Children's Hospital Feeding Scale Research Articles

Nutritional status and feeding difficulties in children up to 2 years of age with cow's milk allergy.

To assess the nutritional status and incidence of feeding difficulties in Polish children up to 2 years of age with cow's milk allergy (CMA) on cow's milk proteins-free diet. A cross-sectional, multi-center study included children aged 6 months to 2 years with confirmed or suspected (without oral food challenge) diagnosis of CMA on the elimination diet for at least 1 month. The primary outcomes were an assessment of proportion of children with impaired nutritional status (with the weight for length and body mass index (BMI) z-score > 1 and <-1), and feeding difficulties according to the Montreal Children's Hospital Feeding Scale. Children with confirmed and suspected CMA were assessed separately. A 144 children with confirmed CMA and 88 with suspected CMA were included (57 and 78% with multiple food allergies, respectively). Among children with confirmed CMA, one-third (35.5%) of participants had any nutritional status impairment regardless of definition. Among those, most of children had mild malnutrition (10.4 vs. 9%) and possible risk of overweight (11.1 vs. 9.7%; following respectively BMI for age and weight for length z-scores). Only 16.0% of children had feeding difficulties. Feeding difficulties was identified to be a risk factor for moderate malnutrition compared to children without feeding difficulties (odds ratio 10, 95% confidence interval: 4-27). Mild malnutrition and possible risk of overweight are concern in children up to 2 years of age on cow's milk proteins-free diet. Feeding difficulties are less common, however, may affect the nutritional status.

Feeding Difficulties and Feeding Behaviors of Thai Children with Cow's Milk Protein Allergy.

Cow's milk protein allergy (CMPA) is a common food allergy in infants and young children and may be a risk factor for feeding difficulties. Studies exploring feeding difficulties and feeding behaviors in Thai children with CMPA are scarce. To determine the prevalence of feeding difficulties and feeding behaviors in Thai children with CMPA compared to healthy controls. A cross-sectional study was performed comparing children aged 1-6 years old diagnosed with CMPA and had eliminated cow's milk for at least 4 months with age-matched healthy children. Feeding difficulties were evaluated using the Montreal Children's Hospital Feeding Scale questionnaire, and feeding behaviors were measured using the Child Eating Behavior Questionnaire (CEBQ). One hundred and twenty-two participants were recruited (30 children with CMPA and 92 controls). The median age of the CMPA and control groups was 31.0 (14.0, 43.3) and 40.0 (28.0, 53.8) months, respectively (p value = 0.01). The CMPA group had lower calcium, phosphorus, and zinc intake than the healthy controls. The prevalence of feeding difficulties between the two groups did not show a significant difference (36.7 vs. 43.5%, p value = 0.70). The slowness in the eating subscale of feeding behaviors exhibited a lower score in the CMPA group than in the healthy group. Feeding difficulties was positively correlated with the desire to drink (β 3.079, p value = 0.011) but negatively correlated with the enjoyment of food subscale of CEBQ among the CMPA children (β -10.684, p value < 0.001). Despite a similar prevalence of feeding difficulties between CMPA and healthy children, the CMPA group demonstrated some differences in feeding behaviors. The lower score of enjoyment of food and a higher score of desire to drink correlated with a higher degree of feeding difficulties in the CMPA children. The provision of appropriate nutrition for this group of children should be prioritized.

From Feeding Challenges to Oral-Motor Dyspraxia: A Comprehensive Description of 10 New Cases with CTNNB1 Syndrome.

CTNNB1 syndrome is an autosomal-dominant neurodevelopmental disorder featuring developmental delay; intellectual disability; behavioral disturbances; movement disorders; visual defects; and subtle facial features caused by de novo loss-of-function variants in the CTNNB1 gene. Due to paucity of data, this study intends to describe feeding issues and oral-motor dyspraxia in an unselected cohort of 10 patients with a confirmed molecular diagnosis. Pathogenic variants along with key information regarding oral-motor features were collected. Sialorrhea was quantified using the Drooling Quotient 5. Feeding abilities were screened using the Italian version of the Montreal Children's Hospital Feeding Scale (I-MCH-FS). Mild-to-severe coordination difficulties in single or in a sequence of movements involving the endo-oral and peri-oral muscles were noticed across the entire cohort. Mild-to-profuse drooling was a commonly complained-about issue by 30% of parents. The mean total I-MCH-FS t-score equivalent was 43.1 ± 7.5. These findings contribute to the understanding of the CTNNB1 syndrome highlighting the oral motor phenotype, and correlating specific gene variants with clinical characteristics.

The prevalence and predictors of feeding difficulties in children at self-feeding transition stage.

To understand the prevalence of feeding difficulties (FD) in young children at self-feeding transition stage (6-24 months age), and the protective and risk predictors associated with FD are to be determined through this study. A cross-sectional study was conducted within 5 representative Women's and Children's hospitals in Chengdu, Southwest China. Children age 6-24 months who underwent routine child health care examination at outpatient and their parents were enrolled, while the Montreal Children's Hospital Feeding Scale which is validated was used to determine whether these children have FD. A total of 1,211 subjects were enrolled in this survey, where 380 children were reported as FD with an prevalence of 31.4%. Adjusted binary logistic regression in the multivariate analysis showed 10 independent predictors of FD. Specifically there were 6 risk predictors: (1) frequent constipation (OR = 1.603, CI = 1.006-2.555) in CHILD sub-theme; (2) anxiety (OR = 4.322, CI = 3.074-6.079) and (3) indulgent parenting style (OR = 2.108, CI = 1.306-3.405) in PARENT sub-theme; (4) luring to eat (OR = 2.806, CI = 2.000-3.937), (5) forcing to eat (OR = 2.040, CI = 1.407-2.958), and (6) allowing playing during mealtime (OR = 2.023, CI = 1.435-2.853) in FEEDING PRACTICE sub-theme. The remaining 4 factors were protective predictors including (1) food preparing (OR = 0.586, CI = 0.385-0.891) in FOOD sub-theme; (2) observing hunger and satiety signals (OR = 0.667, CI = 0.457-0.974), (3) interacting with child during mealtime (OR = 0.505, CI = 0.308-0.828), as well as (4) providing exclusive tableware (OR = 0.370, CI = 0.191-0.719) in FEEDING PRACTICE sub-theme. There appeared to be an increasing trend of FD prevalence. Child health care clinicians and pediatricians are expected to attach more importance to FD in their daily work, and are obliged to provide parents with practical and effective preventive strategies highlighted in this study.

Oral exploration and food selectivity: A case-control study conducted in a multidisciplinary outpatient setting.

Pediatric feeding disorders (PFDs) are common, and their great phenotypic variability reflects the breadth of the associated nosological profiles. PFDs should be assessed and managed by multidisciplinary teams. Our study aimed to describe clinical signs of feeding difficulties in a group of PFD patients assessed by such a team, and to compare them with children in a control group. In this case-control study, case group patients 1 to 6 years old were consecutively recruited through the multidisciplinary unit for the treatment of pediatric feeding difficulties based at Robert Debré Teaching Hospital in Paris, France. Children with an encephalopathy, severe neurometabolic disorder, or genetic syndrome (suspected or confirmed) were excluded. Members of the control group, consisting of children with no feeding difficulties (i.e., Montreal Children's Hospital Feeding Scale scores below 60) or severe chronic diseases, were recruited from a day care center and 2 kindergartens. Data from medical histories and clinical examination related to mealtime practices, oral motor skills, neurodevelopment, sensory processing, and any functional gastrointestinal disorders (FGIDs) were recorded and compared between groups. In all, 244 PFD cases were compared with 109 controls (mean ages: cases, 3.42 [±1.47]; controls, 3.32 [±1.17]; P = 0.55). Use of distractions during meals was much more among PFD children (cases, 77.46%; controls, 5.5%; P < 0.001), as was conflict during meals. While the groups did not differ in their members' hand-mouth coordination or ability to grab objects, cases began exploring their environments later; mouthing, especially, was less common in the case group (cases, n = 80 [32.92%]; controls, n = 102 [94.44%]; P < 0.001). FGIDs and signs of visual, olfactory, tactile, and oral hypersensitivity were significantly more frequent among cases. Initial clinical assessments showed that, in the children with PFDs, normal stages of environmental exploration were altered, and that this was often associated with signs of sensory hypersensitivity and digestive discomfort.

Cross-cultural adaptation and validation of the Italian version of the Montreal Children's Hospital Feeding Scale in a special healthcare needs population.

The Montreal Children's Hospital Feeding Scale (MCH-FS) allows paediatricians and other health care professionals to identify feeding difficulties among children. To translate and adapt the MCH-FS into Italian, and to evaluate the validity and reliability of this Italian version of the Montreal Children's Hospital Feeding Scale (I-MCH-FS). A total of 150 children with special healthcare needs were admitted to the Rare Disease Unit of the Paediatrics Department at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, between March 2021 and March 2022 (74 males; mean age = 3.85 ± 1.96 years; median age = 4 years; age range = 6 months-6 years and 11 months) and 150 healthy participants (83 males; mean age = 3.5 ± 1.98 years; median age = 3 years; age range = 6 months-6 years and 11 months) were included in the study, which was approved by the local ethics committee. The original version of the MCH-FS was translated and cross-cultural adapted through five stages: (1) initial translation, (2) synthesis of the translations, (3) back translation, (4) expert committee and (5) test of the prefinal version. Test-retest reliability and internal consistency were assessed using Pearson r, Spearman r and Cronbach's alpha, respectively. Construct validity was established by comparing data obtained from patients with those of healthy participants using the Mann-Whitney U-test. A Pearson r of 0.98, a Spearman r of 0.95 and Cronbach's alpha value of 0.86 were obtained. In the clinical group, 40.6% children were classified as having feeding disorders (n = 61), while in the normative group 4.7% were diagnosed with feeding problems (n = 7). Mean total score of the clinical group was significatively different from the normative's. The I-MCH-FS is a valid and reliable one-page, quick screening tool used to identify feeding disorders among children with special needs in outpatient paediatric setting. What is already known on the subject The MCH-FS is a valid and reliable parent-report measure aimed at discriminating between children presenting or not feeding disorders. What this paper adds to existing knowledge This paper presents the translation and cross-cultural adaptation of the scale into the Italian language. What are the potential or actual clinical implications of this work? The Italian version of the MCH-FS can be used in the special healthcare needs population.

Describing and Predicting Feeding Problems During the First 2 Years Within an Urban Pediatric Primary Care Center.

We conducted a prospective cohort study with children aged 6 to 18 months to identify predictors of feeding problems in an urban sample. Parent-reported child feeding problems (Montreal Children's Hospital Feeding Scale) and picky eating, parental anxiety (Generalized Anxiety Disorder 7), and family meal structure (Meals in Our Household) were assessed via a Web-based survey at 3 time points. Data analysis included descriptive statistics, correlations, and mixed-effects regression modeling. Eighty parents completed the survey. Child picky eating (r =.51) and resistance to try new foods (r = .30), parental anxiety (r = .34), rushed mealtimes (r = .28), and child age (r = .32) were significantly associated with child feeding problems. Feeding Scale scores were, on average, 6 points higher among picky eaters than those who were not over time (p < .001). Parent reports of picky eating early in life may warrant additional clinical investigation and referral to feeding specialists.

Electronic media use and food intake in Thai toddlers

ObjectivesViewing electronic media at mealtime is a common coping strategy for feeding difficulties, but its impact on food consumption is not known. We studied the prevalence of electronic media use at mealtime, its association with food intake, and associated factors. Methods138 healthy 18- to 30-month-old children were classified according to the presence of feeding difficulties using the Thai language version of the Montreal Children's Hospital Feeding Scale. Electronic media use and 3-day food intake history were collected. Each child's mean energy intake and time spent eating were compared between meals consumed with and without electronic media. Results58% of children watched electronic media while eating. Children with feeding difficulties ingested significantly more energy per meal when they watched media (184.0 ± 104.0 vs 152.7 ± 67.0, p = 0.04). Children without feeding difficulties spent significantly more minutes per meal when watching media (29.9 ± 10.1 vs 26.2 ± 7.6, p = 0.001). Longer total daily screen time (p < 0.001) and presence of feeding difficulties (p = 0.006) were associated with regular media use. Children who regularly used media at mealtime were significantly more likely to have a BMI-for-age z score classification as obese (16.7% VS 0.9%, p < 0.001). ConclusionMedia use during feeding is associated with greater energy intake and longer meal duration. Thai children who regularly use media at mealtime were significantly more likely to be obese. Children with longer total daily screen time, and those with feeding difficulties are more likely to regularly use media at mealtime.

Feeding Difficulty Among Chinese Toddlers Aged 1-3 Years and Its Association With Health and Development.

Feeding problems are biopsychosocial in nature and have a great influence on children's growth. The aim of this study was to profile the status and possible influencing factors of feeding difficulty among normal Chinese toddlers, and to investigate its association with health and development. This study is a part of the Young Investigation (YI study) conducted in 10 cities in China. Data from 924 children aged 1–3 years were analyzed. Data on socio-demographic factors, feeding behaviors, self-reported diseases, and anthropometry parameters were collected. Blood samples were drawn to determine hemoglobin levels. Feeding difficulty was evaluated by the Montreal Children's Hospital Feeding Scale (MCH-FS). Ages and Stages Questionnaires, Third Edition (ASQ-3) were used to assess developmental progress. Multivariable analyses were performed to explore the potential associations. The mean total score of the MCH-FS was 35.21 ± 12.90 and the highest scored item was “acting up/making a big fuss during mealtimes.” Feeding difficulty occurred more often among children with picky eating behavior or whose caregivers once used the strategy of pre-mastication. Children with feeding difficulty had lower intakes of cereals, vegetables, and fruits, and were more likely to suffer from diarrhea (OR, 2.04; 95%CI: 1.32, 3.11) or constipation (OR, 2.04; 95%CI: 1.27, 3.24), but not anemia. Feeding difficulty was also negatively associated with weight, height, head circumference and mid-upper-arm circumference-related Z-scores (P all < 0.05). In addition, it was related to poorer fine motor skills, personal and social skills, and total scores of ASQ-3 (β, −9.00; 95%CI: −15.11, −2.89). Feeding difficulty assessed by MCH-FS showed a negative association with children's health and development, supporting the need for early identification.

Feeding Difficulty and Its Association with Growth and Development Among Young Children in China

Abstract Objectives To profile the current status of feeding difficulty, and to investigate its association with growth and development of Chinese young children. Methods A cross-sectional survey named YI Study was conducted among children aged 1 to 3 years in four cities (Beijing, Ningbo, Shenyang and Xuchang) of China in 2019. Feeding-related information and anthropometry indicators including height, weight, head circumference (HC) and mid-upper arm circumference (MUAC) were collected by trained interviewers. Feeding difficulty was evaluated by the Montreal Children's Hospital Feeding Scale (MCHFS), which is a brief 14 item-7point Likert parental report tool to assess about feeding and growth. Children with a total score of at least one standard deviation above the mean were marked as having feeding difficulty. The weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), BMI-for-age Z-score (BAZ), HC-for-age Z-score (HCZ), and MUAC-for-age Z-score (MUACZ) were calculated using the WHO Anthro software. Binary logistic regression and Multiple linear regression were used to explore the risk factors of feeding difficulty and its association with anthropometry parameters. Results Of the 376 children included, the total score of MCHFS was 34.26 ± 12.66. Among all the 14 items, the item with the highest (3.33 ± 1.99) and lowest (1.67 ± 1.25) score was “acting up/making a big fuss” and “Gagging/spiting/vomiting with certain types of food”, respectively. After adjustment for age, gender, area, family monthly income and physical activity, results of binary logistic regression showed that children with early addition of complementary food (early than 6 months, P = 0.027), self-reported pickiness (P &amp;lt; 0.001) or food allergy (P = 0.024) were more likely to suffer from feeding difficulty. Multiple linear regression showed that feeding difficulty was negatively associated with WHZ (β = −0.299, P = 0.022), HAZ (β = −0.434, P = 0.004), WAZ (β = −0.424, P &amp;lt; 0.001), HCZ (β = −0.542, P &amp;lt; 0.001) and MUACZ (β = −0.517, P &amp;lt; 0.001), expect BAZ. Conclusions Using MCHFS, feeding difficulty was detected among Chinese young children, which may be related to their growth and development to some extent. Funding Sources This study was supported by the Inner Mongolia Yili Industrial Group Co. Ltd.

Parental feeding concerns of infants and young children with oesophageal atresia.

Feeding problems have been described in young children with oesophageal atresia (OA). The primary aim of this study was to determine the specific concerns of parents and carers of infants and young children with OA regarding introducing solids and moving up to family foods. A questionnaire was developed for parents and carers of infants and children with OA, aged 12 months to 6 years. Questionnaires were completed by 20 parents attending a multidisciplinary OA clinic between June 2016 and June 2017. Demographics and parental concern regarding feeding milestones were collected. The Montreal Children's Hospital Feeding Scale was completed. The majority of children (95%) had type C OA. Eleven (55%) parents agreed/strongly agreed that they were concerned about their child's feeding prior to the introduction of solids and about moving to more textured solids. The most common concern was choking and food impaction for both time points. Twelve (60%) parents agreed/strongly agreed that the majority of mealtimes in their child's first 1-2 years of life were stressful. Thirteen (65%) parents reported avoiding particular foods due to their child's OA. The majority of children (n = 17) had no feeding difficulty according to an objective scale, and the rest had minor difficulty. Parental concern around feeding still exists in infants and children without a severe feeding difficulty. Multidisciplinary involvement, including a dietitian and speech pathologist, from an early age is important for infants and children with OA.

Impact of asthma on children´s gustatory sensitivity, masticatory and feeding behaviors

Asthma is a chronic inflammatory disease, in which disturbances in breathing, masticatory and swallowing functions may impact the eating behavior. The aim of the study was to evaluate the impact of asthma on taste sensitivity, masticatory behavior and feeding problems in children. The sample consisted of 91 children (6-7y) divided into two groups: asthma (n=46) and control group (n=45). Interviews were held with parents/guardians and clinical examinations were performed to gather information on medical, dental and feeding aspects. The gustatory sensitivity for sucrose and urea (sweet and bitter, respectively) were measured by staircase method designed for this age-range. The respiratory and masticatory functions were evaluated using the Orofacial Myofunctional Evaluation with Scores-expanded (OMES-e) protocol. Feeding problems were assessed using the Montreal Children's Hospital Feeding Scale, exploring oral motor, sensory, appetite, maternal concerns, child's behavior, and strategy aspects after transcultural adaptation to Brazilian Portuguese. The two groups were homogeneous relative to sociodemographic characteristics and nutritional status. Although the total OMES-e scores did not differ between groups, the frequency of changes in food incision and escape were different (p=0.007 and p=0.0011, respectively). The Asthma group required more time and higher number of masticatory cycles to eat the test-food (p<0.05). The gustatory thresholds for sweet and bitter were different, with asthmatic children requiring significantly higher concentrations to perceive the taste (p<0.001). The frequency of children classified by their parents according to feeding difficulties also differed between groups (p=0.001; Fisher's exact test). Asthmatic children showed remarkable changes in taste, chewing and eating behaviors, thereby pointing out the eating problems they may experience, which should be considered when designing and implementing therapeutic interventions.

Feeding characteristics of infants in a lower-middle-income country.

To describe feeding characteristics (such as breast feeding and complementary feeding) and determine the nature of feeding difficulties of infants in a primary health-care clinic (PHC) in South Africa. A total of 200 infants aged 6-12 months (mean = 8.54, standard deviation = 2.18) received a feeding screening by a speech-language therapist at a PHC in a semi-urban area using the Montreal Children's Hospital-Feeding Scale (MCH-FS). Children who failed screening underwent further clinical feeding evaluation using the Schedule of Oral Motor Assessment. The sample consisted of 200 participants, and most participants (n = 174; 87%) received breastfeeding, irrespective of their mothers' human immunodeficiency virus status. The longer the breastfeeding period, the less likely parents were to show concern about infants' feeding (P = 0.035). Complementary feeding was introduced between 6 and 8 months (n = 122; 82%). The MCH-FS identified 13 participants with feeding difficulties (6.5%), of which 11 were diagnosed with oral motor dysfunction (OMD) using the Schedule of Oral Motor Assessment. The 6.5% (n = 13) that failed had mild (n = 8; 61.5%), moderate (n = 2; 15.4%) and severe (n = 3; 23.1%) feeding difficulties, as reported by care givers using the MCH-FS. The MCH-FS showed that distraction during meals/following infants (n = 42; 21%); food refusal (n = 31; 15.5%); care giver unease about feeding (n = 29; 14.5%); and problems with vomiting, gagging or spitting (n = 28; 14%) were characteristics of feeding in this sample. Participants in the age groups 6 (n = 3; 27.3%) and 10 months (n = 3; 27.3%) were prone to OMD. This study is the first of its kind to describe the feeding characteristics of a group of infants during the transitional feeding stage in late infancy in South Africa. Important findings were the existence of OMD in 11 infants and feeding difficulties during transitional feeding in 13 infants. The study's findings may be used as a starting point for larger-scale studies in a similar setting, investigating the development of future care giver education and health-care professional training programmes regarding transitional feeding. Research endeavours by speech-language therapists need to prioritise late infancy and transitional feeding in order to prevent possible difficulties arising from sub-optimal care giver feeding practices. The study may be valuable to all health-care providers in PHC.

Turkish Montreal Children's Hospital Feeding Scale

Turkish Montreal Children's Hospital Feeding Scale

DOZ047.22: FEED-EASY: feeding disorders in children with esophageal atresia study

Abstract Introduction With advances in surgical and neonatal care, survival of patients with esophageal atresia (EA) has improved over time. While a number of conditions associated with EA may have an impact on feeding development (delayed primary anastomosis, anastomotic leaks, recurrent tracheoesophageal fistula, anastomotic stricture, gastroesophageal reflux, esophageal dysmotility, etc.) and although children with EA experience a number of oral aversive events in their first year of life, feeding disorders (FD) are poorly described and frequently unrecognized. The primary aim of this study was to describe FD in children born with EA, with a standardized scale. The secondary aim was to describe conditions associated with FD. Methods FEED-EASY is a multicentric French study. Parents of children born with EA between 2013 and 2016 in one of the 22 participating centers were asked to participate and received the French version of the standardized and reproductive ‘Montreal Children's Hospital Feeding Scale (MCH-FS)’. Results One hundred and forty-five children were included; 61 (42%) had FD according to the MCH-FS. These children were characterized by disinterest in food, oral hypersensitivity, difficulty in touching some textures and food avoidance, with an influence in quality of life. Nineteen (13%) were tube-fed between 1 and 4 years of age. Birth weight and chronic respiratory difficulties were associated with FD in children with EA. Anastomotic stricture (present in 31% of the included children) was not associated with FD. Conclusions FD is frequent and unrecognized in children with EA, and can influence growth and quality of life. MCH-FS allows pediatricians to identify FD in children with EA within a couple of minutes.

DOZ047.20: Growth, feeding difficulties, and developmental scores in children born with esophageal atresia: a single-center study

Abstract Background Children with repaired tracheoesophageal fistula/oesophageal atresia (TOF/OA) often have ongoing feeding difficulties and poor growth related to esophageal dysmotility, strictures, gastroesophageal reflux, aspiration, and respiratory infections. The impact of neurocognitive development on feeding in this cohort is less well studied. Objective The objective of this study was to investigate the growth, parent-reported feeding difficulties, and developmental scores of children with TOF/OA at The Children's Hospital at Westmead in Sydney, Australia. Methods The validated Montreal Children's Hospital Feeding Scale (MCH-FS) was completed by parents of patients aged 6 months to 6 years at a multidisciplinary aerodigestive clinic between February 2016 and October 2018. Growth, developmental outcomes (using the Bayley Scales of Infant and Toddler Development [BAYLEY-III]), demographic information, OA subtype, and associated comorbidities were reviewed. Results Forty-three caregivers completed the MCH-FS at least once, with questionnaires returned up to five times, totaling 101 reviews. The mean age was 4 years (± 1.9) and 53% were female. Thirty percent of patients were born prematurely and 30% had VACTERL association. Mean [± SD] growth z-scores were below WHO/CDC means for weight (−0.86 ± 1.37), length/height (−0.70 ± 1.2), and weight-for-length/BMI (−0.35 ± 1.15). BAYLEY-III scores were available for 27 children at 13 (± 1) months. Mean scores for four domains were within ‘average’ range (8–12): cognition (11 ± 2), receptive language (8 ± 3), expressive language (8 ± 2), and fine motor skills (9 ± 2). The mean gross motor score was below average (7 ± 3). Parent-reported feeding difficulties were moderate. When first completed, cumulative MCH-FS scores indicated 44% of patients had severe feeding difficulties, 40% moderate, and 14% mild. Sixty percent of patients required referral to a speech pathologist. However, most parents did not feel that these feeding difficulties influenced the relationship with their child or their family (88% and 84%, respectively). Conclusions The majority of patients in the cohort experienced significant feeding difficulties and some below average developmental scores, underscoring the need for multidiscplinary support for children born with TOF/OA. Further work in correlating growth, developmental, and feeding outcomes within subjects will assist in identifying early risk factors that may highlight infants most predisposed to these challenges, and who may benefit from early intervention.

DOZ047.07: Parental feeding concerns of infants and children with esophageal atresia

Abstract Background Feeding problems have been described in children with esophageal atresia (EA). This can cause high levels of parental/caregiver concern. Aims The primary aim of this study was to determine specific feeding concerns of parents/caregivers of infants and young children with EA, including introducing solids and grading up to family foods. Methods A questionnaire was developed for parents/caregivers of infants/children with EA, aged 12 months to 6 years. Questionnaires were completed by 20 parents of infants/children attending a multidisciplinary EA clinic between June 2016 and June 2017. All children had type C EA. Demographics, feeding history, and parental concerns around feeding were assessed. The Montreal Children's Hospital Feeding Scale was also completed by parents. Results Eleven (55%) parents agree/strongly agree that they were concerned about their child's feeding prior to the introduction of solids and about moving from a smooth puree to more textured solids. The most common concerns were choking and food impaction for both time points. Twelve (60%) parents agree/strongly agree that the majority of mealtimes in their child's first 1–2 years of life were stressful. Thirteen (65%) parents reported avoiding particular foods due to their child's EA. The majority of children (n = 17) had no feeding difficulty according to an objective scale, with the rest minor. Conclusions This study highlights that parental concern around feeding still exists in infants and children without a severe feeding difficulty and needs to be addressed. Multidisciplinary involvement including a dietitian and speech pathologist from an early age is important for infants and children with EA. Further education provided to parents/caregivers may assist with reduced stress around feeding and create more positive mealtime behaviours.

Parent-report instruments for assessing feeding difficulties in children with neurological impairments: a systematic review.

This study aimed to review the psychometric properties and clinical application of parent-report instruments that assess feeding difficulties in children with neurological impairments. Papers were identified through five electronic databases based on 15 keywords and were included if they met the following criteria: published in English, described the implementation of parent-report instruments, and included children with neurological impairments (either in the report or a related study population). In total, 1220 relevant abstracts were screened and 22 full-text articles were evaluated. The following six parent-report instruments met the inclusion criteria: (1) Screening Tool of Feeding Problems applied to children, (2) Paediatric Eating Assessment Tool, (3) Paediatric Assessment Scale for Severe Feeding Problems, (4) Montreal Children's Hospital Feeding Scale, (5) Children's Eating Behaviour Inventory, and (6) Behavioural Paediatric Feeding Assessment Scale (BPFAS). Based on comprehensive psychometric testing and consistently good results, the BPFAS was considered the most valid and reliable instrument. The BPFAS also showed good clinical applicability because it was readily available, required a short administration time, and used a simple scoring system. We reviewed the available parent-report instruments for assessing feeding difficulties in children with neurological impairments. The BPFAS had the best psychometric properties and clinical applicability. Six parent-report instruments were suitable for assessing feeding in children with neurological impairments. The Behavioural Paediatric Feeding Assessment Scale (BPFAS) has the strongest psychometric properties. The BPFAS also has good clinical applicability.

Measuring feeding difficulties in toddlers with Down syndrome

Early feeding problems occur frequently across the population, but have a higher incidence in children with Down syndrome (DS). Early identification can possibly be improved with the help of a valid screening instrument based on caregiver reports. In a previous study, we investigated the concurrent validity of the Dutch version of the Montreal Children's Hospital Feeding Scale (MCH-FS, SEP in Dutch) in a sample of typically developing toddlers, and we found a correlation between the score on the instrument and observed behavior during a regular meal. The current pilot study was a replication in a sample of children with DS (aged 1; 0–3; 0) and their primary caregivers (n = 32).The results showed that children in the sample did not score higher on the SEP than children in their respective norm groups. In addition, when caregivers reported more symptoms of feeding problems on the SEP, children showed more food refusal and negative affect during the observed meal. This suggests that the screening instrument is particularly associated with negative mealtime interactions. This is in contrast with earlier results, which mainly indicated a relation with eating skills.

The Montreal Children’s Hospital Feeding Scale: Relationships with parental report of child eating behaviours and observed feeding interactions

Feeding problems are common, with implications for nutrition, growth and family stress, placing burden on primary care services. The Montreal Children's Hospital Feeding Scale (MCHFS) is a quick and reliable measure of feeding problems for clinical settings, but there is little examination of its relationship to commonly used research measures of parental feeding practice, child eating behaviour and observations of parent-infant interaction at mealtimes. We examined the relationships between the MCHFS, demographics and early feeding history, weight across the first year, parental report of feeding practices and child eating behaviours, and observations of maternal-infant feeding interaction at 1 year. The MCHFS, Comprehensive Feeding Practices Questionnaire (CFPQ) and Child Eating Behaviour Questionnaire (CEBQ) were completed by 69 mothers when their infants were 1-year-old (37 male, 32 female). Infant weight was measured at 1 week, 1 month, 6 months and 1 year. Mothers were observed feeding their infants at 1 year. The MCHFS was reliable (Cronbach's alpha = .90) and showed significant overlap with other measures of feeding and eating. Potential feeding problems were identified in 10 of the children (14%) reflecting similar rates in other community samples. Higher MCHFS scores were associated with lower birthweight and weight across the first year, greater satiety responsiveness, fussiness and slowness in eating, lower enjoyment of food and food responsiveness, and less observed infant food acceptance. Parents of infants with more feeding problems reported less encouragement of balance and variety in their children's diets. Conclusion: MCHFS showed good criterion validity with other parental report measures of eating and observations of mealtime interactions. MCHFS may be a useful tool for researching feeding problems in community samples.