearss et al. (2015) classified the parent-training programmes for children with ASD as follows: parent support programmes (PSPs) and parent-mediated programmes (PMPs). PSPs supply parents with information and knowledge about ASD, while PMPs can be categorized as primary and complementary; in the former, caregivers facilitate the treatment from the outset, whereas in the latter, the therapist initially leads the treatment and involves the caregiver afterwards (31)(32)(33)(34) . ...
Autism Spectrum Disorder (ASD) is a complex group of neurodevelopmental disorders characterized by impaired social communication and restricted interests/repetitive behaviors. In this regard, sensory processing difficulties and delayed oral motor skills often predispose individuals with ASD to food selectivity (FS). It is usually associated with repetitive eating patterns that can lead to multiple malnutrition conditions. The objective of this narrative review is to present an overview about the existing nutritional interventions aiming at promoting a healthy eating pattern and addressing food selectivity among individuals with ASD. Regarding the interventions targeting nutrition education, the majority of the analyzed studies failed to demonstrate their effectiveness. On the other hand, many educational interventions involving taste or cooking sessions, as well as behavioral interventions for FS, demonstrated effective results. Moreover, multidisciplinary in tailoring such programs, including psychology speech therapy and nutritional skills, is acknowledged as a key approach.
... In severe and refractory cases, individuals are typically referred to an intensive program with a trial of outpatient therapy offered if desired for continuity of care but with limited anticipation of improvement. Current reviews have demonstrated the success of this model regardless of nature of feeding disorder (Benson et al., 2013;Fishbein et al., 2006;Gosa et al., 2020). ...
... In addition, the follow-up packet included an abbreviated second intake form and patient satisfaction query, to be mailed back to investigators in a self-addressed, self-stamped envelope, with a request to return 3 months after the initial visit. A 3-month reassessment was selected due to our prior study indicating feeding status improvement over this time interval and reducing likelihood of loss to follow-up and/or completion of therapy (Fishbein et al., 2006). Both initial and follow-up packets were for study purposes only and were not used in the clinical care of the subject. ...
... The implementation of self-addressed, self-stamped envelopes and 3 months turnaround interval was intended to improve yield; however, it was not greatly successful. Reassessment at 3 months has been used successfully in a prior outpatient investigation and is typically used at our center as a benchmark interval for "measurable" progress (Fishbein et al., 2006). Feeding therapists at our institution typically follow patients for 3 months weekly and then biweekly to monthly for up to 9 months afterward if necessary. ...
Pediatric feeding disorders are common and are often associated with chronic medical conditions and developmental disorders. A multidisciplinary treatment approach may be offered through outpatient or intensive programs. Benefit has been demonstrated with intensive programs, but there is little data regarding outpatient approaches. We described outcomes from a well-established outpatient feeding assessment program related to the referral base and program outcomes. Study packets collecting demographics and self-reported feeding skills were distributed to the referral population and redistributed three months later. Standardized surveys implemented included Montreal Children’s Hospital Feeding Scale (MCH-FS) and parenting stress index (PSI-SF). One hundred and ninety-eight subjects completed the initial packet. MCH-FS was elevated in all subjects indicating a broad range of feeding concerns. PSI elevation was present in a broad range of comorbidities compared to group without comorbidities. At 3 months (n = 55), MCH-FS and feeding skills improved without change in PSI-SF. The quality of therapy overall was deemed excellent to above average by most subjects. A multidisciplinary outpatient program has a role in managing infants and children with feeding disorders regardless of comorbidity. Severely affected individuals may benefit from more intensive programs and/or may require long-term care to effect significant change.
... Food selectivity, which is characterized by food refusal, is defined as the consumption of a limited variety of food (Bandini et al., 2019). Toddlers are in a period to learn to self-feeding, try new foods and textures, and thereby food selectivity could also be seen in typically developing children (Fishbein et al. 2006). Although food selectivity was previously reported in typically developing children, our study shows that toddlers with DS also experienced food selectivity, which may result in varying degrees of feeding difficulties. ...
The aim of this study was to define swallowing and feeding-related problems among typically developing children aged between 2 and 6 years. The presence of food selectivity, limited appetite, chewing dysfunction, and dysphagia signs was questioned and scored as “absent” or “present” according to parent report. Children were divided into 2 groups: children with swallowing and feeding disorders and children without swallowing and feeding disorders. The Turkish version of the Behavioral Pediatrics Feeding Assessment Scale (T-BPFAS) was used to evaluate feeding behaviors of children, and Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to measure the impact on caregivers. A total of 234 children were included. Food selectivity was defined in 62.4% (n = 146), limited appetite in 26.9% (n = 63), and chewing dysfunction in 7.3% (n = 17). The most common dysphagia-related sign was coughing. There were significant differences between groups in terms of both T-BPFAS and T-FS-IS (P < .001). In conclusion, children with typical development have experienced a wide range of swallowing and feeding-related problems, which have an impact on mothers’ perceptions regarding feeding and their quality of life.
... Food selectivity, which is characterized by food refusal, is defined as the consumption of a limited variety of food (Bandini et al., 2019). Toddlers are in a period to learn to self-feeding, try new foods and textures, and thereby food selectivity could also be seen in typically developing children (Fishbein et al. 2006). Although food selectivity was previously reported in typically developing children, our study shows that toddlers with DS also experienced food selectivity, which may result in varying degrees of feeding difficulties. ...
The study was aimed to define swallowing related problems of toddlers with Down syndrome (DS) by comparing toddlers with typically developing children (TDC). A total of 127 children (96 DS, 31 TDC), and their mothers included in the study. The presence of chewing disorders, food selectivity, drooling, coughing during swallowing was scored as ‘absent’ or ‘present’. The Pediatric version of the Eating Assessment Tool-10 (PEDI EAT-10) was used to determine dysphagia symptom severity, and the Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to measure the impact of swallowing disorders on caregivers. Mothers of DS reported higher rates of chewing disorders (n = 39, 40.6%), drooling (n = 30, 31.3%) and coughing during swallowing (n = 50, 41.7%) than mothers of TDC (p < 0.01). The mean PEDI-EAT-10 score of children with DS was higher than TDC (p = 0.006). There were significant differences between groups in terms of T-FS-IS. Moderate to strong correlations were detected between PEDI-EAT-10 and total and subscale scores from T-FS-IS (p < 0.001). This prospective study defines swallowing related problems of toddlers with DS. The study results highlight the importance of early investigation of (i) swallowing concerns in children with DS, and (ii) caregivers’ quality of life to define swallowing problems and plan an appropriate swallowing related management program.
... The real-world implications of our questionnaires could support health professionals in identifying foods least preferred across the five core food groups and allow for uniquely tailored interventions. For example, behavioural techniques for the management of food selectivity such as food chaining/associative conditioning or fading could be implemented starting with 'moderately challenging' non-preferred food items (e.g., wholegrain cereals), then progressing to 'more challenging' non-preferred food items (e.g., green leafy vegetables) (Fishbein et al., 2006;Milano, Chatoor, & Kerzner, 2019). Similarly, behavioural theorybased nutrition education interventions could be implemented to increase intake of non-preferred foods across the core food groups (especially wholegrain breakfast cereals) and not just vegetables (e.g., try adding one yellow-orange vegetable to your lunch and one wholegrain cereal to your breakfast or dinner at-least 3 times a week) to achieve holistic food behaviour change in children (Cullen, Baranowski, & Smith, 2001;Enright, Allman-Farinelli, & Redfern, 2020). ...
Limited literature has examined parents’ perceptions of children’s pickiness in relation to all the five core food groups (vegetables, legumes/beans; fruits; dairy and alternatives; meat and alternatives; cereals), which is representative of a nutritionally balanced diet and critical for optimal growth and development in children. This study aimed to develop and validate two questionnaires in Australian-Indian mothers and children 7-12 years (N=482). The core food Picky Eating Questionnaire (PEQ), completed by mothers, identified maternal perceptions of their child’s pickiness. The Child-reported Food Preference Questionnaire (C-FPQ) studied children’s self-reported food preferences. The questionnaires comprised specific food items commonly available in Australia across the five core food groups (PEQ, N=32; C-FPQ, N=33) and discretionary foods (C-FPQ, N=11). Exploratory Factor Analysis identified the initial factor structure, and Confirmatory Factor Analysis provided construct validity. The PEQ observed five constructs, and C-FPQ observed three constructs for food items perceived as picky/non-preferred-green leafy vegetables; other vegetables, pulses/legumes; fruits; wholegrain/wholemeal cereals (PEQ only) and dairy (PEQ only). The PEQ and C-FPQ observed four constructs for food items perceived as not picky/preferred-green vegetables; other vegetables; fruits and nuts, and dairy. C-FPQ also observed savoury and sweet discretionary food constructs. All constructs observed acceptable reliability (test-retest, internal consistency) and validity (convergent, relative, predictive) testing. Mean scores indicated that mothers’ perceptions of pickiness were positively correlated with their children’s report of non-preference. In conclusion, this study pilot validated two questionnaires to examine maternal perceptions of pickiness and children’s self-reported food preferences among Australian-Indians, Australia’s largest ethnic community.
... Food chaining, an approach that aims to expand a child's food repertoire by emphasizing similarities between targeted and accepted food, has been found to improve dietary variety for children with food aversions. (Fishbein et al., 2006). However, this intervention does not emphasize the importance of shifting mealtime routines to promote long-term behavior change. ...
Promoting Routines of Exploration and Play during Mealtime (Mealtime PREP) is an intervention designed to support healthy dietary variety in children. To estimate the effects of this intervention, we recruited 20 parents and children (aged 1-5 years) with sensory food aversions to participate in a pilot study. Parents were coached to enhance daily child meals using Mealtime PREP. Our primary outcome was acceptance of targeted food (number of bites) over time. Descriptive statistics and effect sizes are reported. Moderate effects were observed for acceptance of targeted food. Mealtime PREP warrants additional research to examine effects in larger, more diverse samples.
... Foods should be offered 8-15 times without pressure to achieve acceptance. Other techniques may be necessary, such as "hiding" vegetables in sauces, using "additives" to enhance flavor, shaping food, giving foods attractive names, involving children in preparation, presenting foods in attractive designs, and the "food chaining" technique, which consists of the gradual replacement of foods that are accepted by others with similar characteristics or shapes, in which the volumes offered are progressively exchanged 41 . Other behavioral techniques include distraction to avoid nausea and techniques to prevent the food from being retained in the cheeks such as going around the child's mouth with the spoon or physically guiding the child to accept the food. ...
Feeding problems during childhood have been described over time by various authors. In 2013, Avoi dant/Restrictive Food Intake Disorder (ARFID) was included in the Diagnostic and Statistical Ma nual of Mental Disorders, 5th Edition (DSM-5), as a new diagnosis within the Feeding and Eating di sorders, to describe a group of patients with avoidant or restrictive eating behaviors unrelated to body image disorder or weight loss desire. ARFID may appear as significant weight loss and/or nutritional deficiency and/or a marked interference in psychosocial functioning. There are three forms of pre sentation, which can co-occur or occur independently. The first one includes children with sensory aversions (selective), who reject certain foods due to their taste, texture, smell, or shape; the second one includes those children with poor appetite or limited intake (limited intake); and the third one includes those children who reject certain foods or stop eating as a result of a traumatic event (aversi- ve). Due to the recent incorporation of ARFID into the DSM-5, there is a lack of information regar ding its treatment. The purpose of this review is to clarify diagnostic criteria and to describe targeted management and treatment interventions with a multidisciplinary approach, without deepening on the treatment of organic medical causes.
... Des programmes ont été conçus afin d'améliorer les spécificités alimentaires chez des enfants tout-venant et ont montré leur efficacité (Ernsperger & Stegen-Hanson, 2004;Fishbein et al., 2006;Toomey, 2002). Chacun de ces programmes détaille les différentes étapes du suivi permettant une amélioration du comportement alimentaire. ...
... Différents aspects peuvent être utilisés afin de réaliser un programme sur-mesure en fonction des spécificités de l'enfant ou de l'adolescent ayant des difficultés alimentaires. Par exemple, des aliments proches de ceux appréciés peuvent être proposés, l'enfant ou l'adolescent peut être invité à participer à la préparation de ses repas et le jeu peut être un outil utilisé au cours des repas (Ernsperger & Stegen-Hanson, 2004;Fishbein et al., 2006;Toomey, 2002). ...
Dès la première description du Trouble du Spectre de l'Autisme, Kanner (1943) a souligné la présence momentanée de manifestations dépressives chez un des cas. Aujourd'hui, l'Episode Dépressif Caractérisé (EDC) est considéré comme étant un des troubles psychiatriques les plus fréquemment associés au TSA, ayant des répercussions à court, moyen et long termes sur l'enfant ayant un TSA et sa famille. Pourtant, aujourd'hui, il n'existe pas de consensus concernant la façon d'évaluer la symptomatologie dépressive chez les enfants et les adolescents ayant un TSA. Les objectifs de cette recherche sont de créer et de valider une échelle de repérage des signes de l'EDC, d'identifier les facteurs associés aux signes de l'EDC chez les enfants et les adolescents ayant un TSA et d'étudier les manifestations dépressives dans leur fonctionnement habituel. Quatre études ont été réalisées. La première a permis de créer l'échelle de repérage des signes de l'EDC spécifique aux enfants et aux adolescents ayant un TSA. Elle est composée de 3 parties : une évaluation des douleurs et des médicaments pris par l'enfant, le listing des changements environnementaux et l'évaluation de la symptomatologie dépressive ; en deux étapes : une description du fonctionnement habituel de l'enfant puis une mesure de l'ampleur des changements de comportements. La seconde étude visait à valider cette échelle (N=153). La fidélité inter-juges est très satisfaisante mais devra être évaluée sur un échantillon plus important (ρfiabilité=0,98 ; ρfiabilité=0,02). L'échelle a de bonnes validités apparente, de contenu et de critère et une excellente consistance interne (αéchelleEDC=0,91). Elle est composée de deux facteurs : un de changements comportementaux et l'autre de changements émotionnels et cognitifs. La troisième étude visait à identifier les facteurs associés à l'EDC chez les enfants et les adolescents ayant un TSA (N=58). Des facteurs individuels, notamment liés au parcours de soin concernant le diagnostic de TSA mais aussi la santé somatique ; familiaux, notamment le vécu parental et le désir d'avoir des amis sont liés à la symptomatologie dépressive. La quatrième étude avait pour objectif d'identifier des manifestations dépressives dans le fonctionnement habituel des enfants et des adolescents ayant un TSA (N=133). Plus d'un tiers de l'échantillon exprime de la tristesse quasiment tous les jours et plus d'un quart n'exprime quasiment jamais de joie. Plus de la moitié des enfants et des adolescents de l'échantillon ne prend aucun plaisir au quotidien. Un jeune sur cinq a des comportements auto-agressifs et 28% ont des comportements hétéro-agressifs tous les jours. La moitié de l'échantillon a des difficultés de sommeil et 58% en a d'appétit tous les jours. Enfin, trois quarts des jeunes expriment de la culpabilité ou de la dévalorisation tous les jours.
