Development and validation of a scale to assess Feeding at Sleep Time (FeAST) among infants and toddlers

Feeding practices adopted by parents play a critical role in the development of children's taste preferences, eating habits, nutrition and eventual weight status. Many scales have been developed to assess feeding practices among children of various age groups. This paper aimed to construct and validate a robust scale for the comprehensive assessment of sleep-time feeding practices for children aged 0-3 years and to establish the risk of developing Early Childhood Caries (ECC).

There were multiple phases to the development of the scale: (a) formation of a conceptual framework, (b) systematic development of an item pool, (c) refinement of the item pool by focus group discussion, cognitive interviewing and pretesting, (d) validity testing and (e) reliability testing. The conceptual framework was built based on four broad constructs: breastfeeding, bottle-feeding, other feeding modes and 'tooth and diet' constructs. Reviews of existing scales in related areas were instrumental in scale development and helped to generate an initial pool of 45 items, which was finally refined to 28 items.

Cognitive interviews by the 'think-aloud protocol' helped to reduce ambiguity and maximize clarity of the questions. Pretesting the scale aided increased comprehension and specificity. Face and content validity were corroborated by 'subject matter experts' who endorsed the suitability and appropriateness of items. Reliability was assessed by test-retest, and a near-perfect agreement was obtained in 96% of the items.

This is the first validated scale currently available for recording sleep-time feeding practices of children less than three years of age. This 28-item scale can be applied as a potential clinical scale to record sleep-time feeding history and the risk of developing ECC as well as a research scale to investigate the association of sleep-time feeding practices with ECC.