Table 2 Problematic Feeding Definitions and Prevalence Calculations

Adams-Chapman, 2013 [14]

Informal/Clinical Assessment

Dysfunctional feeding defined as: 1) medical order not to ingest feedings by mouth, 2) need for gastrostomy or tube feedings, 3) gags/chokes or coughs with feeds, 4) documented aspiration, 5) excessive drooling during feeds, or 6) difficulty swallowing.

13% of the sample were reported to have dysfunctional feeding per the definition at left.

Adams-Chapman, 2015 [13]

Informal/Clinical Assessment

Abnormal feeding defined as: unable to tolerate foods by mouth, requiring tube feeds for > 50% of nutritional intake, or choking, gagging, coughing, or gasping with solids. Drooling continuously or having documented history of dysphagia or aspiration were also considered abnormal.

47% had abnormal feeding at 18 months. 25% had abnormal feeding at 30 months.

Bilgin, 2016 [15]

Informal/Clinical Assessment and Faddy Eating/Food Refusal Scale

Problems in oral motor functioning were measured with the following items: (1) stopping after a few sucks, (2) excessive dribbling/difficulty swallowing, and (3) gagging/choking during the feed. Participants who endorsed 2 or 3 items were determined to have an oral-motor function problem.

Faddy eating/food refusal: At term, 3, and 6 months, endorsement of the following item was deemed faddy eating/food refusal: fighting against the bottle/breast. At 18 months, a faddy eating/food refusal scale included the following variables: Eats too little, leaves most of the food offered, poor appetite, picky eater, slow eater, refuses to eat lumpy food, or refuses to eat pureed food. Participants who endorsed 5 or more problems were determined to have faddy eating/food refusal.

Feeding problems were defined as having an oral-motor function problem and/or faddy eating/food refusal (per definitions at left). These authors found the following prevalence of feeding problems at each age: Term – 50.7%; 3 months – 20.5%; 6 months – 26%; and 18 months – 57.5%.

Buswell, 2009 [16]

Schedule for Oral Motor Assessment (SOMA)

Infants who scored on or above the threshold on the SOMA were determined to have oral motor dysfunction.

20% of the sample were found to have oral-motor dysfunction.

Cerro, 2002 [17]

Informal/Clinical Assessment

Parents’ perceptions of their child’s eating behavior were explored using an unpublished 48-item questionnaire developed in consultation with various experts and consideration of current literature. The questionnaire involved closed questions, Likert scales and specified lists.

73% of the sample was reported to have at least one feeding problem.

Crapnell, 2013 [18]

Infant – Toddler Social Emotional Assessment – Eating subscale

Children were determined to have a feeding problem if their score exceeded the ≥10th percentile of the normative sample.

23% of the sample met criteria for a feeding problem.

DeMauro, 2011 [19]

Informal/Clinical Assessment

A feeding behavior questionnaire was used that included 4 questions about oromotor dysfunction and 7 questions about avoidant feeding behavior. Participant scores were categorized as normal/low if no items were endorsed, borderline/medium if 1 item was endorsed, and high if 2 or more of the items were endorsed.

At 3 months, 33% of early preterm infants and 29% of late preterm infants had medium or high avoidant behavior. At 6 months, 18% of early preterm infants and 20% of late preterm infants had medium or high avoidant behavior. At 12 months, 14% of early preterm infants and 12% of late preterm infants had medium or high avoidant behavior.

den Boer, 2013 [5]

Informal/Clinical Assessment

Eating and drinking observed by a speech and language therapist. The feeding was then rated for: choking while drinking, choking while eating, and gagging.

40% of the sample was found to have choking while drinking. 46% of the sample was found to have choking while eating. 55% of the sample was found to have gagging during a meal. For the meta-analysis, we used an average of these problems for a prevalence of 47% of the preterm sample having feeding-related problem.

Dodrill, 2004 [20]

Royal Children’s Hospital Oral Sensitivity Checklist

A subset of questions on the Royal Children’s Hospital Oral Sensitivity Checklist evaluates the child’s response to stimulation of the oral region. Abnormal sensitivity was defined as any behavior suggesting abnormal sensitivity, included behaviors such as head turning, gagging, and vomiting with oral stimulation.

100% of the sample displayed behaviors suggestive of abnormal oral sensitivity.

Enomoto, 2017 [21]

Informal/Clinical Assessment

A feeding problem was defined as oral feeding difficulty requiring a milk-thickening agent.

17.1% of the sample required a milk-thickening agent.

Hawdon, 2000 [22]

Neonatal Oral Motor Assessment Scale (NOMAS)

Feeding pattern was categorized according to the NOMAS as normal, disorganized, or dysfunctional.

Of the 27 preterm infants in the sample, 11(i.e., 40.7%) were found to have either disorganized or dysfunctional feeding.

Hoogewerf, 2017 [2]

Montreal Children’s Hospital Feeding Scale (MCHFS)– Dutch version

Children were categorized as having a feeding problem if their score on the MCHFS was > 1 standard deviation from the mean score of the reference population.

Of the children born extremely preterm, 26.3% of the sample were found to have a feeding problem. 19.5% of the children born very preterm were found to have a feeding problem, while 15.8% of children born moderately preterm were found to have a feeding problem.

Johnson, 2016 [4]

17-item “Validated eating behavior questionnaire”

Total eating difficulties score was calculated for the 17-item questionnaire. A score > 90th percentile of the term, control group was considered significant eating difficulties.

14.9% of the late- and moderately-preterm group were found to have significant eating difficulties.

Jonsson, 2013 [23]

Informal/Clinical Assessment

Questionnaire developed by authors - Symptoms measured included vomiting, eating reluctance, poor weight gain, long feeding time, or other symptoms.

48% of the preterm group were reported to have had some form of difficulty with feeding at the time of being discharged from the hospital.

Kmita, 2011 [24]

Informal/Clinical Assessment

Parental descriptions of feeding behavior were explored through exploratory analysis of semi structured interviews and daily diaries.

Parents reported no problems with feeding in 31.8% of group 1 and 44.4% of group 2. We then calculated that 68.2% of group 1 and 55.6% of group 2 had some problematic feeding behavior.

Mathisen, 2000 [25]

Schedule for Oral Motor Assessment (SOMA)

Scores on or above the threshold of the SOMA met criteria for oral motor dysfunction.

80% of the extremely low birth weight infants were reported to have feeding problems.

Nieuwenhuis, 2016 [26]

Montreal Children’s Hospital Feeding Scale (MCHFS) – Dutch version

Scores on the MCHFS – Dutch version >84th percentile met criteria for a feeding problem.

11% of the preterm sample was found to have a score on the MCHFS – Dutch version that met criteria for a feeding problem.

Pridham, 2007 [27]

Child Feeding Skills Checklist

Preterm-born children were observed using the Child Feeding Skills Checklist to assess feeding skills that would be expected at 1, 4, 8, and 12 months corrected gestational age.

Pridham and colleagues reported the percent of the sample that was able to perform the oral-motor skills expected at each time of measure. From this, we calculated the average percent of the sample at each time of measure that was not able to perform the expected oral-motor skill, and therefore determined to have some degree or problematic feeding. At 1 month, an average of 28.7% were not able to perform the expected oral-motor skills. At 4 months, an average of 19.8% were not able to perform expected skills. At 8 months, an average of 34.5% were not able to perform expected skills. At 12 months, an average of 41.2% were not able to perform expected skills.

Sanchez, 2016 [3]

Schedule for Oral Motor Assessment (SOMA)

Oral motor feeding impairment was defined as failing ≥1 SOMA challenge.

38% of the sample of preterm children failed ≥1 SOMA challenge.

Sweet, 2003 [28]

Informal/Clinical Assessment

“Feeding problems” observed during neonatal follow-up clinic visit.

13 of the 21 infants (i.e., 62%) who returned for the 2 year follow-up were found to have feeding problems.

Torola, 2012 [29]

Neonatal Oral Motor Assessment Scale (NOMAS)

The NOMAS categorizes the sucking pattern into normal, disorganized or dysfunctional.

None of the preterm infants had a normal sucking pattern. 84.2% had disorganized sucking while 15.8% had a dysfunctional sucking pattern.

Wood, 2003 [30]

Informal/Clinical Assessment

Feeding history obtained using a semi-structured interview.

Parents of 33% of children reported feeding difficulties at 30 months corrected gestational age.