Behavioral Pediatrics Feeding Assessment Scale Research Articles

A comparative analysis of oropharyngeal functions in preterm and term children with cerebral palsy

This study aims to compare term and preterm children with Cerebral Palsy (CP) in terms of their oropharyngeal functions. A total of 50 children with CP participated in the study, and were divided into two groups according to their birth history including preterm group (gestational age below 37 weeks; 60 % female; mean age = 6.86 ± 4.35 years) and term group (gestational age between 37 and 41 weeks; 60 % female; mean age = 6.48 ± 4.86 years). Chewing and swallowing functions were evaluated in terms of oropharyngeal functions. Chewing evaluation was performed by using the Karaduman Chewing Performance Scale (KCPS) and the Turkish version of the Mastication Observation and Evaluation Instrument (T-MOE). The pediatric version of the Eating Assessment Tool (PEDI-EAT-10) was used to evaluate swallowing performance of children. In addition, the Behavioral Pediatric Feeding Assessment Scale (BPFAS) was used to assess feeding behaviors of children. There were significant differences between groups in terms of KCPS (p = 0.03), T-MOE (p = 0.01), and PEDI-EAT-10 scores (p = 0.04). There was a significant difference between groups in terms of the parental frequency score from the BPFAS (p = 0.04). Oropharyngeal functions of preterm children with CP were more adversely affected than term children with CP. Clinicians working with children with CP should be aware of the risks of preterm birth on oropharyngeal functions, and take precautions for oropharyngeal dysfunction in the early period in preterm children with CP.

Mother-child pairs’ eating and feeding behaviours in two different nutritional status from two distinct provinces

Nutrition plays a crucial role for the bio-psycho-social growth and development of children. Mother-child pairs’ eating-feeding problems can be hypothesized to relate to the child’s nutritional status and living area. Our focus was to assess maternal attitudes and children’s eating habits in thin and normal-weight children across two cities characterized by distinct socioeconomic and demographic profiles: Ankara and Şanlıurfa. This double case-control study included the mothers whose children are aged between 2 and 7 years old in both cities. Figure Rating Scale, Child Feeding Questionnaire and Behavioral Pediatrics Feeding Assessment Scale were filled by mothers of children. The mothers of thin children were concerned more about the weight of their children, felt more responsible for feeding their children, and use of pressured them to eat more frequently compared to normal-weight children’s mothers in both cities. In Ankara, the duration of breastfeeding is longer, using formula is rarer and starting complementary food on time is more common, mother had higher scores on perceived responsibility, perceived child weight, and concern about child weight subscales; lower score on the restriction subscale compared to Şanlıurfa. Mothers of both thin and normal weight children in Şanlıurfa rated their children as weaker compared to those in Ankara. In conclusion, child eating behaviors and parental feeding practices were associated with the weight of children depending on demographic and sociocultural differences. Implementing customized, location-specific preventive educational initiatives on child feeding will not only foster behavioral changes but also yield valuable insights for shaping future interventions.

Impact of the COVID-19 pandemic on the eating behaviors of children and adolescents with autism spectrum disorder.

Introduction. Children with autism spectrum disorder (ASD) have difficulties adapting to stressful situations, such as the COVID-19 pandemic. Objective. To assess the impact of the first year of the pandemic on feeding difficulties in children with ASD. Population and methods. The caregivers of children and adolescents with non-syndromic ASD (age: 2-18 years) from a neurodevelopment unit were invited to participate. Participants completed a questionnaire and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) online before and during the first year of the pandemic. A priority score (product between the average frequency and the problem) for each BPFAS item was estimated. Results. Among the caregivers, 56.6% (86/152) completed the survey (mother: 74.4%); children's median age was 6.3 years (p25-p75: 4.7-8.2); 80.2% of children were males; 58.1% continued with their therapy during the pandemic; and 61.6% had behavioral problems before the pandemic. During the first year of the pandemic, children had greater behavioral problems (34.9%) and feeding difficulties (61.6%); however, 31.4% of caregivers referred improvements in feeding. There were no significant differences in the BPFAS scores before and during the pandemic. The following items obtained the highest priority scores: gets up from table during meal, does not try new food, does not eat vegetables, does not eat fruits. Conclusions. A high frequency of feeding difficulties was noted during the first year of the pandemic. No differences were observed in feeding characteristics before and during the pandemic.

The Behavioral Pediatrics Feeding Assessment Scale in Telugu (BPFAS-T)

The Behavioural Paediatrics Feeding Assessment Scale (BPFAS) was commonly used to assess the children's feeding behaviours. Assessing behaviours is extremely beneficial in understanding the child's mental state and tracking further developmental aspects. This scale was available in the majority of languages; which is not available in Telugu, the language spoken by the Indian states of Andhra Pradesh and Telangana. However, cultural and lingual aspects should be considered when assessing certain aspects of children's behaviour. In this context the current study aimed to adapt the BPFAS scale into Telugu. This study included 380 parents of children with autism spectrum disorders (ASD). The children ranged in age from 1 to 8 years. Parents were instructed to fill out the questionnaire correctly. The obtained scores were examined using reliability, independent t test, and one way ANOVA. The results revealed a Cronbach's alpha of 0.729, indicating that the BPFS-Telugu is acceptable and can be used clinically. The independent t test revealed that there is a high significant difference between total scores, a significant difference between frequency scores, and no significant difference between problem scores. One-way ANOVA was used to compare severity, and the results show that there is a significant difference between total scores, a high significant difference between problem scores, and no significant difference between frequency scores. The independent test for frequency score revealed a highly significant difference between ASD children with and without behavioural problems, as well as problem scores. Overall, 55.5 % (frequency scores) and 55.1% (problem scores) of ASD children were identified with behavioural issues during feeding time. Finally, the authors stated that BPFAS in Telugu is clinically acceptable and can be used to assess for behavioural issues during feeding time.

Developmental Feeding Stages and Their Impact on Child Feeding Behavior.

Previous research has shown that critical periods of feeding skills development exist and feeding problems can arise in children due to delays in attaining feeding developmental milestones. This study aims to delineate the transitional process of feeding development in healthy children and children with gastrointestinal diseases (GIDs) and to examine the relationship between feeding milestones and the appearance of later feeding problems. A cross-sectional case-control study among 711 healthy Greek children and 119 children with GID, aged 2-7 years. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale and "self-reported" questionnaires assessing child's feeding history. Differences in feeding behavior of preschoolers between the 2 groups were found concerning the time of introduction of complementary (pureed), lumpy, and table foods as well as finger feeding and regular cup-drinking. Age-specific milestones as proposed by guidelines were not reached. Late introduction of complementary and lumpy foods (>6 months and >9 months, respectively) as well as finger feeding (>9 months) were predictive of more problematic feeding behaviors later on. The trajectory of feeding development, including less studied feeding milestones, both in healthy children and children with GIDs, indicates that there are discrepancies between current feeding practices and infant feeding guidelines, and a tendency to delay the acquisition of all assessed feeding milestones.

Relationship between Sensory Processing Skills and Feeding Behaviors in Children Aged 3-6 Years with Cerebral Palsy with Cerebral Visual Impairment.

The current study aimed to examine the relationship between sensory processing skills and feeding behavior in cerebral palsy (CP) children aged 3-6 years with cerebral visual impairment (CVI). A total of ninety mothers participated in the study in three groups: thirty mothers of children with CP with CVI, thirty mothers of children with CP without CVI, and thirty mothers of children with typical development (TD). The sensory processing skill of the children was evaluated with the Sensory Profile (SP), and feeding behavior was evaluated with the the Behavioral Pediatric Feeding Assessment Scale (BPFAS). In the triple comparison, a significant difference was found between the groups in all SP parameter and BPFAS scores (p < 0.001). Post hoc analysis revealed statistically significant differences between the groups in all parameters (p < 0.001). Feeding problems were detected in 65% of all groups. In the correlation analysis, a significant relationship was found between all parameters of the SP and the BPFAS (p < 0.05). In terms of sensory processing skills and feeding status, it was determined that children with CVI with CP had more problems than children with CP without CVI, and children with CP without CVI had more problems than children with TD. With these results, it was concluded that sensory processing problems affect feeding status, and visual impairment causes both sensory problems and feeding problems.

Association between feeding/mealtime behavior problems and internalizing/externalizing problems in autism spectrum disorder, other neurodevelopmental disorders and typically developing children.

The aim of current study was to examine the nature and prevalence of feeding problems and mealtime behavior problems in children with autism spectrum disorder (ASD) comparing to children with other neurodevelopmental disorders (NNDs) and TD children. We also investigated the impact of intelligence quotient (IQ) and/or emotional and behavioral problems on feeding and mealtime behavior problems. Participants completed the following tests: Social Communication Questionnaire (SCQ), Child Behavior Checklist (CBCL), Brief Autism Mealtime Behavior Inventory (BAMBI) and Behavioral Pediatric Feeding Assessment Scale (BPFAS). Children with ASD showed more feeding and mealtime behavior problems including food refusal (P<0.001, P<0.001) and limited variety of foods (P=0.014; P=0.018) compared with NDDs and TD children. ASD group showed more problems in mealtime behavior (P=0.034) and parent behaviors (P=0.028) compared to TD group. Internalizing (P=0.003) and externalizing (P=0.008) problems were positively related to parent frustration during mealtime in ASD group. These results suggest that routine screening for feeding and mealtime behavior problems among children with ASD is necessary to prevent dietary inadequacies that may be associated with eating habits.

Feeding Problems in Young Children: A Cross-Sectional Study in Sweden.

Parents of children attending regular 10-, 18-, and 36-month visits at the child health care centers (CHCCs) in Sweden answered a questionnaire including a Swedish version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) as well as demographic questions. CHCCs were stratified according to a sociodemographic index. Parents of 238 girls (115) and boys (123) completed the questionnaire. Using international thresholds for FP detection, 8.4% of the children had a total frequency score (TFS) indicating FP. Based on the total problem score (TPS), the result was 9.3%. The mean score for all children was 62.7 for TFS (median 60; range 41-100), and 2.2 for TPS (median 0; range 0-22). Children aged 36 months had a significantly higher average TPS score than younger children, but TFS scores did not differ by age. There were no significant difference in gender, parents' education, or sociodemographic index. Prevalence numbers found in this study are similar to those found in studies with BPFAS in other countries. Children 36 months of age had a significantly higher prevalence of FP than children aged 10 and 18 months. Young children with FP should be referred to health care specializing in FP and PFD. Creating awareness of FP and PFD in primary care facilities and child health services may facilitate early detection and intervention for children with FP.

Screening of Swallowing and Feeding-Related Problems in Typically Developing Children.

The aim of this study was to define swallowing and feeding-related problems among typically developing children aged between 2 and 6 years. The presence of food selectivity, limited appetite, chewing dysfunction, and dysphagia signs was questioned and scored as "absent" or "present" according to parent report. Children were divided into 2 groups: children with swallowing and feeding disorders and children without swallowing and feeding disorders. The Turkish version of the Behavioral Pediatrics Feeding Assessment Scale (T-BPFAS) was used to evaluate feeding behaviors of children, and Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to measure the impact on caregivers. A total of 234 children were included. Food selectivity was defined in 62.4% (n = 146), limited appetite in 26.9% (n = 63), and chewing dysfunction in 7.3% (n = 17). The most common dysphagia-related sign was coughing. There were significant differences between groups in terms of both T-BPFAS and T-FS-IS (P < .001). In conclusion, children with typical development have experienced a wide range of swallowing and feeding-related problems, which have an impact on mothers' perceptions regarding feeding and their quality of life.

Nutritional Status and Feeding Problems in Pediatric Specific Learning Disability.

This cross-sectional study aims to determine the feeding problems and nutritional status of children diagnosed with specific learning disability (SLD), which is one of the neurodevelopmental disorders. Sociodemographic information, anthropometric measurements, and food consumption records of 76 children (38 boys and 38 girls) diagnosed with SLD were obtained by applying a questionnaire. The Behavioral Pediatrics Feeding Assessment Scale was used to determine the feeding problems of children. About 31.6% of children with SLD are overweight and obese. Feeding behavioral problems were found in 39.5% of the children with SLD. Binary logistic regression analysis showed a significantly higher frequency of feeding behavior problems in children with SLD: (1) lower body mass index (adjusted odds ratio [AOR]: 0.841, 95% confidence interval [CI]: 0.722-0.979), (2) lower tri-ponderal mass index (AOR: 0.738, 95% CI: 0.585-0.933), (3) lower upper middle arm circumference (AOR: 0.772, 95% CI: 0.649-0.918),and (4) lower triceps skinfold thickness (TSFT) (AOR: 0.890, 95% CI: 0.808-0.980). In this study, feeding behavior problems are common in children diagnosed with SLD. Therefore, identifying feeding behavior problems in children diagnosed with SLD and developing solutions specific to the problem are important for gaining healthy eating habits throughout life.

O efeito das atitudes nutricionais de mães que trabalham como profissionais de saúde sobre os hábitos alimentares de seus filhos

ABSTRACT Objective This study aimed to determine the effects of the attitudes of mothers as health care professionals and their sociodemographic characteristics on their children’s eating habits. Methods The data of this descriptive and cross-sectional study were collected between January and March 2022, using a web-based survey of 386 mothers. Results The mean age of the mothers was 32.88±4.96 years, and the mean age of the children was 38.78±18.24 months. Regarding educational status, 62.7% of the mothers were university graduates, while 54.4% were nurses. A significant and positive correlation was found between the sub-dimensions of the Mother’s Attitudes towards the Feeding Process Scale and the Behavioral Pediatric Feeding Assessment scale (p=0.000). According to the multiple regression analysis, the main determinant of the picky eaters sub-dimension of the Behavioral Pediatric Feeding Assessment scale was the mother’s occupation (β=0.28; 95% Cl: 3.07, 6.50), the main determinant of the toddler refusal-general sub-dimension was negative affect during the meal (β=0.38; 95% Cl: 0.19, 0.32), the main determinant of the older children refusal - general sub-dimension was negative affect during the meal (β=0.30; 95% Cl: 0.16, 0.33), and the main determinant of the toddler refusal – textured foods sub-dimension was forced feeding (β=0.48; 95% Cl: 0.41, 0.63). Conclusion The study found that problems related to mothers’ attitudes toward the nutrition process were moderate and that these problems were mainly caused by mothers’ attitudes toward inadequate/unbalanced nutrition. It was also found that the children had moderate problematic eating behavior and eating habits.

Parental perception of their children#39;s eating behaviors: Comparison between premature and full-term children

Feeding is a complex process, and that’s why feeding difficulties are so common in early childhood. Prematurity appears to be a risk factor for increased feeding problems, so our goal was to evaluate the effect of prematurity on children&#39;s feeding behavior. We also intended to identify situations that have a significant impact on the child&#39;s and family&#39;s life and refer them to a specialized consultation. In our study participated 109 children (51 preterm and 58 full-term), whose parents answered the Behavioral Pediatrics Feeding Assessment Scale and a demographic questionnaire. It was found that the perception of feeding difficulties is higher in parents of preterm children, likewise the perception of those problems, and although not statistically significant, the risk of feeding difficulties is higher in the preterm group compared to the other one.

Feeding and growth patterns in preterm children at 3-4 years of age

Aim: to describe the feeding and growth patterns of preterm-born children at preschool age, considering feeding problems based on behaviours and skills, diet quality and parental feeding practices. Methods: a cross-sectional study was performed on preterm children born in Asturias (Spain) in 2016 (n = 94). When preterm-born children reached 3-4 years of age their families were asked to complete the Behavioral Pediatrics Feeding Assessment Scale and a food frequency questionnaire to identify possible feeding problems and assess diet quality (KIDMED index), respectively. Self-reported anthropometric data were also collected to assess weight growth. Electronic health records were reviewed to gather gestational and neonatal clinical data. Results: feeding problems were found in 7.4 % of children and 20.2 % of parents. According to the KIDMED index, 25.5 % of children had a high-quality diet. Feeding problems were higher in children born before 32 weeks of gestation, and decreased in frequency as the gestational age increased (p = 0.030). No differences were found in parental feeding practices (p = 0.455) or diet quality according to gestational age (p = 0.399), but body weight at 3-4 years was lower in preterm-born children (p = 0.015). Conclusions: feeding patterns of preterm-born children were suitable at the age of 3-4 years, but diet quality was moderate to poor in the majority of children. Follow-up of very preterm children beyond 3-4 years of age becomes necessary as they displayed more feeding problems and lower body weight.

The Effect of Maternal Attitude on the Evaluation of Behavioral Feeding

Introduction: This study was planned to determine maternal attitudes' effect on behavioral pediatric feeding assessment in mothers with children aged 6-9 years.&#x0D; Methods: The sample consisted of 196 mothers with children aged 6-9 years. The Behavioral Pediatric Feeding Assessment Scale and the Hamel Maternal Attitude Scale were employed to assess behavioral pediatric feeding and maternal attitudes, respectively.&#x0D; Results: A significant correlation was found between the Behavioral Pediatric Feeding Assessment Scale total scores and the “authoritarian” subscale of the Hamel Maternal Attitude Scale. There were significant differences in the participants’ Behavioral Pediatric Feeding Assessment Scale scores in terms of children's ages and family types.&#x0D; Conclusion: As a result, it was determined that the mother's feeding behavior of her child is affected by both the factors related to her child, the environment in which she lives, and her own attitude.

Feeding Difficulties Among Children With Special Needs: A Cross-Sectional Study From India.

Deficits in feeding can lead to impairments in occupational performance for children with special needs. This correlational study assessed the relationship between oromotor deficits, behavior problems related to feeding, and caregiver perception of the behavior in children with special needs. We included children with neurodevelopmental disorders (n=79), between 2 and 12 years of chronological age, and their caregivers. Those fulfilling the selection criteria were administered the Behavioral Pediatric Feeding Assessment Scale (BPFAS) and Schedule for Oromotor Assessment (SOMA). More than half the sample had skill deficits and behavioral problems related to feeding. There was a statistically significant correlation of oromotor deficits with specific food consistencies and feeding-related behavior problems. Children with special needs have impaired participation in feeding. Deficits at the body system level are associated with parental and cultural factors, which would have to be mitigated to optimize performance.

Annelere Yönelik Beslenme Eğitiminin Yeme Farkındalığı Çocuk Besleme Davranışları ve Antropometrik Ölçümler Üzerine Etkisi: Randomize Kontrollü Pilot Çalışma

This pretest-posttest randomized controlled, pilot study was conducted to determine the effect of feeding education for mothers on eating awareness, child nutrition behaviors and anthropometric measurements. It was conducted with 24 mothers with three to six-year-old children attending a public kindergarten. An eight-week education consisting of eight sessions on mother and child feeding was given to mothers in the intervention group. The data were collected using the Information Form, the Eating Awareness Scale, and the Behavioral Pediatric Feeding Assessment Scale and performing anthropometric measurements. After the education program, the eating awareness mean score of the mothers in the intervention group was higher than the control group; however, the increase was not statistically significant (p&amp;gt; 0.05). Prior to the education, the mean behavioral pediatric feeding assessment scale score of the intervention group was higher than that of the control group (p&amp;gt;0.05). There was no significant difference in Body Mass Index (BMI) of the mothers in the intervention and control groups (p&amp;gt; 0.05). In line with the results obtained from this pilot study, it is recommended to increase the effectiveness of education by integrating programs containing web-based, game-supported applications into education as well as nutrition education.

Dietary treatment in Dutch children with phenylketonuria: An inventory of associated social restrictions and eating problems

ObjectivesDietary treatment in phenylketonuria (PKU) is known to cause eating problems, but knowledge of both prevalence and magnitude, especially for social restrictions, is scarce. Our aim was to evaluate the social restrictions and eating problems that children with PKU and their caregivers experience with dietary treatment. MethodsA web-based questionnaire, based on the Behavioral Pediatrics Feeding Assessment Scale with additional PKU-specific questions, was developed in close collaboration with and distributed by the Dutch PKU Association, which sent an e-mail to its members containing a link to the questionnaire. The questionnaire was completed by caregivers of children with PKU in the Netherlands and caregivers of age-matched children without PKU. Data were analyzed with the Kruskal-Wallis and Mann-Whitney U test using SPSS. ResultsCompared with caregivers of children in the control group (ages 1–16 y; n = 50), caregivers of children with PKU (ages 1–16 y; n = 57) reported more difficulty in offering food variety, experienced more stress when eating an evening meal outside the home and during vacation, and were stricter about (accidental) spilling of food during dinner by the child (P < 0.05). They also reported to being angrier, more frustrated, and more anxious when feeding their child, and they more often felt that their child's eating pattern had a negative influence on the child's general health (P < 0.05). ConclusionThis pilot study provides further evidence that restriction of social activities and eating problems associated with dietary restrictions is more common in children with PKU, and warrants awareness on this topic among professionals working with these children.

Sensory Based Feeding Intervention for Toddlers With Food Refusal: A Randomized Controlled Trial.

ObjectiveTo investigate the effect of sensory-based feeding treatment for toddlers with food refusal compared with only providing nutrition education.MethodsThirty-two toddlers with food refusal were randomly assigned to an intervention group or the control group. Toddlers in the intervention group received the sensory-based feeding intervention and the duration was for 1 hour for 5 days per week for 4 weeks, and then 1 hour, once a week for 8 weeks. Subjects in both the intervention and control groups received nutritional education once every 4 weeks for 12 weeks. The participants were evaluated at their entry into the study and 12 weeks later based on height, weight, behavior at mealtime using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), and sensory processing ability using the Infant/Toddler Sensory Profile.ResultsSixteen toddlers were included in each group. Two subjects in the intervention group and four toddlers in the control group were excluded from the final analysis. Significant improvements in child or parent subscales of the BPFAS were observed in the intervention group. In contrast, there were no significant improvements in any BPFAS scores in the control group.ConclusionSensory-based feeding intervention was effective for improving mealtime behavior in toddlers with food refusal. Therefore, a sensory-based feeding intervention could be considered as an intervention approach to address feeding disorders in toddlers.

Feeding difficulties in Asian children with autism spectrum disorder

To characterize the nature and severity of feeding difficulties in Asian young children with Autism Spectrum Disorders (ASD) and identify potential predictors of poorer feeding outcomes. Cross sectional study of children aged 1-7 years with ASD. Parents completed the following: demographic information, brief autism mealtime behavior inventory, aberrant behavior checklist (ABC), behavioral pediatrics feeding assessment scale (BPFAS) and caregiver feeding style questionnaire. Additional information (medical data, cognitive and developmental assessment results, e.g., Autism Diagnostic Observation Schedule Second Edition, Autism Diagnostic Interview, Revised, Vineland Adaptive Behaviour Scales, etc.) were subsequently obtained from electronic medical records retrospectively by one of the study team members. Of the 67 children, 28.4% had feeding difficulties (high BPFAS total frequency score). Caregiver feeding styles were authoritarian (34.8%) or indulgent (39.4%). Child characteristics did not significantly predict for the severity of feeding difficulties. Univariate analysis revealed that authoritarian feeding style (p=0.001) and ABC hyperactivity score (p=0.006) were significantly associated with BPFAS severity score. Multivariate analysis revealed that ABC hyperactivity score remained significantly associated with BPFAS severity score after controlling for all other ABC subscale scores. A final regression model including all child characteristics and ABC scores did not reveal any significant predictors of BPFAS total frequency score (R2=0.557). Our findings suggest an association between hyperactivity, authoritarian feeding style and feeding difficulties. Children with ASD who have significant hyperactivity behaviors in the context of parents with an authoritarian feeding style should be actively screened for problematic feeding behaviors.

Parent Education Class for Children With Feeding Difficulties

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The purpose of this study was to determine the feasibility and effectiveness of a multidisciplinary educational class for parents in improving child feeding behaviors and reducing caregiver distress associated with feeding difficulties. This class has proven to be effective in educating parents about the intricate and dynamic nature of feeding per positive responses on Behavioral Pediatrics Feeding Assessment Scale, Parent Mealtime Action Scale, and parent survey. Primary Author and Speaker: Adina P. Schwartz Additional Authors and Speakers: Judy Hopkins