Healthy Eating Learning Program (HELP) Study for Children Recovering from Cancer.

INTERVENTION: Arm One: HELPing Mealtime Behaviour Type of intervention: One‐on‐one behaviour modification therapy. Delivery of intervention: To be run in individual sessions for 1 hour per week over 10 weeks (weekly schedule) or run twice daily over 1 week (intensive schedule). Description of Intervention: Involves providing a verbal prompt to encourage consumption of spoonfuls of new food/s , with positive reinforcement (verbal and/or with toys etc), upon consumption of these foods. Parents initially observe from behind a one‐way mirror and assist in collecting information about the behaviours they are observing in their child. As sessions continue, parents are transitioned into the room, and are trained to offer new foods and provide positive reinforcement by the end of the therapy block. Arm Two: HELPing Mealtime Experience Type of Intervention: Small group sensory desensitisation therapy Delivery of intervention: Run in small group sessions for 1 hour per week over 10 weeks (weekly schedule) or twice daily for 1 week (intensive schedule). Involves the child being exposed to gradually more challenging modelling and play with food (based on a sensory heirarchy of look>touch>smell>taste). Parents initially observe the sessions from behing a one‐way mirror with a second therapist and assist in observing transitions and reactions in their children. As the block continues, parents are rotated in and out of the room to assist in modeling play using the sensory hierarchy (i.e. 1 parent and primary therapist in room; 1 parent and secondary therapist outside of room). Arm Three: HELPing Mealtime Knowledge. Type of intervention: Parent education regarding nutrition and behaviour management. Delivery of Intervention: This is a parents only intervention. In groups of 6, parents are provided with a 3 hour education session regarding general nutrition and behaviour management, and will receive 2 hours of follow‐up phone calls during the duration of the 10 week block. This form of intervention is not able to be run in an intensive model and will therefore only be offered in this format. CONDITION: Children recovering from cancer Feeding Difficulties PRIMARY OUTCOME: Adequacy of diet and overall increase in dietary variety ; ; Assessed via 3‐day weighed food diary, Modified Children's Dietary Questionnaire (Margarey et al., 1999), and a Food Frequency Questionnaire. In addition to this, there will be a New Foods List where parents indicate, in an ongoing fashion, how many times their child is offered new foods and the number of acceptances or rejections. Change in fat‐free mass as measured by body composition assessments. ; ; Measured via Body Impedence Analysis and Total Body Potassium Measurement. Change in growth (weight and height) SECONDARY OUTCOME: Improvement in mealtime behaviours (% desirable vs undesirable behaviours; mealtime duration) ; ; Measured via Behaviour Paediatrics Feeding Assessment (Adapted from Crist et al., 2001), and self‐developed HELP study: Eating Skills and Behaviour Questionnaire. Questionnaire involves parent‐rated likert scales (parents rate how often their child presents with a certain behaviour from 0 = Never to 4 = Always). Improvement in mealtime interactions between parent and child. ; ; ; Measured via self‐developed HELP Study: Parent Perceived Stress Questionnaire and the Parenting Stress Index ‐ Short Form. Increased interest in trying unfamiliar foods ; INCLUSION CRITERIA: Children will be eligible for assessment to further determine suitability for participation if: *Child is aged between 1 and 6 years *Child is stable and/or in their maintenance phase of treatment for cancer *Child must present with at least one of the following features: ; Measured via Dyadic Parent‐Child Interaction Coding System (Revised) (Eyberg, 1994). A video‐tape is taken of the parent interacting with their child in a non‐food related activity, a parent offering their child a preferred food and the parent offering their child a non‐preferred food. All videos will be rated externally by the team psychologist who will not be working directly with the children involved. Improvement in parental stress (overall and mealtime specific). ; Measured with the Children's Picky Eating Questionnaire (Adapted from Carruth and Skinner, 2000) and the New Foods List, where parents indicate in an ongoing fashion how many times their child is offered new foods and the number of acceptances or rejections. 1. Limited range of textures; 2. Limited range of foods; 3. Prolonged mealtime duration; 4. Battles or problematic behaviour at mealtimes; 5. Family stress related to mealtimes.