Integrated Eating Aversion Treatment Manual-Parent Version

The purpose of the current study is to further develop the integrated Eating Aversion
Treatment (iEAT) manual and address the unmet needs of many children with chronic food
refusal by providing a technology-based treatment that makes it easy for parents to
understand how to duplicate the models of institutional care. The study seeks to expand upon
this treatment by introducing the manual and procedures in an electronic form to be
implemented by caregivers in a home environment.

The study team aims to enroll 20 participants with chronic food refusal and formula or
feeding tube dependence. Participants will be randomly assigned to receive the iEAT manual
intervention with the technology supported manual or a control group (10 participants per
group). The intervention with the iEAT manual will involve 10 biweekly outpatient
appointments of about 45 minutes in length. Target behaviors will be assessed during each
treatment meal. Participants will be assessed pre-treatment and at a one month follow-up to
assess long term effects. Parents in the control group will provide a food diary once a
month, for 5 months. Those assigned to the control group will be able to cross-over to
receive the iEAT treatment manual following completion of post-study measures. Screening,
collecting data for outcomes measures, and the intervention will be conducted at the each
participant's home. Data will be collected on parent compliance with the treatment manual and
child food acceptance, nutritional intake, and refusal behaviors.

Inclusion Criteria, for the child:

- The child demonstrates failure to meet appropriate nutritional and/or energy needs
based on Diagnostic and Statistical Manual (DSM)-V criteria (American Psychiatric
Association, 2013) for Avoidant/Restrictive Food Intake Disorder

- Present with partial food refusal as evidenced by greater than 50% of caloric needs
met by bottle, formula, or tube feedings

- Have a medical history significant for an organic factor (e.g., gastrointestinal
issues) which precipitated or played a role in the development of feeding concern

Inclusion Criteria, for the parent/caretaker:

- Must be English literate

- Must have access to an iPad or a computer

Exclusion Criteria, for the child:

- Patients with active medical diagnoses requiring hospitalization or significant
oversight from a physician

- Patients with active medical, structural, or functional limitations preventing safe
oral intake of pureed foods (e.g., aspiration, upper airway obstruction)

Exclusion Criteria, for the parent/caretaker:

- Caregivers do not commit to implementing the structured feeding protocol at least 2
times daily