CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE MONTREAL CHILDREN’S HOSPITAL FEEDING SCALE INTO BRAZILIAN PORTUGUESE

Diniz, Patricia Barcellos; Fagondes, Simone Chaves; Ramsay, Maria

doi:10.1590/1984-0462/2021/39/2019377

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Revista Paulista de Pediatria

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ORIGINAL ARTICLE • Rev. paul. pediatr. 39 • 2021 • https://doi.org/10.1590/1984-0462/2021/39/2019377 copy

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE MONTREAL CHILDREN’S HOSPITAL FEEDING SCALE INTO BRAZILIAN PORTUGUESE

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To cross-culturally adapt and validate the Montreal Children’s Hospital Feeding Scale (MCH-FS) into Brazilian Portuguese.

Methods:

The MCH-FS, originally validated in Canada, was validated in Brazil as Escala Brasileira de Alimentação Infantil (EBAI) and developed according to the following steps: translation, production of the Brazilian Portuguese version, testing of the original and the Brazilian Portuguese versions, back-translation, analysis by experts and by the developer of the original questionnaire, and application of the final version. The EBAI was applied to 242 parents/caregivers responsible for feeding children from 6 months to 6 years and 11 months of age between February and May 2018, with 174 subjects in the control group and 68 ones in the case group. The psychometric properties evaluated were validity and reliability.

Results:

In the case group, 79% of children were reported to have feeding difficulties, against 13% in the control group. The EBAI had good internal consistency (Cronbach’s alpha=0.79). Using the suggested cutoff point of 45, the raw score discriminated between cases and controls with a sensitivity of 79.4% and specificity of 86.8% (area under the ROC curve=0.87).

Conclusions:

The results obtained in the validation process of the EBAI demonstrate that the questionnaire has adequate psychometric properties and, thus, can be used to identify feeding difficulties in Brazilian children from 6 months to 6 years and 11 months of age.

Keywords:
Feeding behavior; Validation study; Child; ROC curve

	Controls (n=174)	Feeding difficulty without comorbidities (n=17)	Feeding difficulty with comorbidities (n=51)	p-value
Age of the mother *	36.5 (33.8-39.0)^a	34.0 (28.5-36.5)^a,b	35.0 (29.0-38.0)^b	0.008*
Education of the mother**
Incomplete Elementary School	-	-	1 (2.0)	<0.001**
Elementary School	9 (5.2)	1 (5.9)	11 (21.6)
High School	37 (21.3)	5 (29.4)	18 (35.6 )
Higher Education	128 (73.6)	11 (64.7)	21 (41.2)
Age of the father*	38.0 (35.0-41.0)	35.0 (30.0-37.0)	36.0 (31.0-41.0)	0.032*
Education of the father**
Incomplete Elementary School	2 (1.2)	-^a,b	4 (8.3)	<0.001**
Elementary School	8 (4.6)	3 (17.6)	10 (20.8)
High School	47 (27.2)	5 (29.4)	15 (31.2)
Higher Education	116 (67.1)	9 (52.9)	19 (39.6)
Age (months)*	37 (24-56)	18 (13-33)	27 (15-40)	<0.001*
Gestational age*	39 (38-40)	39 (38-40)	37 (33-39)	<0.001*
Weight at birth (g)*	3,255 (2,984-3,535)	3,150 (2,655-3,699)	2,730 (1,795-3,095)	<0.001*
Male**	84 (48.3)	8 (47.1)	30 (58.8)	0.399**
Firstborn**	117 (67.2)	9 (52.9)	23 (45.1)	0.013**

Items	Cases (n=68)					Controls (n=174)					p-value*
	Mean	Median	Standard deviation	Percentage		Mean	Median	Standard deviation	Percentage
	Mean	Median	Standard deviation	25	75	Mean	Median	Standard deviation	25	75
1	4.47	5.00	2.00	3.00	6.00	2.61	2.00	1.55	1.00	3.25	<0.001
2	5.47	6.00	1.77	4.00	7.00	3.68	3.00	2.05	2.00	5.00	<0.001
3	3.69	4.00	2.06	1.00	5.00	2.22	1.50	1.55	1.00	3.00	<0.001
4	4.63	5.00	2.15	3.00	6.75	2.82	2.00	2.13	1.00	4.00	<0.001
5	3.00	3.00	1.40	2.00	4.00	2.66	2.50	1.05	2.00	3.00	0.088
6	4.06	4.00	1.88	3.00	5.00	2.83	2.00	1.76	1.00	4.00	<0.001
7	4.13	4.00	2.11	2.00	6.00	1.85	1.00	1.31	1.00	2.00	<0.001
8	3.37	3.00	2.05	1.00	5.00	1.70	1.00	1.32	1.00	2.00	<0.001
9	4.21	5.00	2.45	2.00	7.00	3.01	2.00	2.15	1.00	4.25	0.001
10	3.54	3.00	2.02	2.00	5.00	2.23	2.00	1.66	1.00	3.00	<0.001
11	3.49	3.00	2.18	1.00	5.00	1.33	1.00	1.03	1.00	1.00	<0.001
12	3.21	3.00	2.20	1.00	4.75	1.53	1.00	1.18	1.00	2.00	<0.001
13	3.18	3.00	1.90	1.00	4.00	1.99	2.00	1.27	1.00	3.00	<0.001
14	3.09	3.00	1.98	1.00	4.00	1.89	1.00	1.22	1.00	2.00	<0.001
Total raw score	53.53	53.00	14.75	46.00	64.00	32.36	30.50	11.28	23.00	39.00	<0.001
T-score	66.53	66.00	11.64	61.00	75.00	49.89	48.50	8.84	43.00	55.00	<0.001

Age in months	Cases			Controls			p-value
Age in months	n	mean±SD	median (IR)	n	mean±SD	median (IR)	p-value
6-24	35	65.1±12.6	65.0 (61.0-75.0)	48	49.6±6.8	50.0 (44.0-54.0)	<0.001
25-83	33	68.0±10.6	68.0 (62.0-75.5)	126	50.0±9.5	48.0 (43.0-55.3)	<0.001

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[1] *Corresponding author. E-mail: patriciafono@terra.com.br (P.B. Diniz).