The Montreal Children's Hospital Feeding Scale: A brief bilingual screening tool for identifying feeding problems

Feeding problems occur in 25% to 50% of healthy infants and toddlers, representing a significant issue in the paediatric population (1–3). Although some feeding problems are relatively common and transient in nature, 3% to 10% of children present with more severe forms of feeding problems that, if left untreated, place them at risk for malnutrition, failure to thrive, and behavioural and developmental disturbances (4,5). Although feeding problems tend to be nonmedical in nature, they may well be the result of medical disorders or interventions that interfere with the normal development of feeding skills. Today, most clinicians agree that feeding problems are biopsychosocial in nature (6) because both physiological and psychosocial factors contribute to their initiation and maintenance. The causes of feeding difficulties may be skill based (oral sensory-motor disorders [7–9]) and/or motivation based (inherent or acquired), which is likely to result in poor weight gain (10–12) and influence the willingness to try new food tastes and textures. These physiological factors tend to trigger altered mealtime behaviours and interactions with parents, which subsequently maintain or increase the severity of feeding problems (8,13). A number of standardized psychometric tools have been developed over the past 25 years to assess feeding problems. The earlier tools were observational scales of mother-child interactions during a mealtime (14,15), whereas more recent scales such as the Children’s Eating Behaviour Inventory (CEBI [16]), the Behavioral Pediatrics Feeding Assessment Scale (BPFAS [17]), and the Children’s Eating Behaviour Questionnaire (18) use parental report to assess child mealtime behaviours. The development of both the CEBI and the BPFAS was based on the assumption that both child and parental characteristics contribute to childhood eating and mealtime problems. The CEBI consists of 40 items pertaining to the child and parent behaviours, as well as interactions between family members. For each item, the respondent indicates how often the behaviour occurs on a five-point Likert scale, and whether the item is perceived to be a problem. The scale, applicable to children two to 12 years of age, has good validity and reliability (16). The BPFAS is a 35-item parent report measure of the child’s mealtime behaviours and related parental reactions. The scale includes new items and reworded items from the CEBI. The scale, developed for children nine months to eight years of age, has adequate reliability. More importantly, results of their validity study (19) showed that children with feeding difficulties engage in the same type of feeding behaviours as children in a nonclinical sample, but at an increased frequency. Although these two scales are reliable and valid tools for the assessment of feeding problems, they do not lend themselves to quick identification of these problems. Paediatricians and other clinicians need access to a valid and reliable instrument that can quickly verify parental complaints about their child’s feeding problems; otherwise, parental complaints may go unnoticed (20,21). Therefore, the purpose of our study was to develop and evaluate a one-page, easily administrable feeding scale that could help clinicians identify feeding problems within a couple of minutes in their offices. In addition, given the bilingual nature of the paediatric population in several hospitals in Canada, the development of a bilingual feeding scale was deemed to be desirable.