Related Experiment Videos
Induction and maintenance of swallowing responses in infants with dysphagia
Insights
A novel treatment package successfully taught swallowing to infants dependent on gastrostomy tubes. This intervention enabled two of three infants to discontinue tube feeding, improving oral intake capabilities.
Area of Science:
- Pediatric feeding therapy
- Infant swallowing disorders
- Behavioral intervention
Background:
- Infants unable to swallow require gastrostomy tube feeding for nutrition and hydration.
- Existing treatments may not be suitable for all infants due to age, fragility, or lack of response.
Observation:
- A treatment package involving physical prompts, eliciting stimuli, reinforcement, and repeated trials was implemented.
- The intervention was applied across various feeding methods, food consistencies, and caregivers.
- Progressive increases in swallows and feeding sessions were targeted.
Findings:
- The treatment package was effective in inducing and maintaining swallowing in infants.
- Two out of three infants were successfully weaned off gastrostomy tubes.
- One infant maintained swallowing but required supplemental tube feedings for other medical reasons.
Implications:
- This behavioral intervention offers a viable alternative when traditional feeding therapies are not feasible.
- Further research may be needed to isolate effective components of the treatment package.
- The findings support the use of structured feeding programs for infants with severe swallowing difficulties.
Abstract:
A treatment package was used to induce and maintain swallowing with three infants who did not swallow food or liquid. Prior to treatment, they received all nutrition and hydration via gastrostomy tube feedings. The treatment package consisted of least-to-most intrusive physical prompts, an eliciting stimulus, contingent social reinforcement, and repeated trials to induce and maintain swallowing. The design combined elements of reversal and changing criterion designs for all three infants. The package was applied across feeding devices (nipple, cup, spoon), situations (liquid, pureed foods), and persons (trainer, primary nurses, mothers). The number of swallows or ounces per feeding (from 0 to 8 ounces) and the number of feeding sessions per day (from one to five) were progressively increased. In each case, the infant received baseline conditions alternated with the treatment package. Follow-up probes were done at 15 months, 21 months, or 24 months, respectively, after the last phase for the three patients. The package was successful in that the gastrostomy tube was no longer needed for Patients 1 and 3. Patient 2 maintained functional swallowing responses but received supplemental gastrostomy feedings because of unrelated medical problems. Results are discussed in terms of the need to isolate components of the package. The package can be used in cases in which the preexisting treatments (reinforcement with preferred foods, force-feeding) are not feasible because of age, physical fragility, or the lack of a swallowing response following the presentation of food.