Framework: Children are able to regulate their oral intake by themselves, if no medical diagnosis disturbs self-regulation. Many children with chronic medical conditions, such as infants born preterm and/or with a very low birth weight, and children with cerebral palsy or malformation of the heart, esophagus or gut, develop a self-regulated oral intake. Sometimes this requires patience or therapeutic guidance, but even in children with severe disabilities a sufficient self-regulated oral feeding routine has been established in 90% of cases (Wilken & Jotzo, 2008). The program has been established in both home-based and inpatient settings.

Diagnostics: Feeding disorders are often linked to chronic medical conditions. To rule out a medical background to the feeding disorder, an evaluation of all medical reports (from birth until end of after care: Neonatal, Gastroenterology, Developmental Test, etc.) is crucial in the diagnostic and therapeutic process. Psychological diagnosis involves the completion of a standardized questionnaire to evaluate nutritional status, oral motor status, feeding situation and frequency of occurrence of feeding disorder symptoms. After evaluation of the questionnaire, an anamnestic interview with the parents is conducted. This is implemented through a home visit.

Intervention: The intervention program focuses on the infant’s ability to self–regulate its needs. The child should learn to regulate the state of hunger and thirst by itself. Therefore the impact of disturbances has to be terminated to enable the development and improvement of oral feeding competence without feeding disorder symptoms. The main therapy goal is the development of self-regulated full oral feeding.
Consequently the symptoms of feeding disorder are not seen as the main problem. The focus is on the developmental pathway to the feeding disorder. Developmental pathways are individual; therefore treatment has to be individualized. First, a deeper understanding of the child and its adapting process and abilities must be sought. Then symptoms are translated: the problematic behavior has a hidden meaning, which must be revealed for parents and child. Understanding oneself and the other is the basic principle of self-regulation. If this understanding is reached, symptoms usually decrease.
The intensity and the length of the treatment depend on the severity of the disorder. In a home-based setting it varies between several appointments and 10 days of intensive treatment.

Aftercare: Even after a successful treatment, short periods of food refusal are typically observed, especially after infections. Therefore, an aftercare period of six months has been established to counsel parents, should an infant refuse food.