Food refusal in failure-to-thrive infants: Nasogastric feeding combined with interactive-behavioral treatment

Five hospitalized failure-to-thrive infants under age 1 were treated for food refusal using an interactive-behavioral approach. Feeding aversion, inadequate caloric intake, and vomiting were associated with poor social responsiveness rather than organic causes. Therapy consisted of tactile oral stimulation, contingent social responsiveness, and auditory stimulation during nasogastric tube feeding conducted for 15-20 minutes 3 to 4 times daily. Initially all feedings were carried out by a therapist. As infant social responsiveness improved, mothers became more involved with the program and, all except one, eventually assumed feedings. In all five infants vomiting and food refusal ceased and nonreactive social behaviors shifted to socially responsive interactions resulting in adequate oral intake. Relationship between feeding behaviors and infant social responsiveness, maternal involvement, follow-up, and cost effectiveness of this interactive-behavioral approach are discussed.