Bobby: A Feeding Intervention Success Story

Bobby is a beautiful brown-eyed 5-year old who came to visit our clinic in 2011. His parents had contacted Applied Behavioral Strategies because they were concerned that his extremely limited diet (only rice waffles and bacon) was doing great harm to his health. They explained that he would eat up to 5 pounds of bacon at a sitting and restricted drinking only to a specific sippy cup. The only other food he allowed in his diet was Ruffles ® potato chips.

When Bobby first arrived in the clinic, he spent most of his time trying to keep away from all adults. He definitely preferred to manage his own time in his own way!  Getting him to try anything new usually led him to try to escape from the room. Mom even had to sit in front of the closed door to prevent him from running out.  In the initial stages of intervention, we target an easy skill to ensure that the child will get access to the preferred items or activities (also known as reinforcers). For Bobby, we chose to start off trying to get him to drink his preferred drink from an open mouth cup rather than his preferred Sippy cup. Every time we approached him with the new cup he ran in the opposite direction. When he eventually touched the cup to his lips (with our assistance), Bobby got to play a game on the iPad. He soon learned that trying new things were amply rewarded! Getting food to his lips was the next challenge.

We realized then that Bobby had a difficult time any change was introduced. On each trial, he attempted to elope (run out the door). After many attempts, Bobby finally allowed us to touch food to his lip. Each new food brought a new round of elopements. On our second day, we asked his father to assist us as we physically prompted him to come to the table and sit down, rather than us bringing the food to Bobby. He was prompted to remain in his seat until he accepted a small morsel of food in his mouth. Just for trying new foods, Bobby got a pile of reinforcement! We showed him he could spit the morsel out if he allowed the morsel in. He also learned that he could have his favorite food reinforcer—bacon!— just for trying the new food. We repeated this procedure many times until Bobby became more comfortable with the procedure.

The next day, the bar was raised again for Bobby when he was asked not only to accept new foods into his mouth, but that he would have to chew and swallow as well.  Understandably,  he was not happy about this change in expectations. Because the challenge was greater, the reinforcement offered was greater too.  Bacon was still being used as a reinforcer for meeting his eating goals, and in addition Bobby was allowed to escape from the eating table and go play with his favorite toys – Thomas the Tank Engine trains and track. Essentially, he would be allowed to leave the table (negative reinforcement) to play with the train (positive reinforcement). After he played for about 1 minute, he was asked to come back to the table. Soon, he was coming to the table with only a verbal reminder (“it’s time to come take a bite”).  Everyone was so excited when it became clear that Bobby was beginning to accept and even enjoy his new routines.

By the fourth day, Bobby was independently coming to the table and independently feeding himself bites of food. His parents were elated and began to take over the feeding process from the therapists. Even though his parents had observed every session, we still reminded them to provide praise, prompts, and reminders as needed.  By our fifth and last day of clinic, Bobby was taking charge of his own meals. He was able to independently select which foods he wanted to eat, in which order, and to handle his own utensils.   Our celebratory dinner was one that would make grandmother’s all over the world cry: our little friend ate steamed kale with Tahini sauce, pureed lentils, pickled cabbage, vegetable soup, mixed vegetables, and brown rice. Moreover, he did this at a local restaurant with both parents and his siblings. The family had never eaten at a restaurant successfully until this day.

His mother recently contacted us to show us pictures of his continued success. Check this out! This is a meal he ate at home!

Congratulations Bobby and to your parents as well! Persistence and bravery carry their own rewards. Happy Eating!