Meta-Analysis of Behavioral Treatments for Pediatric Feeding Disorders

PROJECT SUMMARY/ABSTRACT A high percentage of children do not eat or drink at sufficient levels, causing substantial health consequences, as well as psychological and financial stress for caregivers. Pediatric Feeding Disorders or Avoidant/Restrictive Food Intake Disorder (ARFID) are especially common in children diagnosed with intellectual and developmental disabilities and results from complications anywhere in the complex chain of reflexive and learned behaviors. Children with a severe feeding difficulty (SFD) can learn to associate feeding with pain and discomfort, leading to intense refusal behavior that leaves caregivers with the inability to feed their children. When children learn that engaging in refusal behavior successfully avoids meals, refusal behavior can persist even after amelioration of underlying medical conditions. If refusal persists, a two-phase behavior-based method (1) assesses conditions maintaining refusal behavior for individual children and (2) bases treatment of refusal behavior on the assessment through teaching developmentally appropriate feeding skills both to children and caregivers. Though highly effective, most evidence supporting behavioral treatments for SFD comes from a large number of published studies using single-case experimental designs. This approach is useful for conducting individualized treatments, but their format impedes evaluation of the most effective methods and generality of outcomes, and limits dissemination across scientific communities, caregivers, insurance companies, and healthcare providers. Limited dissemination among primary health-care providers is particularly problematic because pediatricians are typically the first contact for child-feeding difficulties, which can result in alternate treatment recommendations that have little empirical support. Moreover, most insurance companies require prior authorization on a case-by- case basis for behavioral treatment of SFD, often resulting in delayed or denied coverage for a myriad of reasons (payor policies not matching evidence-based practice), leading to invasive interventions (g-tube) and deleterious outcomes for developing children. Therefore, the present research proposes to synthesize and disseminate the ample evidence for behavioral treatments for SFD with aims to (1) systematically identify and meta-analyze the range of independent and dependent variables examined from the diversity of methods used, (2) explore the degree to which demographic variables, number/types of medical diagnoses, and dependence on supplemental feeding moderate treatment effectiveness, and (3) explore approaches to disseminating treatment effectiveness by surveying and receiving feedback from key stakeholder groups (caregivers, health-care providers, insurance companies). Conducting a meta-analysis of these treatments for SFD is a critical step (1) preceding evaluation through a randomized-controlled trial, (2) toward recognizing it as a medically necessary, highly effective evidence-based medical approach, (3) that needs to be disseminated across scientific communities, caregivers, insurance companies, and healthcare providers. Such dissemination would support greater insurance coverage, increased access to care, and improved health and quality of life of children and their families.