Appetite Manipulation

The first component of successful behavioral treatment of feeding problems is often appetite manipulation. For behavioral modification techniques to be effective, the child must be motivated to eat, and such motivation typically comes from the need to consume calories from food (Linscheid 2006). Therefore, the child's appetite must be controlled so that hunger is induced at the time of meals. Typically, appetite manipulation involves limiting the child's intake of calories between meals and from sources other than oral intake of targeted foods. For example, appetite manipulation might include eliminating snacking between meals and limiting intake of preferred foods that decrease the child's motivation to eat target foods (e.g., restricting junk food to encourage intake of healthier foods). For children who receive tube feedings, the calories taken in by tube may need to be limited because these feedings can decrease appetite and motivation to take food by mouth. Of course, appetite manipulation requires balancing the desire to increase the child's appetite and ensuring that the child receives adequate levels of daily calories.

Programs targeting appetite manipulation, whether conducted in inpatient or outpatient settings, should be closely monitored by physicians and should include frequent weight and caloric intake checks (Linscheid 2006). Maintaining adequate levels of hydration is also crucial, and regular water intake should be emphasized. The aggressiveness of the appetite manipulation component of treatment is an area of debate; however, some evidence suggests that aggressive protocols may produce effective results in shorter periods of time (Linscheid 2006). In addition to manipulating appetite by restricting intake between meals, appetite-stimulant medications can be used to promote hunger at mealtime (Homnick et al. 2005). Cyproheptadine (Periactin), for example, has shown some effectiveness in promoting weight gain among children with cystic fibrosis, with only mild side effects (Homnick et al. 2005). Overall, the failure to adequately induce appetite through either restriction of intake between meals or appetite-stimulant medication may impede progress by decreasing the child's motivation to eat at meals.

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