Improving Nutrition in Toddlers and Preschool Children with Cystic Fibrosis: Behavioral Parent Training Intervention

The purpose of this single-case study was to pilot a developmentally sensitive adaptation of an evidence-based intervention aimed at improving nutrition in children with cystic fibrosis (CF). Children with CF must adhere to a high-calorie diet to prevent malnutrition and maintain health. Toddler and preschool age children present a unique feeding challenge to parents as they begin to exert independence and exhibit a variety of challenging behaviors. Parents trying to adhere to CF nutrition guidelines often use ineffective strategies that inadvertently encourage children not to eat. This six-week group parent-training intervention combined nutrition and behavior elements to provide parents with the nutrition and child behavior management strategies necessary to improve children’s intake and ensure adequate nutrition. Parents of four children (one girl) between the ages of 21 and 30 months of age participated in two groups; all children were Caucasian, and all parents were married. Two children were malnourished and had primary goals of increasing intake and weight; two were adequately nourished and had primary goals of improving diet quality. Primary and secondary treatment outcomes were established individually for each child. Families completed three-day diet diaries and video recorded mealtime interactions across two baseline weeks, six weeks of intervention, and a twelve-week post-intervention follow-up. Children’s weights were measured at baseline, post-treatment, and follow-up. Caloric intake was calculated for all meals, and video taped meals were coded using a behavioral coding system. Treatment fidelity was also assessed. The two malnourished children increased caloric intake throughout the intervention and demonstrated clinically significant weight gains at post-treatment. Further, these gains were maintained at follow-up. One of the two adequately nourished children demonstrated improved diet quality. Findings support the efficacy of this developmentally-sensitive adaptation to increase weight in toddler children with CF, and findings provide partial support for the efficacy of this intervention in improving diet quality in adequately nourished children. A parent group intervention provides training in CF-specific child management skills to multiple families and may provide significant benefits to parents who often struggle with the demands of nutrition requirements and toddler behavior