Screening Solid Foods Infants 1 (SSFI-1) development of a screening tool to detect problems in the transition from milk to solid food in infants from six to nine months of age

To establish the psychometric properties of a newly developed screening tool Screening Solid Foods Infants 1 (SSFI-1) used by early childhood professionals, to detect problems in the transition from milk to solid food of smooth consistency in infants 6-9 months of age. The SSFI-1 score was filled out by the parents of a subgroup with term infants (n=35); healthy preterm infants (n=26); infants with comorbidity (n=17); infants with feeding problems (n=13). Internal consistency, reproducibility, construct, criterion and related validity was evaluated. The preterm subgroup differed significantly in age when starting with fruits/vegetables and period of experience (p <0.01). The SSFI-1 was sufficiently reliable for the total group and term subgroup (α=0.78 and 0.76), but not for the preterm and comorbidity/feeding problem subgroup (α=0.51 and 0.69). Inter-rater reliability was high for the total score (n=25, ICC r=0.93), and moderate to good for individual items (weighted kappa range 0.55-0.95). Validity was confirmed by significantly higher scores for the comorbidity/feeding problem subgroups and clinically distinguishable subgroups (p <0.05) and area under the curve values>0.78. The initial 10-item screening tool was modified to a seven item screening tool. A SSFI-1 score of 4, +2 SD of the term subgroup, had 76.9% sensitivity and 82.1% specificity, for detecting the presence of a feeding problem. The seven-item screening tool Screening Solid Foods 1 may be used as a screening tool for term infants. Further testing of the SSFI-1 in new infants is needed, to confirm reliability and validity both for term, preterm and (risk for) feeding problem infants