by Drs. Sarah Taylor & Tessa Taylor
Figure 2.The top panel shows the number of studies identified in the literature search, by treatment approach. The bottom panel shows the frequency of children that accessed each approach prior to behaviour analytic treatment (BA) in clinical practice in Australia and New Zealand (NZ).
Controlled study designs included: RCT (randomised controlled trial) and SCED (single-case experimental design). Uncontrolled designs included: nonrandomised studies (NRS), retrospective chart review (RCR), and case report (CR).
Treatment approaches included: BA (behaviour-analytic), SOS (sequential oral sensory), DOR (division of responsibility), OM (oral motor), HP (hunger provocation), Psych. (psychological), MDT (multidisciplinary team consultation), Hosp (MDT hospital admission), Med (medication), and Hypno (Hypnosis)
For paediatric feeding problems, behaviour-analytic treatments are the only approach with empirical support, but are not globally accessible. Outside of the United States, children and families are therefore likely to receive generic recommendations, or services which are not empirically-supported.
Objective: This paper aims to systematically review current evidence for the most common recommendations and treatment approaches accessed in Australia and New Zealand. We highlight the risks associated with treatments that have no empirical support. In addition to literature review, we support findings by clinical observations that are rarely reported in the literature.
Method: We identified the most common internet-based recommendations for paediatric feeding problems, as well as the most commonly accessed treatment approaches, as based on our clinical records. We then searched the research literature between 2009-2020 to evaluate evidence for common treatment approaches.
Results: The majority of generic recommendations for feeding do not correspond with research evidence. The literature review of treatment approaches identified 131 studies. Of these studies most were behaviour-analytic. Of the remaining studies, few of the commonly accessed approaches were represented in the literature, and concerns with study quality were noted.
Conclusions: At the current time, generic recommendations and the majority of prevalent treatments are not empirically-supported and present risks to children with paediatric feeding problems. In addition, behaviour-analytic research should expand to coverage of milder feeding problems and younger ages, or consideration of “prevention.” In clinical practice, referral should be prioritised to empirically-supported treatment.