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 thatincorporates caregivers' responses to concerns about their children's dietary intake, appetite, size, and behaviors ratherthan relying exclusively on caregiver actions. Content validity included review by an expert panel (n = 7) and testing in apilot sample (n = 105) of low-income mothers of toddlers. Construct validity and reliability were assessed among a secondsample of low-income mothers of predominately African-American (70%) toddlers aged 12-32 mo (n = 297) participatingin the baseline evaluation of a toddler overweight prevention study. Internal consistency (Cronbach's a: 0.64-0.87) andtest-retest (0.57-0.88) reliability were acceptable for most constructs. Exploratory and confirmatory factor analysesrevealed 5 theoretically derived constructs of feeding: responsive, forceful/pressuring, restrictive, indulgent, anduninvolved (root mean square error of approximation = 0.047, comparative fit index = 0.90, standardized root mean squareresidual = 0.06). Statistically significant (P < 0.05) convergent validity results further validated the scale, confirmingestablished relations between feeding behaviors, toddler overweight status, perceived toddler fussiness, and maternalmental health. The Toddler Feeding Behavior Questionnaire adds to the field by providing a brief instrument thatcan be administered in 5 min to examine how caregiver-reported feeding behaviors relate to toddler health and behavior.