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Role Reversal Method for Treatment of Food Refusal Associated With Infantile Feeding Disorders

Segal, Idit*; Tirosh, Anat; Sinai, Tali; Alony, Sari; Levi, Anat*; Korenfeld, Lia*; Zangen, Tsili*; Mizrachi, Avi*; Boaz, Mona; Levine, Arie*

Journal of Pediatric Gastroenterology and Nutrition: June 2014 - Volume 58 - Issue 6 - p 739–742
doi: 10.1097/MPG.0000000000000309
Original Articles: Hepatology and Nutrition

Objectives: Infantile feeding disorders (IFDs) are common causes of food refusal and failure to thrive, and are frequently encountered by primary care physicians and specialists. We have published the Wolfson criteria for IFD, which have eased the approach to the diagnosis of IFDs. Along with and complementary to the Wolfson criteria, we have also developed the role reversal treatment method for IFD, which has been briefly described earlier. The aim of this study was to validate the role reversal treatment method on a cohort of infants diagnosed as having IFD and to present a detailed description of this method for the first time.

Methods: Parents of infants and children diagnosed as having IFD were invited to participate in the study; they were handed over a questionnaire comprising 6 categories of questions related to patient and parents behaviors, attitudes, and perceptions, which was completed at initiation and at the end of treatment. Full response was defined as improved normative feeding, cessation of abnormal parental feeding, and improved or normal growth patterns. A partial response was defined as success with two-third categories.

Results: We enrolled 38 patients, and 32 patients completed the study. Improved feeding occurred in 78%, full recovery was documented in 53% of infants by 6 months, and partial response was observed in another 25%. All forms of pathological feeding improved significantly (mechanistic, nocturnal, persecutory, forced feeding, and distraction).

Conclusions: The role reversal treatment method is a simple and effective approach to the treatment of food refusal associated with IFD.

Supplemental Digital Content is available in the text

*Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Holon

School of Nutritional Sciences, Hebrew University, Rehovot

Epidemiology Unit, Wolfson Medical, Center, Tel Aviv University, Israel.

Address correspondence and reprint requests to Idit Segal, MD, Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, PO Box 5, Holon, Israel (e-mail:

Received 7 January, 2014

Accepted 7 January, 2014

I.S., A.T., T.S., and A.L. are senior authors.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,