Navigating through trauma-informed care and behavioral treatment in young children with feeding problems

Children may experience pediatric medical traumatic stress as a consequence of exposure to medical procedures, illness, or injury that are perceived as distressing, threatening, or otherwise aversive. In order to address the traumatic stress, trauma-informed care practices are warranted. The application of trauma-informed care practices has been widely used in healthcare for over 25 years; however, its integration into behavior-analytic practice has emerged more recently. Although trauma-informed care principles have informed practice across multiple areas of behavior analysis, relatively few studies have addressed their application to the treatment of pediatric feeding problems. Rajaraman et al. proposed four tenets of trauma-informed care that complement behavior-analytic practice as a whole: (1) acknowledge trauma and its potential impact, (2) ensure safety and trust, (3) promote choice and shared governance, and (4) emphasize skill building. In this paper, we describe a novel framework of the application of these tenets into behavioral feeding treatment. Specifically, we examine a balanced progression in which trauma-informed care and evidence-based interventions are integrated and implemented in tandem.