Further evaluation of modified-bolus-placement methods during initial treatment of pediatric feeding disorders

Children with feeding disorders might pack or expel food when they lack the oral-motor skills, the motivation, or both, to swallow. Bolus placement directly on the tongue with a Nuk (e.g., Milnes et al., 2019) or flipped spoon (e.g., Sharp et al., 2010) is a treatment that researchers generally implement after such behavior emerges (e.g., Girolami et al., 2007). However, Wilkins et al. (2014) tested the relative efficacy of Nuk presentation and upright-spoon presentation during initial treatment of pediatric feeding disorders. In the current study, we compared the effects of (a) upright-spoon presentation; (b) Nuk presentation; and (c) flipped-spoon presentation on two product measures of swallowing: 15- and 30-s mouth clean, and expulsion during the initial treatment of feeding disorders with 5 children. We also monitored lip closure during bite presentation and following bolus placement. Nuk presentation produced the highest levels of mouth clean and the lowest rates of expels relative to upright-spoon presentation and flipped-spoon presentation. We discuss potential reasons why modified-bolus-placement methods improved feeding behavior and how measures of oral-motor skills might predict its necessity during initial treatment.