Nutritional Disorders Telehealth Network Project

Reinforcement is one of the most powerful strategies to teach a child what to do. A reinforcer is anything that increases or strengthens a behavior.

 

Positive reinforcement is defined as the delivery of a desired stimulus (e.g., praise, stickers, points toward a reward), contingent on performance of a target behavior (e.g., eating fresh fruits and vegetables), that strengthens the probability that the target behavior will occur in the future. Typically, affectionate or approving forms of attention are used as positive reinforcement for younger children. For older children, the use of a sticker chart or point system in which points can be accumulated to earn prizes or privileges may be of value. Thus, an integral component of most behavioral intervention programs is social approval contingent on desired eating habits.

 

Another common technique to reinforce desirable behavior is based on the Premack Principle, using a high-probability behavior (ability to earn screen time) to reinforce a low-probability behavior (engaging in aerobic exercise). Often children will benefit from a clearly described plan with incentives to increase the amount of physically active periods they engage in. For example, a child may earn 30 min of screen time for each 30 min of physically active time they spend each day. Rewarding exercise with another desirable behavior should increase the frequency and intensity of exercise periods each week. Be sure to check with a child’s pediatrician before deciding on the correct amount of time each child should be active, and to discuss which types of exercise the child might most benefit from. 

 

Healthcare providers should discuss with parents their normal mealtime patterns, and the positive and negative behaviors that occur during mealtimes. Healthcare providers should provide information for parents on appropriate mealtime behaviors that should be reinforced, and the appropriate ways to provide positive reinforcement. Remind parents that attention is one of the most powerful reinforcers that they can use with their children. Handouts on positive reinforcement strategies and sticker charts (if age appropriate) should be given to parents to help them apply positive reinforcement strategies at home.