Psychometrics of the Functional Oral Intake Scale for Children With Dysphagia

The functional oral intake scale (FOIS), developed for adults based on the categories of consumable food has been adapted for infants. A FOIS for children is necessary as oral motor development continues after 1 year of age. This study proposed a FOIS for children and investigated the reliability and validity of the scale.

We adapted the original FOIS into a scale for children by removing 2 item levels to generate a 5-point scale. This retrospective study included 194 children ages 1 to 7 years. Their nutrition records were evaluated separately by 2 raters using the FOIS for children. Dysphagia and aspiration severity were evaluated based on the findings from a videofluoroscopic swallowing study. For children partially dependent on tube feeding, medical records were investigated to determine whether full oral feeding was accomplished within 1 year.

The inter-rater reliability of FOIS for children had 97.4% agreement (weighted kappa = 0.985, intraclass correlation coefficient = 0.994). Significant associations were identified between the FOIS for children and aspiration severity (P < 0.001, r = 0.315) and dysphagia severity (P < 0.001, r = 0.287). The rate of reaching full oral feeding within 1 year was greater (71.4% vs 30%) in children at the FOIS 3 level (tube and oral feeding in parallel) than for children at FOIS 2 (tube-dependent with minimal oral intake).

The FOIS for children showed adequate reliability and validity and could be appropriate for documenting children's eating abilities and evaluating the effectiveness of interventions.