A comparison of flipped-spoon presentation and redistribution to decrease packing in children with feeding disorders

For children with feeding disorders, nonremoval procedures combined with reinforcement are often used by practitioners to treat initial food refusal (Volkert et al., 2016; Volkert & Piazza, 2012). However, this treatment may not always be sufficient to increase food consumption because problematic behaviors such as packing (holding food in the mouth) or expulsion emerge. Antecedent- and consequence-based interventions have both been effective to decrease packing (or increase mouth clean) in children with feeding disorders. Depositing the bite using a flipped spoon or Nuk upon presentation has been shown to increase mouth clean (Sharp, Harker et al., 2010; Wilkens et al., 2014), and redistribution and/or swallow facilitation havebeen effective to decrease packing (Gulotta et al., 2005; Volkert et al., 2011). To our knowledge, flipped-spoon presentation and redistribution have not been directly compared to reduce packing, and this was the aim of the current study.