Research Corner: Psychometric Properties of the Early Feeding Skills (EFS) Assessment Tool

Wanted to update you on a new manuscript about the EFS which I co-authored that is now in press with Advances in Neonatal Care.  Abstract below – Dr. Thoyre and I hope to see it published ahead of print in the next few weeks. We are very excited that the psychometrics of the EFS, demonstrating its reliability and validity, will soon be published. 

Psychometric Properties of the Early Feeding Skills (EFS) Assessment Tool Abstract

 Background: Supporting infants as they develop feeding skills is an essential component of neonatal and pediatric care. Selecting appropriate and supportive interventions begins with 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 inter-professional clinicians in three settings scored 142 feeding observations of infants aged 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’s α = .81). The total EFS score had construct validity with the IDFS-Q (r = -.73; p < .01), and with gestational age of a subsample of premature infants (= .22; p < .05).

Implications for Practice: As a valid and reliable tool, the EFS can assist the inter-professional 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.

Please plan to join Dr. Suzanne Thoyre and I on August 15thand 16th for a Train-the-Trainer session on the EFS Tool in Atlanta, GA. Learn to use the EFS to effectively plan and provide an infant-guided approach to feeding. Simultaneously learn to train others back home to use the EFS to strengthen your unit’s feeding care. Review current research, the role of experience, dynamic systems theory, and feeding outcomes after NICU. Videotapes with enhanced audio of swallowing and breathing to learn key skill areas of the EFS: respiratory regulation, oral motor and swallowing function, physiologic stability, engagement, and change in coordination patterns of s-s-b as infants develop. Gain confidence scoring early feeding skills as not yet evident, emerging or established. Learn components of an infant-guided, co-regulated approach to feeding and contingent adaptations that make this approach so effective, using the EFS to plan individualized interventions. Receive teaching resources to take back to your unit to train others to use the EFS. As a group, we will network and navigate challenging issues and role-model a collaborative feeding practice. 

Bring yourself, your colleagues, or your whole feeding team! We are aiming for a multi-professional group, putting our heads together to improve feeding experiences for our most vulnerable infants. We hope to see you in Atlanta! 





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