Training parents is key to helping children eat a variety of foods

Families dealing with the stress and frustration of their child's overly picky eating habits may have a new addition to their parental toolbox. Pediatric researchers recently described a brief group cognitive-behavioral therapy program that provides parents with specific techniques to improve their child's mealtime behaviors and expand the range of foods their children will eat. Although the study size was small, the parents involved reported "life-changing" improvements.

Researchers from Children's Hospital of Philadelphia (CHOP) and The University of Pennsylvania published this study in the August 2019 issue of Cognitive and Behavioral Practice.

"Our research shows the acceptability, feasibility and positive outcomes of the Picky Eaters Clinic, a seven-session, parent-only, group-based intervention intended to train parents of children with Avoidant/Restrictive Food Intake Disorder (ARFID)," said study leader Katherine Dahlsgaard, PhD, ABPP, Clinical Director of the Anxiety Behaviors Clinic at CHOP. "In the Clinic, parents are taught to act as behavioral therapists who promote long-term improvements in food acceptance and positive mealtime behaviors."

This study included 21 patients and their parents, who were referred to the Picky Eaters Clinic at CHOP. Families, including the child, attended a diagnostic evaluation and were assessed for treatment eligibility. The children ranged in age from 4 to 12 years and were diagnosed with ARFID, due to excessive picky eating and associated functional impairment.

The families reported that picky eating caused considerable stress. Parental stress resulted from: diet containing less than 20 foods; refusal of entire food groups (typically vegetables, meats or fruits); the need to make a separate meal; difficulty traveling, socializing or going to restaurants; high child distress/refusal to eat when presented with a new or non-preferred food; and lack of child's motivation to change or unwillingness to receive treatment.

The seven clinic sessions occurred over a 6-month period. The first four sessions were held one week apart; the fifth and sixth were spaced two 3 to 4 weeks apart, allowing families time to practice the assigned behavior strategies at home. Children were challenged at home to chew and swallow a portion of a new or non-preferred food and a successful challenge resulted in a post-meal reward. The majority chose screen time.

The seventh "reunion" session was held 3 months later, to allow parents to catch up and share gains. The researchers administered post-treatment feeding measures and a parent satisfaction survey at the last sessions.

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