Promoting Routines of Exploration and Play during Mealtime: Estimated Effects and Identified Barriers.
Angela R Caldwell, Elizabeth R Skidmore, Lauren Terhorst and 4 others
PMID 34338588WHAT IT FOUND
Children with sensory food aversion accepted more bites of targeted foods after Mealtime PREP, a bundled parent-coaching mealtime programme, and risk of nutritional problems fell.
Key findings
01Average targeted food bites per meal increased from 1.53 during pre-intervention to 3.48 during post-intervention, and 13 of 20 children improved.
02NutriSTEP risk scores decreased from 21.75 to 18.15; pre-intervention categories were six low, 10 moderate, and four high, and post-intervention categories were 13 low, six moderate, and one high.
03All 20 parents rated the intervention acceptable, mean 43.6, and only two parents gave any item rating below four.
STILL TO COME
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What it does not show
This was a pilot with 20 children and a single-group pretest-posttest design, so it does not determine efficacy. The intervention bundled parent coaching, mealtime routine, positive reinforcement, repeated exposure, play, and behavioral activation, so the contribution of any single component cannot be separated. Thirteen of 20 children improved food acceptance, but the preschool subgroup changed little, with d = 0.02 from 2.93 to 2.37 bites per meal. The sample was small and not diverse in race, ethnicity, or income, which limits how far the results can be applied. Acceptance data were missing after intervention for two children, one from camera malfunction and one from conflicting parental demands. Other childhood eating disorders, developmental delays, or cognitive deficits were not formally tested, and response may have been influenced by unassessed issues. Therapist experience varied from one to thirteen years, and therapist presence during meals and meal length were not controlled. NutriSTEP was used as a nutrition risk screen, and formal testing for other feeding issues was not completed.
Declared interests
The authors reported no conflicts of interest and said they alone were responsible for the content and writing.
The easy way to misread this
Do not read the increase in bites or lower nutrition risk as proof that Mealtime PREP works. This was a 20-child single-group pilot, and the intervention bundled routine, positive reinforcement, repeated exposure, play, and behavioral activation, so any single component cannot be credited. The preschool group changed little, with 2.93 bites before and 2.37 after.