The Pedi-EAT was systematically developed and content validated with input from researchers, clinicians, and parents.

Purpose This study tested the milk flow rates and variability in flow of currently available nipples used for bottle-feeding infants who are hospitalized. Method Clinicians in 3 countries were surveyed regarding nipples available to them for feeding infants who are hospitalized. Twenty-nine nipple types were identified, and 10 nipples of each type were tested by measuring the amount of infant formula expressed in 1 min using a breast pump. Mean milk flow rate (mL/min) and coefficient of variation were used to compare nipples within brand and within category (i.e., Slow, Standard, Premature). Results Flow rates varied widely between nipples, ranging from 2.10 mL/min for the Enfamil Cross-Cut to 85.34 mL/min for the Dr. Brown's Y-Cut Standard Neck. Variability of flow rates among nipples of the same type ranged from a coefficient of variation of 0.05 for Dr. Brown's Level 1 Standard- and Wide-Neck to 0.42 for the Enfamil Cross-Cut. Mean coefficient of variation by brand ranged from 0.08 for Dr. Brown's to 0.36 for Bionix. Conclusions Milk flow is an easily manipulated variable that may contribute to the degree of physiologic instability experienced by infants who are medically fragile during oral feeding. This study provides clinicians with information to guide appropriate selection of bottle nipples for feeding infants who are hospitalized.

Background Feeding difficulty is common in infants less than six months old. Identification of infants in need of specialized treatment is critical to ensure appropriate nutrition and feeding skill development. Valid and reliable assessment tools help clinicians objectively evaluate feeding. Purpose To identify and evaluate assessment tools available for clinical assessment of bottle- and breast-feeding in infants less than six months old. Methods/Search Strategy CINAHL, HaPI, PubMed, and Web of Science were searched for “infant feeding” and “assessment tool.” The literature (n=237) was reviewed for relevant assessment tools. A secondary search was conducted in CINAHL and PubMed for additional literature on identified tools. Findings/Results Eighteen assessment tools met inclusion criteria. Of these, seven were excluded because of limited available literature or because they were intended for use with a specific diagnosis or in research only. There are 11 assessment tools available for clinical practice. Only two of these were intended for bottle-feeding. All 11 indicated they were appropriate for use with breast-feeding. None of the available tools have adequate psychometric development and testing. Implications for Practice All of the tools should be used with caution. The Early Feeding Skills Assessment and Bristol Breastfeeding Assessment Tool had the most supportive psychometric development and testing. Implications for Research Feeding assessment tools need to be developed and tested to guide optimal clinical care of infants from birth through six months. A tool that assesses both bottle- and breast-feeding would allow for consistent assessment across feeding methods.