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Case Study 2: 8-year-old Progresses From G Tube to Feeding Independence

Progress in Feeding Independence Noah added 13 new foods to his diet in 13 therapy sessions; incorporated 8 more throughout follow up

Noah added 13 new foods to his diet in 13 therapy sessions; incorporated 8
more throughout follow up

Noah, an 8-year-old male, faced numerous medical challenges starting from birth. He was born prematurely at 35 weeks and weighed under 3lbs. In his first days of life he needed emergency surgery and spent 5.5 months in the hospital. He relied on feeding tubes for nutrition, and a colostomy bag.

Due to issues with his throat mechanisms, Noah struggled to consume nutrition orally. His parents enrolled him in feeding therapy which worked with him for years and eventually got him to consume yogurt. Instead of looking towards the next goal, Noah and his family were told that yogurt was all he could handle and discharged from this program.

His parents knew he had the potential to eat a wider variety of foods, eat more independently, and increase his volume of food intake, so they searched for alternative therapy programs.

Noah’s journey into a new, remote Telehealth feeding program began when the BCBA therapist recognized his ability to tolerate yogurt like textures, indicating potential progress with pureed foods.

Noah’s acceptance of pureed foods was promising, but a new challenge emerged as he ate too quickly, posing a risk of aspiration. Prioritizing Noah’s safety, addressing this eating speed issue became the primary focus, prompting the start of treatment.

Over the course of the second and third weeks of treatment the focus shifted to pacing to decrease the length of mealtimes.

A structured protocol was implemented, which included:

Differential Reinforcement of Alternative Behaviors (DRA): Encourage good mealtime behavior as well as positive Telehealth session conduct. Reinforcement included praise, virtual emoticons (clapping and thumbs up), and preferred videos and images.

Blocking techniques: Mom was taught blocking techniques to stop him from taking
bites too quickly.


Generalization meals: Used to ensure that the positive changes observed
during live sessions extended into his daily life.

After 13 therapy sessions, Noah added 13 new foods to his diet, maintaining a 100%
acceptance rate and reduced negative vocalizations.

As a result of the increase of food variety, volume, and ability to self-pace, Noah is now able to rely on food for his nutritional and caloric needs, relying on tubes on an as-needed, supplemental basis.

Follow Up: During outpatient follow-up, Noah incorporated eight more foods, bringing his total to 21 after 35 sessions. He also learned to self-pace without requiring his mother’s assistance, meeting the criteria for discharge.