Objective: To determine whether behavior therapy was more effective than nutritional therapy in obviating the need for enteral feeding in infants with resistance to feeding. Study design: Sixty-four children aged 4 to 36 months who were tube fed for at least 1 month and had resistance to feeding were randomly assigned to either behavioral or nutritional interventions (32 per group). For 7 consecutive weeks subjects and their primary feeders attended a weekly clinic with 1 of 2 dietitians followed by 4 follow-up visits. The nutritional intervention provided structured schedules and routines to stimulate the hunger/satiety cycle. The behavioral intervention provided the same schedules and routines plus behavioral therapy (extinction). The primary outcome measure was the proportion of successes, defined as infants no longer requiring tube feeding at the third follow-up visit in each group (4½ months after start of trial). The decision to discontinue tube feeding was made by an independent observer who used criteria defined before the study commencement. Results: Fifteen (47%) of 32 subjects in the behavioral group versus none in the nutritional group were successes (P <.001). Conclusion: Behavior therapy is more efficacious in eliminating the need for tube feeding than nutritional counseling alone. (J Pediatr 2000;137:498-503)