Development, Psychometric Testing, and Reference Values of the Infant Eating Assessment Tool (InfantEAT).

BACKGROUND: Problematic feeding is common in infancy, particularly in infants with a history of premature birth or medical complexity. A concise, valid, and reliable measure of feeding that can be used across feeding methods is needed for clinical practice and research. PURPOSE: The purpose of this study was to create an assessment tool to evaluate symptoms of problematic feeding in infants that can be used across all feeding methods (breastfeeding, bottle-feeding, and mixed feeding), then test its psychometric properties and establish reference values. METHODS: Item response theory (IRT) was used to identify the most important items on the Neonatal Eating Assessment Tool (NeoEAT) related to symptoms of problematic feeding in infants (N = 1054) to create the Infant Eating Assessment Tool (InfantEAT). Reliability of the InfantEAT was tested using Cronbach's α and interitem correlations. Reference values of the InfantEAT were determined from a sample of healthy, full-term infants (n = 561). Percent agreement in identifying problematic feeding between the NeoEAT and the InfantEAT was calculated. RESULTS: The InfantEAT is comprised of 31 items in 9 subscales. The InfantEAT has evidence of acceptable reliability (α = 0.88). There was 74% agreement between the NeoEAT and the InfantEAT, with the InfantEAT being more sensitive to identifying problematic feeding. References values are presented for infants 0 to 2, 2 to 4, 4 to 6, and 6 to 7 months. IMPLICATIONS PRACTICE AND RESEARCH: The InfantEAT is a reliable and sensitive tool to evaluate symptoms of problematic feeding across feeding methods for infants younger than 7 months in both practice and research.

Age-based norm-reference values for the Pediatric Eating Assessment Tool.

BACKGROUND AND OBJECTIVES: Differentiating problematic feeding from variations of typical behavior is a challenge for pediatric providers. The Pediatric Eating Assessment Tool (PediEAT) is a parent-report measure of symptoms of problematic feeding in children 6 months to 7 years old with evidence of reliability and validity. This study aimed to determine age-based, norm-referenced values for the PediEAT. METHODS: Parents of children between 6 months and 7 years old (n = 1110) completed the PediEAT. Descriptive statistics were calculated for subscale and total scores of the PediEAT within 11 age groups. RESULTS: The PediEAT total scores followed a general downward trajectory with increasing age. Physiologic Symptoms were relatively steady from 6 to 15 months, and then rapidly declined in 15-18 month olds and continued to decline thereafter. Problematic Mealtime Behaviors increased from 6 to 9 months to a peak in 24-30 month olds and then declined with increasing age. Selective/Restrictive Eating increased from 6 to 9 months to a peak at 12-15 months and then decreased over time thereafter. Symptoms of difficulty with Oral Processing were highest in 6-9 month olds and decreased with age. CONCLUSIONS: The PediEAT now has age-based norm-reference values to guide score interpretation and clinical decision-making.

The Pediatric Eating Assessment Tool: Factor Structure and Psychometric Properties.

OBJECTIVES: The Pediatric Eating Assessment Tool (PediEAT) is a parent-report instrument developed to assess symptoms of feeding problems in children aged 6 months to 7 years. The purpose of this study was to identify the factor structure of the PediEAT and test its psychometric properties, including internal consistency reliability, temporal stability, and construct validity. METHODS: Participants included 567 parents of children aged 6 months to 7 years. Fifty-four percent of the sample had parent report of a diagnosed feeding problem or feeding concerns. Exploratory factor-analysis techniques were used to remove redundant or non-endorsed items and identify the factor structure of the instrument. Construct validity was examined with 466 parents completing the Mealtime Behavior Questionnaire as a criterion standard. Known-groups validation was used to compare PediEAT scores between children with and without diagnosed feeding problems. Temporal stability of the PediEAT was examined with 97 parents repeating the PediEAT after 2 weeks. RESULTS: Principal components factor analysis with varimax rotation supported a 4-factor model accounting for 39.4% of the total variance. The 4 subscales (Physiologic Symptoms, Problematic Mealtime Behaviors, Selective/Restrictive Eating, Oral Processing) demonstrated acceptable internal consistencies (coefficient alphas: 0.92, 0.91, 0.83, 0.83; respectively). Construct validity was supported in 2 ways. The PediEAT correlated with the Mealtime Behavior Questionnaire (r = 0.77, P < 0.001) and total score and subscale scores were significantly different between children with and without diagnosed feeding problem (P < 0.001). Temporal stability was demonstrated through test-retest reliability (r = 0.95, P < 0.001). CONCLUSIONS: Strong psychometric properties support the use of the PediEAT in research and clinical practice.

The Neonatal Eating Assessment Tool: Development and Content Validation.

PURPOSE: To develop and content validate the Neonatal Eating Assessment Tool (NeoEAT), a parent-report measure of infant feeding. DESIGN: The NeoEAT was developed in three phases. Phase 1: Items were generated from a literature review, available assessment tools, and parents' descriptions of problematic feeding in infants.Phase 2: Professionals rated items for relevance and clarity. Content validity indices were calculated. Phase 3: Parent understanding was explored through cognitive interviews. SAMPLE: Phase 1: Descriptions of infant feeding were obtained from 12 parents of children with diagnosed feeding problems and 29 parents of infants younger than seven months. Phase 2: Nine professionals rated items. Phase 3: Sixteen parents of infants younger than seven months completed the cognitive interview. MAIN OUTCOME VARIABLE: Content validity of the NeoEAT. RESULTS: Three versions were developed: NeoEAT Breastfeeding (72 items), NeoEAT Bottle Feeding (74 items), and NeoEAT Breastfeeding and Bottle Feeding (89 items).

Mothers' Psychological Distress and Feeding of Their Preterm Infants.

PURPOSE: To examine the change in psychological distress of mothers of preterm infants and its association with maternal feeding behaviors as the infant transitions to full oral feeding. STUDY DESIGN AND METHODS: This descriptive exploratory study used a subset of data from a study of the effects of a coregulated feeding intervention for 34 mothers and hospitalized preterm infants in a Level-III neonatal intensive care unit (NICU). Maternal psychological distress was measured by maternal worry (Child Health Worry Scale), depression (Center for Epidemiology-Depression Scale), and role stress (Parental Stress Scale: NICU-Role Alteration) at three time points: within 1 week prior to the first oral feeding (T1), and at achievement of half (T2) and full oral feeding (T3). Feedings were videotaped at T2 and T3. An observational coding system measured maternal feeding behaviors. Linear mixed modeling evaluated the change in maternal psychological distress and its association with mothers' feeding behaviors as the infant transitioned to full oral feeding. RESULTS: Maternal depressive symptoms were highest at T1 and declined over time. Maternal worry and role stress were also highest at T1 but remained stable from T2 to T3. Increased maternal psychological distress, particularly depressive symptoms and role stress, were associated with less use of developmentally supportive feeding behaviors, that is, minimizing tactile stimulation, providing steady touch to contain or stabilize the infant, and regulating milk flow. CLINICAL IMPLICATIONS: Supporting maternal psychological well-being while infants are learning to feed orally may be an appropriate target for interventions to support mother-infant early feeding interactions.

Assessment Tools for Evaluation of Oral Feeding in Infants Younger Than 6 Months.

BACKGROUND: Feeding difficulty is common in infants younger than 6 months. Identification of infants in need of specialized treatment is critical to ensure appropriate nutrition and feeding skill development. Valid and reliable assessment tools help clinicians objectively evaluate feeding. PURPOSE: To identify and evaluate assessment tools available for clinical assessment of bottle- and breastfeeding in infants younger than 6 months. METHODS/SEARCH STRATEGY: CINAHL, HaPI, PubMed, and Web of Science were searched for "infant feeding" and "assessment tool." The literature (n = 237) was reviewed for relevant assessment tools. A secondary search was conducted in CINAHL and PubMed for additional literature on identified tools. FINDINGS/RESULTS: Eighteen assessment tools met inclusion criteria. Of these, 7 were excluded because of limited available literature or because they were intended for use with a specific diagnosis or in research only. There are 11 assessment tools available for clinical practice. Only 2 of these were intended for bottle-feeding. All 11 indicated that they were appropriate for use with breastfeeding. None of the available tools have adequate psychometric development and testing. IMPLICATIONS FOR PRACTICE: All of the tools should be used with caution. The Early Feeding Skills Assessment and Bristol Breastfeeding Assessment Tool had the most supportive psychometric development and testing. IMPLICATIONS FOR RESEARCH: Feeding assessment tools need to be developed and tested to guide optimal clinical care of infants from birth through 6 months. A tool that assesses both bottle- and breastfeeding would allow for consistent assessment across feeding methods.

Development and content validation of the Pediatric Eating Assessment Tool (Pedi-EAT).

PURPOSE: In this article, the authors describe the development and content validation of a parent-report measure of problematic eating behaviors: the Pediatric Eating Assessment Tool (Pedi-EAT). METHOD: In Phase I, items were generated from parents' descriptions of problematic feeding behaviors of children, review of literature, and review of existing eating-related instruments. In Phase II, interdisciplinary experts on pediatric eating behaviors rated the items for clarity and relevance using content validity indices (CVI) and provided feedback on the comprehensiveness of the instrument. In Phases III and IV, 2 groups of parents of children with and without feeding difficulties participated in cognitive interviews to gain respondent feedback on content, format, and item interpretation. The authors analyzed interviews using matrix display strategies. RESULTS: Experts rated the total scale CVI > .90 for both relevance and clarity; item CVI ranged from .67 to 1.0 for relevance and .5 to 1.0 for clarity. Analysis of each item with low scores, along with experts' and parents' feedback, resulted in refinement of the items, scoring options, and directions. Experts and parents added additional items. Readability after refinements was acceptable at less than a 5th-grade level. CONCLUSION: The Pedi-EAT was systematically developed and content validated with input from researchers, clinicians, and parents.