Packing involves not swallowing solids or liquids in the mouth. It is a significant mealtime behaviour to treat. Research has shown effectiveness of redistribution, but only two studies in highly specialised hospital settings in the United States have evaluated the use of a chaser. We extended this literature by conducting treatment in the home setting, and comparing a liquid and puree chaser separately to infant gum brush redistribution and a move-on to the next bite presentation component. A 4-year-old male with autism spectrum disorder and gastrostomy tube dependence participated in his home. He also had a history of prematurity (24 weeks), ventilator, CPAP, oxygen, and failure to thrive. He ate custard and soup as a nonself-feeder at a certain temperature. If a minuscule lump was in the soup, he would gag and vomit. He had never chewed or used his teeth or swallowed any texture. He might accept 2 other specific foods, but would pack for hours or expel. He consumed chocolate milk mix via spoon feeding as a nonself-feeder. He used an adaptive water bottle that squirted water into his mouth with prompting and assistance. He did not take medications orally (via G-tube). Previous treatment attempts included multiple years since birth with a hospital feeding team, various therapies, and a 10-day hospitalisation for tube weaning (resulting in some small oral intake of custard, liquid soup, and chocolate milk mix). His parents persisted in oral feeding and volume and decreased tube nutrition dependence on their own. We used a multielement single-case experimental design. With the liquid chaser, consumption increased to 100%. Swallowing latency was significantly lower with the liquid chaser compared to other packing treatments. His variety reached over 124 foods at any temperature. He learned self-feeding and scooping, including holding the container, and using a fork. He learned drinking independently from a full cup including sipping, a regular water bottle, and regular straw. Liquid variety was increased to multiple flavours of formula and water in a regular open cup. He learned to eat independently from pouch and take medications orally rather than via tube. He learned to bite off, chew with his molars, lateralize, masticate, and swallow a wide variety of regular texture foods, including meats and raw fruit/vegetables. Refusal, expulsion, packing (not swallowing), emesis (vomit), and gagging/coughing all decreased to low/zero levels, and independence, chewing/texture, and swallowing increased significantly. He transitioned from a highchair to a booster at the family dinner table. His parents were trained to implement the protocol. He met all 22 of his goals in 15 days.
“Another more typical example was an extreme premmie with a G-tube who had to learn his mealtime skills later in life. He had already been through an unsuccessful hospital admission that stopped the tube feedings to promote hunger.
This child had two intensive admissions with us, the second focusing on chewing and increasing food texture. He was such a trooper and learned it all! We’ll always remember his “graduation meal” where he was able to order off the menu at a cafe and drink from a cup instead of his mum having to pack formula and purées.”
➡️From the Blend 4 👉