Reducing tube feeds and tongue thrust: combining an oral-motor and behavioral approach to feeding.
OBJECTIVE
A treatment package combining oral-motor and behavioral interventions was implemented for a 6-year-old girl with Down syndrome referred to an intensive day treatment feeding program for gastrostomy tube dependence and food refusal. The participant exhibited a tongue thrust, resulting in the expulsion of all foods presented.


METHODS
An oral-motor procedure was used to reduce the tongue thrust and allow the food to be swallowed. This procedure was paired with positive reinforcement and escape prevention to increase oral consumption of liquids and solids. A multiple-probe design was used to evaluate treatment effectiveness.


RESULTS
By the end of treatment, tube feedings were eliminated and tongue thrust was significantly reduced.


CONCLUSIONS
This intervention demonstrated the successful combination of oral-motor and behavioral components in the treatment of a severe feeding problem. It could serve as a model for the development of future interventions.
Gibbons
Bridget G
BG
Kennedy Krieger Institute, Baltimore, MD, USA.
Williams
Keith E
KE
Riegel
Katherine E
KE
D002648:Child; D004314:Down Syndrome / Q000150:complications; D004750:Enteral Nutrition; D019959:Feeding and Eating Disorders of Childhood / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D009788:Occupational Therapy / Q000379:methods*; D014061:Tongue Habits / Q000009:adverse effects*