Transform a Child's Relationship with Food

The Approach

MEAL PlanR’s treatment approach rests on three assumptions.

First, behavioral intervention is the central method to introduce foods, promote oral intake, and expand dietary diversity. There is a 25-year-plus history of literature supporting the effectiveness of behaviorally-based treatments to improve mealtime performance in a wide range of pediatric populations.

Second, parents must play a central role in delivery of intervention and generalization of treatment gains into the home setting. It is parents, after all, who are responsible for structuring meals, presenting foods, and maintaining treatment gains following intervention.

Third, a feeding intervention should be nutritionally informed. While mealtime behaviors contribute to the development and maintenance of feeding problems, the feeding problem also directly impacts the child’s diet, nutrition, and health. Therefore, nutrition education focusing on targeting nutritionally meaningful foods is a theme interwoven throughout the curriculum.

The combination of behavior management strategies plus nutrition education recognizes that feeding intervention should not only improve mealtime behavior (a proximal goal), but ultimately establish a well-balanced diet (a more distal goal).

Recommended Child Characteristics

Matching Treatment to Feeding Concern and Feeding Skill

MEAL PlanR is intended for children with a certain pattern of food intake (i.e., moderate food selectivity), foundational feeding skills (i.e., self-feeding, chewing), and who have an engaged parent. It is also intended for a certain age range (i.e., children between 3 and 10 years old) with some level of communication skills.

Recommended Criteria - Additional Details:

Moderate food selectivity - Consuming a restricted diet (i.e., two or fewer food items in one or more food categories) but also with some degree of variety (i.e., multiple foods in at least two food groups).

Communication skills - Receptive language involves ability to follow developmentally appropriate commands and questions; expressive language involves being able to put together words into sentences that are grammatically correct and meaningful.

Parent engagement - A parent who can participate in treatment on a regular basis and who is responsible for conducting meals in the home setting.

Rationale

Targeting early to middle childhood captures a time when, developmentally, a child is expected to have made the transition to solid foods and some level of independence during meals (e.g., self-feeding) and also when parent-directed intervention would be developmentally appropriate (e.g., prior to adolescence). The intervention is also targeted to those who can chew at least some food because 1) the likelihood of success is higher if foundational skills are already in place, and 2) chew training and texture advancement are skills taught through specialized, discreet programming which is not covered in MEAL PlanR.

The Importance of Screening for Medical and Behavioral Concern

Finally, there are certain co-morbid medical and/or behavioral conditions that would exclude a child from being an appropriate candidate for this treatment. This includes presence of complex medical concerns (e.g., severe food allergies; swallow safety concerns), severe problem behaviors (e.g., self-injury, aggression) outside of meals, and/or requiring a specialized diet due to a medical condition (Renal disease, Metabolic disorder). These medical/behavioral complexities require a different level of multidisciplinary support beyond what the MEAL PlanR can provide.

About the Revision

The R in MEAL PlanR

Based on feedback from therapists, caregivers, and community providers combined with our team’s experience in delivering intervention, we revised MEAL Plan in a number of important areas. First, MEAL PlanR is now an individually delivered intervention (vs. group-based treatment) to permit greater flexibility in scheduling and better alignment with current therapeutic practice. Second, live coaching now begins at the onset of intervention, with parents learning key skills for interacting with their child while presenting preferred foods. Third, a therapist now models and first introduces new foods directly to the child in clinic (versus as part of parent homework) to better understand the child’s reaction to novel feeding demands and then can modify how new foods are presented as needed. Finally, we updated the educational materials, handouts, and the order of psychoeducation and other therapeutic activities to support these key revisions. Together, MEAL PlanR retains the core focus on behavioral intervention, parent training, and nutrition education while also involving a new model of treatment delivery better suited for routine clinical care.