Update Case Report: Using Same Food to Facilitate Consumption of Table Texture

Update Case Report:
“Using Same Food to Facilitate Consumption of Table Texture in a 4-Year-Old”

Ben Zimmerman, Los Altos Feeding Clinic

There are many protocols for consumption of higher texture. Some of these protocols include the use of chewy tubes, oral-motor techniques and texture grading among others. In this case study the mitigating variable was use of the same food for the consumption of higher texture.


J. is a 4-year-old boy who, prior to treatment, was vomiting and refusing all foods in different textures. Prior to going to Los Altos Feeding Clinic he had spent three years seeing various therapists and his pediatrician recommended a feeding tube on several occasions.

During initial assessments it was found that more refusal, vomiting and less volume consumed was observed with table texture. Vomiting and refusal would still occur with purees such as yogurt.

He had an unremarkable medical history and was diagnosed with autism.


An escape extinction procedure was implemented using purees. Each session was capped at 30 minutes. Once acceptance was at or near 100 percent, refusal behaviors subsided to an average of less than 0.5 per trial and vomiting did not occur for a period 10 sessions texture was introduced. Acceptance was defined as accepting a bite within five seconds of its presentation. This initial treatment lasted 16 sessions. Sessions were conducted three times weekly.

Following this stability in eating purees, parents were quickly faded into the meal and trained to feed according to protocol. Thereafter the meal was generalized to the home setting. After two weeks of feeding at home there were no incidences of vomiting or refusal. Home sessions were then conducted for the remainder of treatment to reintroduce texture.

Treatment initially consisted of presenting a random puree followed by a table texture food. After four sessions only one session was without refusal, gagging and vomiting.

Purees were then changed from random foods to the exact food that was subsequently presented in full table texture. Twelve of the next fifteen sessions were without refusal or vomiting. All meals were consumed completely within the 30 minute time cap. After the first six sessions of changing the puree from random to static the therapist was faded from the meal. All subsequent sessions were conducted by parents at home without the therapist present. Parents were then instructed to serve all foods in table texture.

A total of 38 non-preferred foods were presented throughout all phases of this case study.


Approximately two months after treatment parents report a large variety of foods being consumed in table texture without vomiting, gagging or refusal.

In this case the control of random purees demonstrated a robust effect. Further studies need to be done to confirm the strength of this study across more children.

Source: pediatricfeeding seminar

supported by

PICKY EATERS CLINIC Klinik Khusus Kesulitan Makan Pada Anak  dan GROW UP CLINIC Klinik Khusus Gangguan Pertumbuhan Berat Badan Anak Yudhasmara Foundation www.pickyeaterschild.wordpress.com/ email : judarwanto@gmail.com

WORKING TOGETHER FOR STRONGER, HEALTHIER AND SMARTER CHILDREN BY EDUCATION, CLINICAL INTERVENTION, RESEARCH AND NETWORKING INFORMATION. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult

  • CHILDREN GROW UP CLINIC I,  JL Taman Bendungan Asahan 5 Bendungan Hilir Jakarta Pusat 10210 Phone : 5703646 – 44466102
  • CHILDREN GROW UP CLINIC II,  MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 Phone 44466103


  • Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation
  • Dr Widodo Judarwanto SpA, Pediatrician
  • Fisioterapis

Clinical – Editor in Chief :

Dr WIDODO JUDARWANTO, pediatrician

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