Preparedness of Speech Language Pathologists and Occupational Therapists to Treat Pediatric Feeding Disorder: A Cross-Sectional Survey.

BACKGROUND: Pediatric feeding disorder (PFD) is increasingly common and is often treated by speech language pathologists (SLPs) and occupational therapists (OTs) in the community setting. However, the preparedness of these disciplines to effectively address PFD is relatively unknown. METHODS: A national (US), online survey was disseminated to providers who assess and treat PFD. For the present analysis, the responses of SLPs (N = 418) and OTs (N = 195) related to their clinical background, educational background, post-graduate training, and self-rated clinical effectiveness were statistically analyzed and compared across the two disciplines. RESULTS: Both SLPs and OTs report feeling underprepared to work with PFD clients immediately following their academic training, but time spent in post-graduate training and years of clinical practice both significantly (p < 0.0001) increased feelings of effectiveness in assessing and treating PFD. Most SLPs and OTs pursued self-directed learning activities to increase competence, with the most common activities being article review, podcasts, and peer case review, although SLPs were significantly more likely to use podcasts (p < 0.0001) and peer review (p = 0.0004) than OTs. The most common barriers for providers were financial, time, travel, and institutional support barriers. CONCLUSIONS: While PFD is a key practice area of both SLPs and OTs, both provider groups feel unprepared and under-supported in providing competent care to these patients upon graduation. Future research and policy should support advancements in training for current SLPs and OTs related to PFD and address current barriers to a specialized educational pathway.

Assessing the US treatment landscape for paediatric feeding disorder: A survey of multidisciplinary providers.

BACKGROUND: Paediatric feeding disorder (PFD) is a common childhood condition, estimated to impact one in 37 American children under the age of five. Such high prevalence occurs against a backdrop of limited understanding of the community treatment landscape in the United States. METHOD: To better understand the community treatment landscape for PFD in the United States and identify provider and treatment delivery characteristics, we collected primary data through a web-based survey targeting providers from all four PFD domains (i.e., medical, nutritional, feeding skill, and/or psychosocial) between January 2022 and March 2022. The 71-item cross sectional survey focussed on patient, provider and treatment characteristics. We distributed the survey using an electronic survey tool through Feeding Matters listserv followed by solicitation to discipline specific listservs and professional networks. The analytic approach involved descriptive statistics compared across settings and provider types, focussing on respondents within the United States. RESULTS: Eighty-three percent of respondents reported practicing in the United States. Most of the US sample (74.3%) involved providers from the feeding skill domain (speech-language pathologist - SLP, occupational therapist - OT) who reported delivering care through early intervention or outpatient settings using responsive and sensory based approaches. These approaches lack rigorous empirical evaluation. CONCLUSIONS: Survey results suggest a need to support community providers in engagement with research activity to promote a better understanding of treatment approaches and outcomes associated with a large cohort of providers delivering care (i.e. SLPs, OTs) to patients with PFD.

A systematic review of parent report measures assessing the psychosocial impact of food allergy on patients and families.

BACKGROUND: Reducing the psychosocial impact of food allergy (FA) represents a top patient-centered research priority. This priority recognizes that psychosocial impact is an important outcome of current FA therapies (eg, oral immunotherapy), as well as interventions aimed at improving overall quality of life and illness adaptation. Reliable and valid measurement is a necessary prerequisite to developing and evaluating current and emerging FA therapies and potential changes in psychosocial impact. METHODS: In this systematic review, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to evaluate available parent report measures assessing the psychosocial impact of pediatric IgE-mediated FA. RESULTS: The systematic search yielded 64 articles involving 13 unique measures. Measures were evaluated through the lens of the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines. Findings indicated that available measures show some evidence of reliability and validity; however, none completely adhere to PROMIS guidelines for measure development. CONCLUSION: Results highlight a continued need to dedicate research to develop a measurement approach that assesses the full range of psychosocial impact that parents and families may experience as a result of FA, as well as serve as a research outcome as the field continues to develop effective treatments, including immunotherapy.

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.

Factor Structure and Psychometric Properties of the Neonatal Eating Assessment Tool-Bottle-Feeding (NeoEAT-Bottle-Feeding).

BACKGROUND: Feeding difficulties are common in infancy. There are currently no valid and reliable parent-report measures to assess bottle-feeding in infants younger than 7 months. The Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding has been developed and content validated. PURPOSE: To determine the factor structure and psychometric properties of the NeoEAT-Bottle-feeding. METHODS: Parents of bottle-feeding infants younger than 7 months were invited to participate. Exploratory factor analysis was used to determine factor structure. Internal consistency reliability was tested using Cronbach α. Test-retest reliability was tested between scores on the NeoEAT-Bottle-feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT-Bottle-feeding, the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested by comparing scores between healthy infants and infants with feeding problems. RESULTS: A total of 441 parents participated. Exploratory factor analysis revealed a 64-item scale with 5 factors. Internal consistency reliability (α= .92) and test-retest reliability (r = 0.90; P < .001) were both excellent. The NeoEAT-Bottle-feeding had construct validity with the I-GERQ-R (r = 0.74; P < .001) and IGSQ (r = 0.64; P < .001). Healthy infants scored lower on the NeoEAT-Bottle-feeding than infants with feeding problems (P < .001), supporting known-groups validity. IMPLICATIONS FOR PRACTICE: The NeoEAT-Bottle-feeding is an available assessment tool for clinical practice. IMPLICATIONS FOR RESEARCH: The NeoEAT-Bottle-feeding is a valid and reliable measure that can now be used in feeding research.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

Feeding problems in infancy and early childhood: evolutionary concept analysis.

AIM: The aim of this study was to report an analysis of the concept of pediatric feeding problems. BACKGROUND: Reviews of the literature on pediatric feeding problems and disorders repeatedly reference the lack of a shared conceptualization of feeding problems. It is difficult to track aetiology, prevalence and incidence of a phenomenon when available definitions and diagnoses lack practical utility. DESIGN: An evolutionary concept analysis. DATA SOURCES: A search was conducted in October 2014 of Google Scholar, CINAHL, PubMed and Web of Science databases, with MeSH terms and key words including: failure to thrive, feeding disorder/difficulty/problems, infantile anorexia, oral aversion, mealtime behaviour and dysphagia. Inclusion criteria were: subject of feeding problems, index children 0-10 years of age, English language and full text. METHODS: The articles (n = 266) were sorted into disciplines of authorship, including Psychology, Medicine, Nursing, Nutrition, Occupational Therapy, Speech Language Pathology or Other. The sample was divided into a historical sample (n = 42) for pre-2000 articles and current for those published post-2000. The current sample was later reduced to 100 and coded for surrogate terms, related concepts, attributes, antecedents and consequences. RESULTS: The historical view of pediatric feeding problems shows a tradition of mother blame or parental culpability, both direct and indirect. Currently, there exist many different definitions and typologies, but none have sound validity or generalizability. Areas of attribute consensus across disciplines are problematic feeding behaviours and selective or restrictive intake. CONCLUSION: A spectrum conceptualization of feeding problems is suggested for further development, with attributes that would be critical to have a feeding problem.

Effects of milk flow on the physiological and behavioural responses to feeding in an infant with hypoplastic left heart syndrome.

Infants with hypoplastic left heart syndrome often experience difficulty with oral feeding, which contributes to growth failure, morbidity, and mortality. In response to feeding difficulty, clinicians often change the bottle nipple, and thus milk flow rate. Slow-flow nipples have been found to reduce the stress of feeding in other fragile infants, but no research has evaluated the responses of infants with hypoplastic left heart syndrome to alterations in milk flow. The purpose of this study was to evaluate the physiological and behavioural responses of an infant with hypoplastic left heart syndrome to bottle feeding with either a slow-flow (Dr. Brown's Preemie) or a standard-flow (Dr. Brown's Level 2) nipple. A single infant was studied for three feedings: two slow-flow and one standard-flow. Oral feeding, whether with a slow-flow or a standard-flow nipple, was distressing for this infant. During slow-flow feeding, she experienced more coughing events, whereas during standard-flow she experienced more gagging. Disengagement and compelling disorganisation were most common during feeding 3, that is slow-flow, which occurred 2 days after surgical placement of a gastrostomy tube. Clinically significant changes in heart rate, oxygen saturation, and respiratory rate were seen during all feedings. Heart rate was higher during standard-flow and respiratory rate was higher during slow-flow. Further research is needed to examine the responses of infants with hypoplastic left heart syndrome to oral feeding and to identify strategies that will support these fragile infants as they learn to feed. Future research should evaluate an even slower-flow nipple along with additional supportive feeding strategies.

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).

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.

Mapping the gaps: A scoping review of research on pediatric feeding disorder.

BACKGROUND & AIMS: Pediatric feeding disorder (PFD) is defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. As PFD is prevalent and increasing, so are publications on the topic; however, the research literature is often disparate in terminology used and siloed by discipline. Greater understanding of the current research concerning PFD will help identify areas in need of further study. The purpose of this scoping review is to examine the extent, range, and nature of research activities concerning PFD and to identify gaps in the empirical literature. METHODS: Three electronic databases (PubMed/Medline, CINAHL, PsycINFO) were searched using terms related to pediatric feeding disorder, which include, but not limited to, "feeding disorder/problem/difficulty", "avoidant restrictive food intake disorder (ARFID)", "dysphagia", "selective/picky eating", "problematic mealtime behaviors" or "food refusal". The following limits were placed on the search: full text, humans, English, and age limit (up to 18 years old), and publication date (last 10 years). Covidence software was used to facilitate a systematic data management/analysis. Two people in the research team independently reviewed each result (screening titles and abstracts first, then moving to the full texts) to identify studies that met our inclusion/exclusion criteria and conflicts were resolved through a team discussion. Data were charted regarding disciplines of the authors, study purposes, study settings/locations, study methodologies, and study participants. Descriptive statistics and thematic analyses were used to summarize the characteristics of the studies. RESULTS: The initial search resulted in 5354 articles after removing duplicates between the databases. With a final set of articles (n = 415), data charting was completed. The majority of studies were completed by authors from Psychology (n = 171) and Medicine (n = 123). The most studied aims were to examine attributes of feeding problems (n = 168) and/or factors associated with feeding problems (n = 183). Sample size median was 53. A total of 166 of the 415 studies examined the effect of an intervention, treatment, or program, but dose of the intervention was difficult or impossible to report across studies. Feeding was studied as an outcome in 400 out of the 415 studies. A closer accounting of the systematically developed parent-report tools revealed 50 distinct parent report tools used across the subset of studies utilizing parent report outcomes (n = 123). CONCLUSIONS: The results of this scoping review highlight the designs and methods used in research on PFD. This reveals critical gaps in knowledge generation and barriers to intervention replication.

The Impact of Feeding on the Parent and Family Scales (Feeding Impact Scales): Development and Psychometric Testing.

BACKGROUND AND PURPOSE: Families of children with feeding disorder face significant challenges in supporting their child's feeding, growth, and development. The Feeding Impact Scales were developed to assess how child feeding impacts parent and family. METHODS: Items were adapted from an existing scale. Parents of children with feeding difficulty completed the online survey. Item response theory (IRT) analyses were used to evaluate and reduce items. Internal consistency reliability, convergent validity, and readability were tested. RESULTS: IRT analyses (n = 317) identified 12 items for the Parent Impact and 13 items for the Family Impact. Internal reliability for the scales were acceptable. Convergent validity was supported. CONCLUSIONS: The Feeding Impact Scales have evidence of reliability and validity. They can be utilized in practice and research.

Feeding During Infancy: Interpersonal Behavior, Physiology, and Obesity Risk.

Infancy is a sensitive developmental period that presents both opportunities and challenges for caregivers to feed their infants in ways that support healthy growth and development. The capacity to eat in a way that supports energy (caloric) intake aligned with the body's physiologic need for growth and development appear to diminish in the years following infancy, but the reasons for this and whether this is developmentally typical are unclear. Feeding interactions that undermine infants' ability to regulate their intake in response to hunger and satiety are thought to confer risk for obesity in infancy and beyond. In this integrative review, we consider what we know about the emergence of self-regulation of behavior and emotion from both a behavioral and a physiological perspective. Then, we apply this information to our emerging understanding of how self-regulation of energy intake may be derailed through feeding interactions between caregivers and infants.

Factor Structure and Psychometric Properties of the Neonatal Eating Assessment Tool-Breastfeeding.

The purpose of this study was to identify the factor structure of the Neonatal Eating Assessment Tool-Breastfeeding (NeoEAT-Breastfeeding) and to assess its psychometric properties, including internal consistency reliability, test-retest reliability, and construct validity as measured by concurrent and known-groups validity. Exploratory factor analysis conducted on responses from 402 parents of breastfeeding infants younger than 7 months old showed a 62-item measure with seven subscales and acceptable internal consistency reliability (Cronbach's α = .92). Test-retest reliability was also acceptable (r = .91). The NeoEAT-Breastfeeding has evidence of concurrent validity with the Infant Gastroesophageal Reflux Questionnaire (r = .69) and Infant Gastrointestinal Symptoms Questionnaire (r = .62). The NeoEAT-Breastfeeding total score and all subscale scores were higher in infants with feeding problems than in typically feeding infants (p < .001, known-groups validity). The NeoEAT-Breastfeeding is a parent-report assessment of breastfeeding in infants from birth to 7 months old with good initial evidence of reliability and validity.

"It's a Long-Term Process": Description of Daily Family Life When a Child Has a Feeding Disorder.

Pediatric feeding problems occur in 25% of the general pediatric population and up to 80% of those who have developmental delays. When feeding problems place the child at nutritional risk, families are typically encouraged to increase their child's intake. Family mealtime can become a battle, which further reinforces problematic feeding behaviors from the child and intensifies well-intentioned but unguided parental mealtime efforts. Family has an essential influence on feeding; however, studies to date neglect to address the family context of feeding difficulty. In this study we describe, in the context of everyday life, family management of feeding when a child had a significant feeding problem. Parents of children with feeding problems were interviewed with the Family Management Style Framework components as a guide. Twelve parents participated, representing nine families of children with feeding disorder. Description of family management of feeding provides a foundation for development of family feeding interventions.

Milk Flow Rates from bottle nipples used after hospital discharge.

PURPOSE: To test the milk flow rates and variability in flow rates of bottle nipples used after hospital discharge. STUDY DESIGN AND METHODS: Twenty-six nipple types that represented 15 common brands as well as variety in price per nipple and store location sold (e.g., Babies R' Us, Walmart, Dollar Store) were chosen for testing. Ten of each nipple type (n = 260 total) were tested by measuring the amount of infant formula expressed in 1 minute using a breast pump. Mean milk flow rate (mL/min) and coefficient of variation (CV) were calculated. Flow rates of nipples within brand were compared statistically. RESULTS: Milk flow rates varied from 1.68 mL/min for the Avent Natural Newborn Flow to 85.34 mL/min for the Dr. Brown's Standard Y-cut. Variability between nipple types also varied widely, from .03 for the Dr. Brown's Standard Level 3 to .37 for MAM Nipple 1 Slow Flow. CLINICAL IMPLICATIONS: The extreme range of milk flow rates found may be significant for medically fragile infants being discharged home who are continuing to develop oral feeding skills. The name of the nipple does not provide clear information about the flow rate to guide parents in decision making. Variability in flow rates within nipples of the same type may complicate oral feeding for the medically fragile infant who may not be able to adapt easily to change in flow rates. Both flow rate and variability should be considered when guiding parents to a nipple choice.

Concept of Pediatric Feeding Problems From the Parent Perspective.

PURPOSE: Feeding difficulties in early childhood are common, affecting approximately 25% of typically developing children and up to 80% of children with developmental disabilities. There is no interdisciplinary consensus on the definition of a feeding problem and there is no input from families in the conceptualization. Lack of common language is a barrier to effective communication between clinicians, researchers, and caregivers, and inhibits collaboration. The purpose of this study was to examine the conceptualization of pediatric feeding problems by family caregivers (parents). STUDY DESIGN AND METHODS: This study reports an empirical phase of a concept analysis. Data from interviews with 12 parents of children with feeding problems were coded for related concepts, attributes, antecedents, and consequences of feeding problems, and then analyzed for themes within conceptual categories. RESULTS: Conceptual elements across interviews are presented with an emphasis on shared perspectives. Parents related pediatric feeding problems to be a process or journey on which they found themselves for an unknown duration. Common themes of attributes were problematic feeding behaviors of the child, restrictive or selective intake, and child weight or growth concerns. CLINICAL IMPLICATIONS: Parents conceptualize feeding problems as a condition with symptoms experienced by the child and family that need to be incorporated into family life. In contrast, prior literature coming from providers' point of view presents this problem to be of the child. Nurses can improve care of families with children who have feeding problems by coordinating interdisciplinary, family-centered care.

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.

Milk Flow Rates From Bottle Nipples Used for Feeding Infants Who Are Hospitalized.

PURPOSE: This study tested the milk flow rates and variability in flow of currently available nipples used for bottle-feeding infants who are hospitalized. METHOD: Clinicians in 3 countries were surveyed regarding nipples available to them for feeding infants who are hospitalized. Twenty-nine nipple types were identified, and 10 nipples of each type were tested by measuring the amount of infant formula expressed in 1 min using a breast pump. Mean milk flow rate (mL/min) and coefficient of variation were used to compare nipples within brand and within category (i.e., Slow, Standard, Premature). RESULTS: Flow rates varied widely between nipples, ranging from 2.10 mL/min for the Enfamil Cross-Cut to 85.34 mL/min for the Dr. Brown's Y-Cut Standard Neck. Variability of flow rates among nipples of the same type ranged from a coefficient of variation of 0.05 for Dr. Brown's Level 1 Standard- and Wide-Neck to 0.42 for the Enfamil Cross-Cut. Mean coefficient of variation by brand ranged from 0.08 for Dr. Brown's to 0.36 for Bionix. CONCLUSIONS: Milk flow is an easily manipulated variable that may contribute to the degree of physiologic instability experienced by infants who are medically fragile during oral feeding. This study provides clinicians with information to guide appropriate selection of bottle nipples for feeding infants who are hospitalized.

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.