Systematic Evaluation of Variables Associated with Emesis: A Case Study
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Recurrent emesis (i.e., vomiting) during mealtime is often a great concern of caregivers of children with pediatric feeding disorders. Identifying the cause and treating the emesis may be difficult due to the multiple factors that may contribute to the occurrence overtime. Emesis may result from various factors, some of which include volume sensitivity, inadequate oral motor skills, and environmental factors related to food novelty and texture. This case study describes a 6-year-old boy with spina bifida who was dependent upon gastrointestinal-tube feedings due to frequent emesis when fed orally. Upon admission to an intensive feeding program, several potential factors maintaining the emesis were identified based upon clinical assessment, observation, and caregiver report. These factors were each evaluated systematically and results indicated that emesis was more likely to occur when foods of novel taste and texture were presented. With exposure, rates of emesis decreased across both type and texture of food. However, emesis decreased more quickly for novel foods at a pureed texture compared to the same food at a higher texture. There were no significant differences in rates of emesis during environmental manipulations related to observer response or associated with volume sensitivity. The methods utilized in this study may be useful to practitioners to systematically evaluate the variables contributing to the occurrence and maintenance of emesis.
KeywordsPediatric feeding disorders Emesis Volume sensitivity Exposure Selectivity
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Conflict of Interest
The authors of this manuscript served as the case supervisors for the patient described in this manuscript during the patient’s intensive admission as part of routine clinical practice. Both authors declared no conflicts of interest. Dr. Gonzalez was affiliated with Johns Hopkins University and Kennedy Krieger Institute wherein the patient was treated when the data were collected, but has since relocated to Pediatric Development and Therapy Center at Our Lady of the Lake Children’s Health in Baton Rouge, LA.
- Boyle, JT. (1989). Gastroesophageal reflux in the pediatric patient. Gastroenterology Clinics of North America, 18 (2), 315–337. https://www.ncbi.nlm.nih.gov/pubmed/2668172. Accessed 12 July 2017.
- Piazza, C. C., Fisher, W. W., Brown, K. A., Shore, B. A., Patel, M. R., Katz, R. M., Sevin, B. M., Gulotta, C. S., & Blakely-Smith, A. (2003). Functional analysis of inappropriate mealtime behaviors. Journal of Applied Behavior Analysis, 36(2), 187–204. https://doi.org/10.1901/jaba.2003.36-187.CrossRefGoogle Scholar
- Rudolph, C. D., Mazur, L. J., Liptak, G. S., Baker, R. D., Boyle, J. T., Colletti, R. B., Gerson, W. T., & Werlin, S. L. (2001). Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: Recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 32(2), S1–S31 https://journals.lww.com/jpgn/Fulltext/2001/00002/Guidelines_for_Evaluation_and_Treatment_of.1.aspx. Accessed 05 May 2018.
- Volkert, V. M., & Piazza, C. C. (2012). Empirically supported treatments for pediatric feeding disorders. In P. Sturmey & M. Hersen (Eds.), Handbook of evidence-based practice in clinical psychology. USA: Wiley.Google Scholar
- Volkert, V.M., Sharp, W., Cole-Clark, M., Ormand, H., Rubio, E.K., & Bryan, L. (2017). Modified bolus placement as a therapeutic tool in the treatment of pediatric feeding disorders: Analysis from a retrospective chart review. Manuscript submitted for publication.Google Scholar