Systematic Development and Validation of a Theory-Based Questionnaire to Assess Toddler Feeding

Abstract

This paper describes the development and validation of a 27-item caregiver-reported questionnaire on toddler feeding. The development of the Toddler Feeding Behavior Questionnaire was based on a theory of interactive feeding that incorporates caregivers' responses to concerns about their children's dietary intake, appetite, size, and behaviors rather than relying exclusively on caregiver actions. Content validity included review by an expert panel (n = 7) and testing in a pilot sample (n = 105) of low-income mothers of toddlers. Construct validity and reliability were assessed among a second sample of low-income mothers of predominately African-American (70%) toddlers aged 12-32 mo (n = 297) participating in the baseline evaluation of a toddler overweight prevention study. Internal consistency (Cronbach's α: 0.64-0.87) and test-retest (0.57-0.88) reliability were acceptable for most constructs. Exploratory and confirmatory factor analyses revealed 5 theoretically derived constructs of feeding: responsive, forceful/pressuring, restrictive, indulgent, and uninvolved (root mean square error of approximation = 0.047, comparative fit index = 0.90, standardized root mean square residual = 0.06). Statistically significant (P < 0.05) convergent validity results further validated the scale, confirming established relations between feeding behaviors, toddler overweight status, perceived toddler fussiness, and maternal mental health. The Toddler Feeding Behavior Questionnaire adds to the field by providing a brief instrument that can be administered in 5 min to examine how caregiver-reported feeding behaviors relate to toddler health and behavior.

Hunger in the household: Food insecurity and associations with maternal eating and toddler feeding

“…Subscales have been shown to be reliable among low-income mothers of toddlers. 42 Reliability in the current sample for the restrictive feeding (α = .75 to .79) and responsive feeding (α = .74 to .79) subscales were adequate.…”

Effects of parent and child behaviours on overweight and obesity in infants and young children from disadvantaged backgrounds: systematic review with narrative synthesis

“…This relationship was not observed by Worobey and colleagues [ 72 ] in their small, cross-sectional sample ( n = 49) of low-income Hispanic mothers of four-year-old children (quality score 50 %). ‘Feeding restriction’ was also associated with higher BMI in some [ 44 , 73 ] but not all [ 72 ] studies.…”

Development, reliability, and validity testing of Toddler NutriSTEP: a nutrition risk screening questionnaire for children 18–35 months of age

“…Therefore, these two questions are considered to have adequate reliability, as they are still able to reliably classify a child into a particular risk-rating category across administrations. American mothers (n=297) (Hurley et al 2013), and relatively advantaged samples in Australia (n=111) (Bell et al 2014). Toddler NutriSTEP ® is novel in that it is comprehensive and includes attributes (e.g., physical growth and development, physical activity and sedentary behaviour, and family factors related to nutrition) in addition to dietary intake that differentiates it from the Australian food-group-based dietary questionnaire, that was validated relative to a food frequency questionnaire (Bell et al 2014).…”

“…A recently-developed Australian questionnaire focuses on toddlers' food group intake (Bell et al 2014); however, it does not include other diverse nutrition risk factors, such as physical growth and development, physical activity and sedentary behaviour, and family factors related to nutrition. Other toddler questionnaires address only caregiver feeding behaviours and practices (Chaidez et al 2011;Hurley et al 2013) and not other nutrition risk factors.…”