Cognitive-behavioral treatment of health-impairing food phobias in children.

Three cases reports describe assessment and treatment of three boys (ages 6 to 8 years) hospitalized because of weight loss and malnutrition, caused by severe dietary restriction and/or refusal to eat solid food. Psychological, behavioral, and medical assessments indicated that the boys were of average intelligence, without other significant psychological or medical disorders. Their eating disturbances were conceptualized as phobic disorders maintained by family factors reinforcing the children's avoidant behaviors. Cognitive-behavioral treatment consisted of an individualized combination of contingency management, shaping, desensitization, relaxation training, education, and cognitive restructuring. Generalization and maintenance were promoted by training parents to implement treatment at home before discharge. Treatment positively affected overall caloric intake, weight gain, number of solid foods accepted, and incidence of emesis.