Abstract
BackgroundEarly identification of feeding difficulty in infancy is critical to supporting breastfeeding and ensuring optimal nutrition for brain development. The Neonatal Eating Assessment Tool (NeoEAT) is a parent-report assessment that currently has two versions: NeoEAT – Breastfeeding and NeoEAT – Bottle-feeding for use in breast and bottle-fed infants, respectively. There are currently no valid and reliable parent-report measures to assess feeding through a combination of both breast and bottle delivery. The purpose of this study was to conduct a factor analysis and test the psychometric properties of a new measure, the NeoEAT – Mixed Breastfeeding and Bottle-Feeding (NeoEAT – Mixed Feeding), including internal consistency reliability, test-retest reliability, construct validity and known-groups validity.MethodsParents of infants younger than 7 months who had fed by both bottle and breast in the previous 7 days were invited to participate. Internal consistency reliability was tested using Cronbach’s α. Test-retest reliability was tested between scores on the NeoEAT – Mixed Feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT – Mixed-Feeding, the Infant Gastroesophageal Reflux Questionnaire - Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested between healthy infants and infants with feeding problems.ResultsA total of 608 parents participated. Exploratory factor analysis revealed a 68-item scale with 5 sub-scales. Internal consistency reliability (Cronbach’s α = .88) and test-retest reliability (r = 0.91; p < .001) were both acceptable. Construct validity was demonstrated through correlations with the I-GERQ-R (r = 0.57; p < .001) and IGSQ (r = 0.5; p < .001). Infants with feeding problems scored significantly higher on the NeoEAT – Mixed Feeding, indicating more problematic feeding symptoms, than infants without feeding problems (p < .001), supporting known-groups validity.ConclusionsThe NeoEAT – Mixed Feeding is a 68-item parent-reported measure of breast- and bottle-feeding behavior for infants less than 7 months old that now has evidence of validity and reliability for use in clinical practice and research. The NeoEAT – Mixed Feeding can be used to identify infants with problematic feeding, guide referral decisions, and evaluate response to interventions.
Highlights
Identification of feeding difficulty in infancy is critical to supporting breastfeeding and ensuring optimal nutrition for brain development
Breastfeeding rates in the United States have been increasing in recent years, but the most recently available data suggest that only 24.9% of infants in the United States are exclusively breastfed at 6 months [2]
The data presented in this paper reports on the item reduction strategy and exploratory factor analysis that determined the Neonatal Eating Assessment Tool (NeoEAT) – Mixed Feeding is a 68-item measure with five subscales: Gastrointestinal Tract Function, Infant Regulation, Energy & Physiologic Stability, Sensory Responsiveness, and Feeding Flexibility
Summary
Identification of feeding difficulty in infancy is critical to supporting breastfeeding and ensuring optimal nutrition for brain development. There are currently no valid and reliable parent-report measures to assess feeding through a combination of both breast and bottle delivery. While not all mothers desire to meet this goal of exclusive breastfeeding (or provision of human milk) through 6 months, one study found that 60% of women in the United States reported that they were not able to meet their desired goals for breastfeeding [3]. Identification of feeding difficulty in infancy is critical for supporting continuation of breastfeeding and ensuring optimal nutrition for brain development. Assessments which focus on infant behavior throughout the feeding are critical for identifying individual problem areas and implementing personalized strategies to optimize nutrition and oral feeding skill development [7]. While clinician assessments are a critical component to the overall assessment of oral feeding, clinicians vary in their knowledge about infant feeding and parent-reported assessments can provide an objective means of guiding the clinician in their decision-making
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