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J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):739-42. doi: 10.1097/MPG.0000000000000309.

Role reversal method for treatment of food refusal associated with infantile feeding disorders.

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  • 1*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.



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.


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.


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).


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

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