Nutritional Disorders Telehealth Network Project

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Stimulus Control Strategies

Stimulus control strategies are a type of behavioral interventions for weight management that are supported by research as being efficacious. Stimulus control strategies involve identification and modification of environmental factors that influence eating patterns. The goal of stimulus control strategies is to reduce environmental characteristics or situations that serve to trigger maladaptive eating behaviors.

Background Education for Providers
 

Setting Characteristics The setting in which eating occurs, exerts an influence over intake. Relevant aspects include the immediate surroundings of the eating area and the child’s position and body support during meals. Activity-related characteristics include events preceding or follow meals. Setting characteristics may have a direct impact on the feeding environment, and/or they may affect feeding through a history of being paired with a child’s learning experiences. In behavioral terms, these paired settings events are described as exerting stimulus control over feeding behavior. Setting characteristics can exert facilitative or detrimental effects on children’s behavior. Research suggests important attributes of the feeding setting include physical surroundings, feeding position and body support, and activities preceding and following eating.


Physical Surroundings of Eating
A solitary location devoid of visual or auditory distractions (e.g., no television, computers and/or other screen time activities) may be most conductive to eating. Caregivers of finicky eaters typically are advised to serve meals in a consistent eating area, to restrict the people present to those who are eating, and to allow toys or activities only if they do not disrupt eating. In addition, it may be advisable to limit the number of feeders – especially early in intervention to one or two people who are trained in the feeding procedure.   In the case of overnutrition, plating the food in the kitchen and offering the child only the portion sizes on his/her plate is recommended. Additionally, clearing the eating area of any excess food immediately after completion of the meal is recommended. 

Feeding Position and Body Support
The goal of positioning is to provide postural control in a manner so that the child does not resort to abnormal postures to compensate for lack of control. A secure, well-balanced posture during meals enhances a child’s motor coordination and attention to feeding. The feeding position for infants is to be cradled in a caregiver’s arms or to be held securely on the caregiver’s lap. Older children typically are seated upright in a chair or high chair, which allows maximal use of the hands for self-feeding and reduces the likelihood of choking. As part of the intervention, parents are often told to seat children securely for meals. Muscle tone and posture are interrelated with a child’s state, physiological control, and oral-motor coordination. Children with physical disabilities often need modifications in feeding positions to provide for optimal alignment of head, neck, and trunk. 
 
Instructions for Provider
The use of schedule and environmental factors to increase the positive effects of mealtime include: promoting appetite improving intake, providing a mealtime environment that minimizes distractions, promoting parental control, and improving overall nutrient intake. 
 
Before Meals
  • Avoid eating between scheduled meals and snacks. Do not allow children to graze on snacks or juice throughout the day. This way your child can come to the table hungry.
  • Try to have meals and snacks around the same time every day. Keeping to a routine every day can be hard, but try to keep to routine on most days.
  • Make one meal for the family (with at least one item that your child enjoys) and expect that everyone eat what has been made (or they don’t eat at that meal). Do NOT act as a “short order cook!”
 
During Meals
  • Turn off the TV and put all toys and other distractions in a different area.
  • Eat all meals and snacks at a table with your child seated in a chair that fits him/her. Do not allow children to wander around the house with food /drink
  • Meals should last a maximum of 20 to 30 minutes. Younger children (under 5) may have 15 to 20 minute meals.
  • As often as possible, try to have family meals.
  • Offer solid food before liquids and oral feeding before tube feeding.
 
Ending Meals
  • Release your child from the table after the time is up (remember 20 to 30 minutes for kids over 5 and 15 to 20 minutes for kids under 5). Do not try to make a child sit at the table “until their plate is clean.”
  • Try to release your child from the table before he/she begins to whine, cry, or tantrum. It is best to end on a success!
  • Try to end meals on a positive note. An example could be your child taking one last bite or sip.
 
Supplemental Materials
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Page Updated 04/15/2014