The Children's Oral Feeding Screener (COFS): Development and Content Validity Testing

Abstract

Purpose: Oropharyngeal dysphagia screening protocols remain limited in hospitalised children due to the lack of a psychometrically valid and reliable tool. This study employed eDelphi methodology to establish content validity for the Children's Oral Feeding Screener (COFS), a novel, nurse-led paediatric oropharyngeal dysphagia screening tool for hospitalised children (0-16 years). Methods: A two-round eDelphi study was completed using Qualtrics software. A multidisciplinary international steering group guided initial tool conceptualisation, reviewed tool modifications between rounds, and finalised items not reaching consensus. Speech pathologists with[two years' experience and practice recency of five years in paediatric acute or critical care settings were invited via professional networks as panellists. Panellists were asked to achieve consensus on a) clinical presentations requiring immediate referral for further dysphagia assessment; b) oral trial component/s; and c) signs observed during oral trials suggestive of oropharyngeal dysphagia. Panellists rated items on a 10-point Likert scale and could also provide open-ended feedback. Consensus between panellists was defined a priori: items rated 1-3 C 75% were discarded, and items rated 8-10 C 75% were included in the COFS. Other items were retained for discussion and re-presentation. Results: Fifty panellists participated in Round 1 and 32 panellists in Round 2 of the eDelphi study. Panellists had primarily worked in Australia (n = 15; 47%) and the UK (n = 10; 31%). Eleven clinical presentations (e.g., vocal fold palsy, inability to manage secretions and new onset facial asymmetry), one bottle trial protocol (feeding in infants' usual position, using usual bottle or if not available hospital slow flow teat) and 15 oropharyngeal dysphagia signs (e.g., coughing, choking and apnoea whilst feeding) met consensus to be included in the COFS. Consensus was not achieved to include food trials. Further steering group discussions are required to finalise items in the COFS. Conclusions: This research utilised group consensus methodology to achieve content validity for a novel, nurse-led paediatric oropharyngeal dysphagia screening tool for use in children 0-16 years in acute and critical care settings. Further work is now required to explore validity and reliability of the COFS in clinical settings.