The Ethics of Intervention for Food Refusal

Escape avoidance strategies are implemented when the feeding problem of a child is maintained by a negative reinforcement. The procedure is employed when avoidance of or escape from eating demand is not permitted (Kerwin, 2003). My initial personal reactions towards escape avoidance strategies are that it is not beneficial especially when used solely without combining it with other strategies. This is because it results to negative progression due to the low levels of motivation employed in this strategy.

While using this therapy, a child is forced to the non-preferred foods using Nuk or other assistance where if they spit, the food is scooped back. This can be termed as unethical as every person has their own preferences in tastes and flavors and children are no exceptions. Some of the food’s refusal habits are caused by medical conditions which causes pain while swallowing. Force and manipulation are therefore the tactics used to feed children which may increase the feeding behavioral problem of the child.

Side Effects

            Although escape avoidance strategies promotes positive behavioral changes in children, it is not due to the attractiveness of the procedure to the child but due to manipulation avoidance. This was illustrated in the case study (Vaz, VOLKERT, & PIAZZA, 2011) where the increase in self-feeding of Jerod was due to Nuk and food manipulations avoidance rather than the target. Therefore, escape avoidance strategies cannot be used in isolation but should be a part of complex package intervention treatments.

This is because using this strategy alone may increase the problem behaviors but if used together with reinforcement strategies; it reduces the severity of the behaviors. According to a studyby Bachmeyer (2009), escape avoidance strategies have been shown to be a risk or correlate factor for eating disorders behaviors. Collateral behaviors may occur like self-injury, disruptions and negative vocalization. This behavioral model is also associated with response bursts (like initial rise of problem behavior), emotional responding (crying), and extinction-induced aggression.

Bachmeyer (2009) explains that when employing this procedure, treatment fidelity may be compromised as a result of the strength and the size of the child. Furthermore, the caregivers may experience aversive from meals while physically preventing avoidance of or escape from eating while they avoid negative effects of extinction, especially in situations where desired behaviors is not automatic. Through this, treatment fidelity is compromised. In conclusion, escape avoidance strategies are not ideal to be conducted by inexperienced behavior change agents like paraprofessionals, teachers and parents; and in natural setting like schools and a child’s home.


However, this is not to term this strategy as ineffective. This is because in combination with other strategies, (LaRue et al., 2011) study reveals that it increases the food eating behaviors of non-preferred foods. According to applied and basic studies, negative reinforcement in maintenance of human behaviors plays a central role. Majority of feeding disorders have medical problems causing eating to be painful thus making the child to refuse eating. The parents’ response may be followed by terminating, postponing or removing bite presentations which make the child to learn that refusal behavior is an escape from eating.

It is hypothesized that escape from eating is a reinforcer for refusal of food when medical conditions causes pain while eating. For example, GERD children associates eating with pain occurring after excess acid is produced in the esophagus or stomach. Even after a child is treated from the condition causing pain, the child may refuse to eat the food in fear of experiencing the pain (LaRue et al., 2011). In this situation, escape avoidance strategies act as a critical treatment because it increases consumption as it causes that child to have direct contact with drink or food they associated with pain. Therefore, escape avoidance strategies remains a positive strategy in improving food habits of children especially those who had medical problems that they associated with food.

Conclusion Sentiments

Escape avoidance strategies have many benefits in regard to behavioral changes of children. However, this procedure is not effective to use at home setting due to its complications and side-effects. In comparison to positive reinforcements, escape avoidance strategies plays a major role in the conservation of food refusal. However, this strategy cannot be termed as unimportant because when combined with other strategies it have illustrated positive effects in promoting positive eating habits in pediatrics. The procedure is also less friendly while compared to positive reinforcements. This is because the child is not given a chance to test different flavors and brands but he is forced into the flavors they dislike.

The process can be named as unethical as every person irrespective of age and sizes have different preferences in flavors and tastes of different foods. Therefore, forcing a child on tastes and flavors they dislike is unethical. This can be altered by providing preferred foods in a preferred flavor or format subject on acceptance of the similar foods presented in a non-preferred flavor or format. This change of strategy results in an increase in the food acceptance by a child in non-preferred flavors or formats. Due to the above sentiments, my feelings on escape avoidance strategies have not changed. However, I have positivity on the benefits the therapy has while combined with other strategies.

Professional Conduct Standards

I believe that the negative reinforcement strategies are in line with professional conduct standards. This is because the behavioral therapy can be used in improving the eating habits of children who previously had pain while eating. Also in conjunction with other strategies, this method is highly effective in improving eating behavioral patterns. It is highly effective while used by professional in health care facilities to promote the healing process of a child.


Bachmeyer, M. (2009). Treatment of Selective and Inadequate Food Intake in Children: A Review and Practical Guide. ABAI- Assocation For Behavior Analysis International, 2(1), 43-50. Retrieved from

Kerwin, M. (2003). Pediatric Feeding Problems: A Behavior Analytic Approach to Assessment and Treatmen. The Behavior Analyst Today, 4(2). Retrieved from

LaRue, R., Piazza, C., Volkert, V., Stewart, V., Patel, M., Zeleny, J., & Zarcone,. (2011). ESCAPE AS REINFORCEMENT AND ESCAPE EXTINCTION IN THE TREATMENT OF FEEDING PROBLEMS. Journal Of Applied Behavior Analysis, 44(4).


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