Reliability of the nursing child assessment feeding scale during toddlerhood

The quality of the maternal-child feeding interaction has been proposed to be an important contributor to a child's being overweight, yet assessment of this proposition has been hindered by a lack of age-appropriate instrumentation. The primary aim of this study was to examine the reliability of the Nursing Child Assessment of Feeding Scale (NCAFS) if extended to use during toddlerhood. A longitudinal design was used to assess NCAFS reliability at 12, 24, and 36 months. The NCAFS was used to code videotaped feeding observations of 116 mother-toddler dyads collected as part of a larger study examining mother-child interactions and adaptations of toddlers. Reliability was explored through the assessment of interrater reliability, internal consistency of the various subscales and the scale as a whole, and stability of the scale measurements over time. At each age, interrater reliability was generally quite good whereas the NCAFS' internal consistency was low. Maternal contributions to feeding interaction quality were stable over time but dyadic and child contributions were not. The lower internal consistency estimates were likely due to relatively low levels of variance among the dyads within each age. Another probable contributor to diminished internal consistency was the attrition of several behavior items due to zero variance. Possible explanations for this restriction of variance and several approaches for improving the NCAFS internal consistency during toddlerhood are considered. With revision, the NCAFS could be useful in assessment of feeding interaction quality during the transition to toddlerhood when issues of control and autonomy become increasingly prominent.