Exploring Healthcare Professionals’ Views on Effective Feeding Interventions for Mealtime Management in Autistic Children: A Delphi Study

Abstract Aim: This study aimed to identify consensus among healthcare professionals regarding feeding interventions and strategies for autistic children and to explore their experiences and perspectives on implementing these approaches in the South African context. Methods: An e-Delphi study approach with qualitative follow-up was employed. A systematic review was conducted to identify effective feeding interventions and strategies. These findings informed the development of a survey to assess which interventions healthcare professionals identified as most effective. The survey was iteratively refined in line with the Delphi technique. Healthcare professionals with clinical and/or research experience in supporting autistic children with feeding difficulties. Participants completed two rounds of online questionnaires, followed by semi-structured interviews. Data was analysed descriptively and through thematic analysis. Results: Twelve healthcare professionals completed the survey, including speech-language therapists, occupational therapists, a social worker, and a teacher. Full agreement (100%) on the consensus to retain strategies in the intervention set was observed for Augmentative and Alternative Communication (AAC), shaping and modelling and family-based strategies and integrated behavioural, sensory and nutritional strategies. High support (≥ 80%) was reported for assistive technology and m-health, positive reinforcement, food chaining, dietary modification, reducing environmental distractions, structured mealtime schedules and sensory desensitisation. Moderate support (below 80%) was found for feeding apps and smart devices, differential reinforcement and modifying food presentation, while escape extinction received low support (below 50%) and was excluded from the final intervention set. Three healthcare professionals who subsequently participated in qualitative interviews reported on current usage of interventions in the South African context, as well as the challenges they faced and suggestions for further strategies to support implementation of feeding strategies. Conclusion: Healthcare professionals demonstrated strong consensus on practical feeding strategies and identified caregiver education, multidisciplinary collaboration, and individualised intervention as central to effective feeding support for autistic children. These findings can inform the development of future clinical guidelines and supportive resources.