Empirically supported treatments in pediatric psychology: severe feeding problems.

OBJECTIVE To identify treatment studies for severe pediatric feeding problems that meet the modified methodological criteria of the Task Force on Promotion and Dissemination of Psychological Procedures (1995). METHODS Articles in peer-reviewed medical and psychological journals (1970-1997) reporting psychosocial or behavioral intervention studies targeting an identified oral feeding problem in children were selected. Methodologically rigorous studies were identified and treatments were classified as well established, probably efficacious, or promising interventions according to specified criteria. RESULTS Effective interventions for children with severe feeding problems are contingency management treatments that include positive reinforcement of appropriate feeding responses and ignoring or guiding inappropriate responses. Promising interventions include positive reinforcement for acceptance and not removing the spoon for refusal and swallow induction training. CONCLUSIONS Because only studies of behavioral interventions met methodological criteria, well-controlled intervention studies are needed across a variety of theoretical perspectives. Empirically supported treatments for feeding problems exist; it is now time to turn to questions about for whom they are appropriate, and when, and why.