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Clinical Case Studies, Vol. 7, No. 2, 79-99 (2008)
DOI: 10.1177/1094428106302871
© 2008 SAGE Publications

The Importance of a Multifaceted Approach in the Assessment and Treatment of Childhood Feeding Disorders

A Two-Year-Old In-Patient Case Study in the U.K. National Health Service

Clarissa Martin

Staffordshire District General Hospital, United Kingdom, clarissa.martin{at}msgh-tr.wmids.nhs.uk

Angela Southall

Staffordshire District General Hospital, United Kingdom

Elizabeth Shea

Birmingham Children's Hospital, United Kingdom

Abby Marr

Staffordshire District General Hospital, United Kingdom

The objective of this article is to describe the use of a multifaceted approach in the assessment and treatment of a child with a severe feeding disorder in an inpatient setting. Family and ward-staff interviews, video observations, and behavioral measures were used in the assessment and treatment of a 2-year-old girl admitted to a pediatric ward with failure to thrive and was being tube fed. Causal and maintaining factors were identified and the subsequent intervention (the feeding program) combined a behavioral treatment (learning principles applied at mealtimes) and family-centered work (systematic parent training procedures). By the time of the psychological intervention, the majority of developmentally and age-appropriate feeding behavior appeared to be absent and the child only fed through a naso-gastric tube. The number and variety of feeding behaviors and the amount and variety of foods taken increased during treatment. These behaviors were maintained during the follow-up and generalized into the home environment. There was also an observed increase in the child's capacity for emotional expression. Successful outcomes can be achieved with complex feeding problems by using a multifaceted approach that places emphasis on effective transdisciplinary collaboration and the inclusion of the family in all stages of the process.

Key Words: multifaceted approach • functional analysis • severe feeding disorder • naso-gastric feeding • failure to thrive • child protection • family stress


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