Date Presented 04/06/19
Children with SFA often demonstrate inappropriate behaviors during meals. Parents manage these behaviors using a variety of strategies. Understanding parental strategy use in the home can guide clinical practice and prioritize needs for parent training. In this secondary data analysis, mealtime strategy use among parents of children with SFA is described and relationships between parental strategy use and child mealtime behaviors are examined.
Primary Author and Speaker: Elise Krause
Additional Authors and Speakers: Allison Juris, Angela Caldwell
PURPOSE: Children with Sensory Food Aversions (SFA) often demonstrate inappropriate mealtime behaviors, such as crying, throwing food, and leaving the table, to avoid food with specific sensory characteristics (Chatoor, 2009). Parents are referred to occupational therapy when mealtimes become a daily struggle. During early childhood, parents play an integral role in shaping child mealtime behavior (Savage, Fisher & Birch, 2007). The purpose of this study is to describe behavioral strategies parents of children with SFA use in the home during mealtimes, and identify associations between these strategies and child behavior.
DESIGN: This secondary data analysis used data collected as part of a larger study investigating the feasibility of a mealtime intervention. We recruited 18 children (aged 18 mo – 5 years) and their parents to participate in the trial using social media advertisements and flyers. Eligible child participants met all four criteria for SFA: 1) refuses foods based on sensory characteristics; 2) onset of food refusal occurs when novel foods are introduced; 3) eats preferred foods without difficulty; and 4) food refusal causes nutritional deficiencies OR oral motor delay.
METHOD: Parents video-recorded 10 typical child meals in the home prior to intervention. We used a random number list to select one meal per participant to be coded for this study. A coding scheme was developed to identify different types of parental strategies observed using the Observer® XT software from Noldus. We coded child behaviors (bites of novel and preferred foods, time out of chair, crying) and parental strategies (labeled praise, unlabeled praise, direct commands, redirection, threats, bribes). We used descriptive statistics, calculated bivariate correlations, and used multiple linear regression to test the predictive value of significant associations.
RESULTS: Parents used unlabeled praise (19 occurrences) and direct commands (27 occurrences) most frequently. On average, children with SFA spent 26% of the mealtime out of their chairs. Use of unlabeled praise was significantly associated with time out of chair (r =-.53, p =.02), indicating that higher parental use of unlabeled praise is related to a lower percentage of time the child is out of chair. Use of direct commands was significantly associated with number of bites of novel foods (r = .50, p = .04), indicating that higher parental use of direct commands is related to a higher number of child bites of novel foods. Multiple regression was used to test if these two parental strategies (unlabeled praise and direct commands) significantly predicted either of these associated child outcomes. The model was not significant for number of bites of novel foods consumed. However, these two strategies explained 38% of the variance (R
2=.38, F(2, 17) = 4.64, p =.03) of time out of chair. It was found that use of unlabeled praise significantly predicted time out of chair (β = -.58, p =.01).
CONCLUSION: Prior to treatment, parents of young children with SFA are using the strategies of direct command and unlabeled praise most frequently to manage child behavior. Use of unlabeled praise predicted the amount of time a child remained seated and may be a useful strategy for behavior management. Future studies will examine how parental strategy use changes over time and examine ways in which different strategies influence mealtime behaviors.
IMPACT STATEMENT: This proposal provides valuable information about the way the parents of children with Sensory Food Aversions are managing behaviors in the home. Clinicians can use this information to guide parent training and optimize behavioral feeding interventions.
References
Savage, J. S., Fisher, J. O., & Birch, L. L. (2007). Parental Influence on Eating Behavior: Conception to Adolescence. The Journal of Law, Medicine & Ethics : A Journal of the American Society of Law, Medicine & Ethics, 35(1), 22–34. http://doi.org/10.1111/j.1748-720X.2007.00111.
Horne, P. J., Hardman, C. A., Lowe, C. F., Tapper, K., Le Noury, J., Madden, P., ... & Doody, M. (2009). Increasing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention. European Journal of Clinical Nutrition, 63(5), 613.
Chatoor, I. (2009). Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers and Young Children. Washington, DC: ZERO TO THREE.
