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Psychometric Properties of the Early Feeding Skills Assessment Tool

Thoyre, Suzanne M., PhD, RN, FAAN; Pados, Britt Frisk, PhD, RN, NNP-BC; Shaker, Catherine S., MS/CCC-SLP, BCS-S; Fuller, Kristy, OTR/L; Park, Jinhee, PhD, RN

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000537
Original Research

Background: Supporting infants as they develop feeding skills is an essential component of neonatal and pediatric care. Selecting appropriate and supportive interventions begins with a thorough assessment of the infant's skills. The Early Feeding Skills (EFS) tool is a clinician-reported instrument developed to assess the emergence of early feeding skills and identify domains in need of intervention.

Purpose: The purpose of this study was to identify the factor structure of the EFS and test its psychometric properties, including internal consistency reliability and construct validity.

Methods: EFS-trained interprofessional clinicians in 3 settings scored 142 feeding observations of infants 33 to 50 weeks' postmenstrual age. Redundant and rarely endorsed items were removed. Factor analysis methods clustered items into subscales. Construct validity was examined through the association of the EFS with (1) concurrently scored Infant-Driven Feeding Scale-Quality (IDFS-Q), (2) infant birth risk (gestational age), and (3) maturity (postmenstrual age).

Results: Principal components analysis with varimax rotation supported a 5-factor structure. The total EFS demonstrated good internal consistency reliability (Cronbach α= 0.81). The total EFS score had construct validity with the IDFS-Q (r =−0.73; P < .01), and with gestational age of a subsample of premature infants (r = 0.22; P < .05).

Implications for Practice: As a valid and reliable tool, the EFS can assist the interprofessional feeding team to organize feeding assessment and plan care.

Implications for Research: The strong psychometric properties of the EFS support its use in future research.

School of Nursing, The University of North Carolina, Chapel Hill (Dr Thoyre); Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts (Drs Pados and Park); Florida Hospital for Children, Orlando (Ms Shaker); and University of Iowa Stead Family Children's Hospital, Iowa City (Ms Fuller).

Correspondence: Suzanne M. Thoyre, PhD, RN, FAAN, School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599 (

Institution Where Work Occurred: School of Nursing, The University of North Carolina at Chapel Hill.

Acknowledgement: School of Nursing, The University of North Carolina at Chapel Hill; The Francis Hill Fox Distinguished Term Professor funds (Suzanne Thoyre). We would like to acknowledge the expertise of the following clinicians who participated in data collection for this study: Mary Krolikowski (Milwaukee, Wisconsin), Katelyn Brown (San Antonio, Texas), Marissa Ward (San Antonio, Texas), Veronica Cade (San Antonio, Texas), Kristie Middendorf (Cedar Rapids, Iowa), Ginger Hejtmancik (San Antonio, Texas), and Lisa Dolphin (Cedar Rapids, Iowa).

Suzanne Thoyre, Catherine Shaker, and Kristy Fuller have provided training on the EFS for pay. No conflicts of interest for Britt Pados or Jinhee Park.

© 2018 by The National Association of Neonatal Nurses