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JPEN J Parenter Enteral Nutr. 2018 Sep 25. doi: 10.1002/jpen.1433. [Epub ahead of print]

Messy Play Therapy in the Treatment of Food Aversion in a Patient With Intestinal Failure: Our Experience.

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Department of Translational Medical Sciences, Section of Paediatrics, University Federico II, Naples, Italy.
Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom.
Paediatric Autologous Bowel Reconstruction and Rehabilitation Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom.
School of Medicine, University of Cagliari, Cagliari, Italy.
Department of Therapeutic and Specialised Play, Royal Manchester Children's Hospital, Manchester, United Kingdom.
Department of Dietetics and Nutrition, Royal Manchester Children's Hospital, Manchester, United Kingdom.
Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy.



Food aversion (FA) is an eating behavior where children refuse solid or fluid intake. FA can compromise the weaning off parenteral nutrition (PN) in children with intestinal failure (IF), reducing their quality of life (QoL). Around 25% of children with IF experience FA, but few data are available on interventions to get over FA. Messy play therapy (MPT) uses sensory activities to provide another meaningful avenue for learning in children by creating a fun way to experience new textures. This study aims to assess the efficacy of MPT in FA.


Demographic data and MPT intervention were retrospectively recorded between 2004 and 2017. Food was categorized by tastes and textures. Data are expressed as median and interquartile range (25%-75%).


Twelve children were identified. MPT was started at 9 (6-16) months with an enrolling time within the program of 10.11 (7.75-12.5) months. MPT was ended after 19.5 (16.75-28.5) months, and all patients achieved tolerance to oral diet. Significant improvement in savory (P = .001), sweet (P = .002), and mixed texture (P = .001) of food intake was reported. Better QoL and mealtimes with family were reported at median follow-up of 39 (24-56) months.


MPT seems to be a positive intervention to overcome FA. In our experience, the children have gone from not tolerating any intake to tolerating an oral diet, which means enjoying their mealtimes. Further studies are needed to evaluate the effectiveness of MPT in a larger scale of patients.


children; enteral nutrition; feeding and eating disorders; messy play; oral aversion; parenteral nutrition; short gut syndrome


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