[en] [en] OBJECTIVE: Feeding difficulties are common in children with and without somatic conditions. Our objective was to develop a parent-report questionnaire (ORALQUEST) designed to be administered by a professional and to assess feeding difficulties in children aged 9 months to 6 years.
METHODS: The questionnaire explores four domains: eating behavior, oral skills, tactile and oral sensitivity, and family environment. A validation study was done in 338 children seen for feeding difficulties (n = 74) or receiving follow-up for conditions at risk for feeding difficulties (n = 264). We assessed the validity and reliability of the tool and we conducted a receiver operating characteristic (ROC) analysis to determine the best total-score cutoff.
RESULTS: The final version of the ORALQUEST has 40 items and produces a total score and four sub-scores. Structural validity, internal consistency, and reliability were excellent; convergent validity was good to acceptable but was challenging to assess given the absence of similar tools for comparisons. The optimal total-score cutoff was 27. Among children seen for feeding difficulties, 85% had a total score ≥ 27. Total scores above the cutoff were less common than expected in children with chronic conditions (esophageal atresia, 39%; autism spectrum disorder, 42%; complex congenital heart disease, 29%; Robin sequence, 31%; and cleft palate, 18%).
CONCLUSION: ORALQUEST for assessing feeding difficulties in young children demonstrated good psychometric properties in children with and without somatic conditions. The investigation by ORALQUEST of four domains may help to determine the best management strategy.
Disciplines :
Pediatrics
Author, co-author :
Thouvenin, Béatrice; General Paediatric Unit, Necker University Hospital, Paris, France
Ould-Ammar, Redha; Unit of Clinical Research, AP-HP, University Necker Hospital, Paris, France
Ouss, Lisa ; Université de Liège - ULiège > Département des sciences cliniques > Psychiatrie infanto-juvénile ; Child Psychiatry Unit, Necker University Hospital, Paris, France
Gavelle, Pascale; Maxillo Facial Surgery Unit, Necker University Hospital, Paris, France
Disnan, Giulia; Paediatric Surgery, Necker University Hospital, Paris, France
Royer, Aurélie; General Paediatric Unit, Necker University Hospital, Paris, France ; Reference Centre for Rare Disease «Robin Sequence and Sucking and Swallowing Congenital Disorders», Necker University Hospital, Paris, France
Vegas, Nancy; General Paediatric Unit, Necker University Hospital, Paris, France ; Reference Centre for Rare Disease «Robin Sequence and Sucking and Swallowing Congenital Disorders», Necker University Hospital, Paris, France ; Paris Cité University, Paris, France
Fraysseix, Catherine du; General Paediatric Unit, Necker University Hospital, Paris, France
Adnot, Pauline; General Paediatric Unit, Necker University Hospital, Paris, France ; Reference Centre for Rare Disease «Robin Sequence and Sucking and Swallowing Congenital Disorders», Necker University Hospital, Paris, France
Barbieri, Valeria; General Paediatric Unit, Necker University Hospital, Paris, France
Hassler, Christine; CESP Centre of Epidemiology and Population Health, INSERM, Villejuif, France
Elie, Caroline; Unit of Clinical Research, AP-HP, University Necker Hospital, Paris, France ; Université Paris Cité, Inserm, Pharmacologie et Évaluations Des Thérapeutiques Chez L'enfant Et La Femme Enceinte, Paris, France
Barry, Caroline; CESP Centre of Epidemiology and Population Health, INSERM, Villejuif, France
Abadie, Véronique ; General Paediatric Unit, Necker University Hospital, Paris, France ; Reference Centre for Rare Disease «Robin Sequence and Sucking and Swallowing Congenital Disorders», Necker University Hospital, Paris, France ; Paris Cité University, Paris, France ; CESP Centre of Epidemiology and Population Health, INSERM, Villejuif, France
Rogers S, Ramsay M, Blissett J. The Montreal Children's Hospital Feeding Scale: relationships with parental report of child eating behaviours and observed feeding interactions. Appetite. 2018;125:201-209. doi:10.1016/j.appet.2018.02.007
Goday PS, Huh SY, Silverman A, et al. Pediatric feeding disorder: consensus definition and conceptual framework. J Pediatr Gastroenterol Nutr. 2019;68(1):124-129. doi:10.1097/MPG.0000000000002188
DSM5 Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition, Text Revision (DSM-5-TR™), American Psychiatric Association, Ed. Amer Psychiatric Pub Inc. 2022.
Raven Morris N, Daw H, Bates L, Horniblow RD. Utilising the diagnostic criteria of paediatric feeding disorder: updated findings from a population-based cohort study. J Pediatr Gastroenterol Nutr. 2025;82(1):33-41. doi:10.1002/jpn3.70258
Pergeline H, Gonnet L, Fernandez A, Solla F, Poinso F, Guivarch J. Diagnosis and treatment of pediatric feeding disorders: a narrative literature review. Children. 2025;12(3):333. doi:10.3390/children12030333
Heckathorn DE, Speyer R, Taylor J, Cordier R. Systematic review: non-instrumental swallowing and feeding assessments in pediatrics. Dysphagia. 2016;31(1):1-23. doi:10.1007/s00455-015-9667-5
Ramsay M, Martel C, Porporino M, Zygmuntowicz C. The Montreal Children's Hospital Feeding Scale: a brief bilingual screening tool for identifying feeding problems. Paediatr Child Health. 2011;16(3):147-e17, e16-e17. doi:10.1093/pch/16.3.147
Archer LA, Rosenbaum PL, Streiner DL. The children's eating behavior inventory: reliability and validity results. J Pediatr Psychol. 1991;16(5):629-642. doi:10.1093/jpepsy/16.5.629
Berlin KS, Davies WH, Silverman AH, Woods DW, Fischer EA, Rudolph CD. Assessing children's mealtime problems with the Mealtime Behavior Questionnaire. Children's Health Care. 2010;39:142-156. doi:10.1080/02739615.2024.2405216
Crist W, Napier-Phillips A. Mealtime behaviors of young children: a comparison of normative and clinical data. J Dev Behav Pediatr. 2001;22(5):279-286. doi:10.1097/00004703-200110000-00001
Thoyre SM, Pados BF, Park J, et al. Development and content validation of the Pediatric Eating Assessment Tool (Pedi-EAT). Am J Speech Lang Pathol. 2014;23:46-59. doi:10.1044/1058-0360(2013/12-0069
Falissard B. Mesurer la subjectivité en santé - Perspective méthodologique et statistique. Ed Masson Abrégés, 2008.
Rouquette A, Falissard B. Sample size requirements for the internal validation of psychiatric scales. Int J Methods Psychiatr Res. 2011;20(4):235-249. doi:10.1002/mpr.352
Primer A, Boateng GO, Neilands TB, Frngillo EA, Melgar-Quinonez HR, Young SL. Best practices for developing and validating scales for health, social, and behavioral research. Front Public Health. 2018;6(149):1-12. doi:10.3389/fpubh.2018.00149
Jellinek MS, Murphy JM, Robinson J, Feins A, Lamb S, Fenton T. Pediatric symptom checklist: screening school-age children for psychosocial dysfunction. J Pediatr. 1988;112(2):201-209. doi:10.1016/s0022-3476(88)80056-8
Skuse D, Stevenson J, Reilly S, Mathisen B. Schedule for oral-motor assessment (SOMA): methods of validation. Dysphagia. 1995;10(3):192-202. doi:10.1007/BF00260976
De Oliveira Lira Ortega A, Ciamponi AL, Mendes FM, Santos MTBR. Assessment scale of the oral motor performance of children and adolescents with neurological damages. J Oral Rehabil. 2009;36(9):653-659. doi:10.1111/j.1365-2842.2009.01979.x
Dunn W. Infant/Toddler Sensory Profile User's Manual. Ed. Elsevier. 2002.
Dunn W, Westman K. The sensory profile: the performance of a national sample of children without disabilities. Am J Occup Ther. 1997;51(1):25-34. doi:10.5014/ajot.51.1.25
Speilberger CD, Gorsuch RL, Lushene RE, Vagg PR, Jacobs g. Manual for the State-Trait Anxiety Inventory (Form Y). Consulting Psychologists Press; 1983.
Guy W. Clinical Global Impression. ECDEU Assessment Manual for Psychopharmacology -Revised. US Department of Health, Education, and Welfare, Public Health service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH; 1976.
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability. J Chiropr Med. 2016;15(2):155-163. doi:10.1016/j.jcm.2016.02.012
Unal I. Defining an optimal cut-point value in ROC analysis: an alternative approach. Comput Math Methods Med. 2017;2017:1-14. doi:10.1155/2017/376265
Rosen R. Prevalence of feeding disorders: a tough reality to swallow. J Pediatr. 2021;228:13-14.
Kerzner B, Milano K, MacLean WC, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding difficulties. Pediatrics. 2015;135(2):344-353. doi:10.1542/peds.2014-1630
Kovacic K, Rein LE, Szabo A, Kommareddy S, Bhagavatula P, Goday PS. Pediatric feeding disorder: a nationwide prevalence study. J Pediatr. 2021;228:126-131.e3. doi:10.1016/j.jpeds.2020.07.047