It is recommended that the intervention for eating disorders be carried out by a qualified therapist outside the family, and that the family be trained so that they can apply the procedures for feeding at home.
The reason why it is better to start the intervention outside is because the child has a history of learning at home, in which the moment of food has been negatively conditioned, which is why it will facilitate the intervention if The treatment of the child takes place in another space with another person, in which the place and the person are not conditioned.
In cases where another therapist cannot be accessed, it will require more effort and the results will take longer to appear because you have to break habits and condition yourself again.
First we perform a behavioral analysis, which will provide us with information about the operant behaviors that maintain the behavior. We can see inflexibility, inappropriate behavior and disobedience.
Next, we address the previous skills of cooperation and instructional control to later be able to intervene in the rest of the problem behaviors. For example, for the child to cooperate and respond well, he has to respond well the rest of the day in other situations.
Prioritize objectives: When we consider starting a feeding intervention, one of the criteria that we have to establish is an order of objectives that we want to address. Starting by; Establish meal times, What meal times? Where are you going to eat? Who are you going to eat with? What kitchen utensils are you going to use? How much food? start entering?, etc.
To condition a place of feeding and food again.
In case the child has difficulty sitting for a while, we will begin by establishing this basic behavior before introducing new foods.
When to intervene? We choose an hour, in which we can spend time, and when the child may be hungry, prevent him from eating between meals so that he does not get full. We do not rush you, we avoid stress and tension.
What amounts? We put the amount that is going to be eaten, we start with small amounts and we increase successively. The child has to understand that when the plate is empty, the food is over.
Where to sit? We sit in front of the child, we put the stimuli and the food in another place so that it does not have a place to throw or spill.
When we go from liquids to solids, at first we must be patient because his face is lax (sagging skin) and he needs to tone up little by little, so he will eat more slowly and tire more easily.
We do not fill the child’s mouth, we allow time for him to chew and swallow, we do not give another spoonful until the mouth is empty.
Do not force and do not quarrel. We prevent mealtime from being negatively conditioned, avoiding struggling, getting angry or scolding, causing an unwanted situation towards food.
Elimination and reduction of inappropriate behaviors: We intervene in behaviors that occur more frequently, that are easier to address and that we can train in their environment.
Patience and consistency: It is essential to have a good attitude and security to carry out feeding therapy. The person in charge of the treatment has to be sure that the child is going to eat the food. Children can perceive insecurity and fear.
Before starting a feeding program, the person must have some control over the child and must be well matched. We want the child to have a high level of obedience and to enjoy the presence of the instructor. The time of the meal should be pleasant.
We attach great importance to the way of addressing the child. The language must be clear, direct, concise and simple. We create norms from the beginning and hire a reinforcer before we eat. We refer to reinforcers, those stimuli or events that in the presence of them causes the probability of the behavior to increase in the future.
As we have mentioned before, feeding is a slow process, there are no standardized times. Losing your cool or becoming desperate when you don’t immediately see the desired results can cause you to force the pace or change your goals and eventually give up.
The keys to success are patience and perseverance. There is no standardized guide, each child has different characteristics and rhythm, so the intervention must be modified and adjusted to the needs of each child.
It is advisable to make recordings during the meal to see our attitude towards the intervention. It will help us to improve our behavior and that of the child.