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Updated: Jun 2, 2025

A Treatment Package without Escape Extinction to Address Food Selectivity
Published on: August 21, 2015
Barriers and facilitators to implementation of a guideline for school-aged children with feeding difficulties
Anna Miles1, Celine Wong1, Bianca Jackson1
1School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand.
Background:
Swallowing difficulties are common and complex in children with physical, behavioural, and cognitive needs. This study (i) describes mealtime management and (ii) identifies barriers and facilitators to implementation of a guideline for school-aged children with feeding difficulties in one specialist school.
Method:
Three data sets were collected: (i) 51 school records, (ii) 48 meal observations, and (iii) seven staff interviews. The model of behaviour COM-B (Capacity Opportunity Motivation and Behaviour) was used to identify barriers and facilitators.
Results:
28 school records stated diet modifications and five children were enterally tube fed. Seventy percent of children had mealtime assistance. Only 25% of children had written plans and these did not contain all strategies observed. When feeding plans were vague or disagreements occurred, policy did not support decision-making.
Conclusions:
A coordinated approach is needed. Target areas for change include staff and family education; defined processes for cross-agency documentation and more detailed plans for all children.
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