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.
Background Education for Providers
Positive reinforcement is defined as the delivery of a desired stimulus (e.g., praise, stickers, points toward a reward, preferred food [to be used only the case of undernutrition]), contingent on performance of a target behavior (e.g., taking a sip of milk, taking 3 bites of a new vegetable), 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 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 feeding behavior.
Next to social attention, the most common consequence in behavioral feeding programs for undernutrition is preferred food. This technique is based on the Premack Principle, using a high-probability behavior (eating preferred food) to reinforce a low-probability behavior (eating new or non-preferred food). Contingent social attention is often combined with tangible forms of reinforcement, such as the opportunity to play with toys, the opportunity to watch television, the opportunity to gain tokens redeemable for items of value, or the opportunity to gain access to other preferred activities.
Instructions for Provider
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.