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Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake.A behavioural treatment package was implemented in an outpatient setting for the treatment of severe food refusal in five toddlers with developmental disabilities. During the course of treatment, treatment principles were generalized to parents in the home setting.Treatment resulted in oral acceptance of a variety of food items in each child and was successfully generalized. Treatment effects were maintained during follow-up between 3 and 12 months. Tube feeding was discontinued in each child and health status of each child improved.Behavioural treatment may be highly effective in establishing oral food intake in children with developmental disabilities (in the absence of organic causes). As a side-effect of this treatment, tube-feeding may be discontinued and general heath status improved.