Impact of a Responsive Feeding Intervention on Children and Caregivers: A Nonrandomized, Repeated-Measures Study

Importance: Limited research exists examining the long-term impact of a parent-mediated responsive feeding intervention on children’s mealtime skills and behaviors and caregiver stress and competence. Objective: To examine children’s changes in mealtime skills and behaviors and to examine caregiver stress and competence. Design: A nonrandomized repeated-measures study. Setting: Home-based. Participants: Twenty-five children who received more than 10% of their calories through tube feeding and from their parents. Intervention: Caregivers participated in a home-based responsive feeding intervention directed at changing caregiver–child interactions during mealtimes. After receiving general caregiver education, interventions were delivered three to five times daily for 10 days, followed by 6 mo. of coaching sessions as needed. Outcome and Measures: Clinical measures and the Children’s Eating Behaviour Questionnaire were used to measure mealtime skills and behaviors. The Parent Stress Index–Short Form–4 and the Parent Sense of Competence Scale were used to measure caregiver competency and stress. Results: Seventeen caregivers completed the assessment battery for at least five of the six time points. All participants reduced tube use. Significant differences existed in children’s mealtime skills and behaviors over time with continued improvement with follow-up coaching. Caregivers continued to feel stressed while their competence improved. Conclusions and Relevance: The intervention was effective at helping children transition to oral feeding and develop oral motor skills. It was not effective at reducing caregiver stress. Plain-Language Summary: This study was conducted to determine whether responsive feeding interventions can help children who are tube fed learn to eat by mouth and develop skills. The results from this study support therapy feeding interventions that target caregiver–child interactions. It also suggests that children with motor impairments can still improve chewing, biting, utensil use, and hand use by participating in motivating and relevant activities. These improvements can occur with continued coaching only. The study showed that children’s mealtime skills and behaviors continued to improve after the intense intervention stopped and with coaching only. Caregivers may feel stressed about children’s eating, despite successful intervention. Occupational therapists who work with tube-fed children should focus interventions on caregiver–child interactions. Therapists should also monitor caregiver stress and mental health, even if the child learns to eat well.