The goal of this study was to determine the psychometric properties of the McGill Ingestive Skills Assessment. Interrater and intrarater reliability and score stability were tested using repeated administration of this test. The Functional Independence Measure and Modified Mini-Mental State Examination, as well as patient characteristics, were used to determine the validity of the assessment. One hundred and two persons with ingestive skill loss of neurologic origin were evaluated. Intraclass correlations for interrater, intrarater reliability and stability reached or surpassed 0.80 for most subscales. In validity testing, significant relationships were found between McGill Ingestive scores and Functional Independence Measure and Mini-Mental scores, as well as with patient characteristics. It is concluded that the McGill Ingestive Skills Assessment approaches or meets levels of reliability necessary for assessing patients and is valid for adults with neurogenic feeding difficulties residing in tertiary care facilities.

Objective. Eating assessment is the first step toward amelioration of eating problems in children. A quantitative evaluation tool with three standard textures of food has been developed to determine the severity of an eating problem. However, children occasionally refuse some of the standard textures. Much time and effort could be saved if substitute textures could be used for testing. The purpose of this study was to examine the feasibility of using substitute food textures. Method. Twenty children (10 without disabilities, 10 with cerebral palsy and eating impairments) with a mean age of 8.2 years(SD = 4.1) years were tested with three standard and three substitute textures of food (solid, viscous, puree). Eating time (in seconds) and chewing cycles were compared between standard and substitute textures as well as between children without disabilities and children with eating impairments. Results. Substitutes for pureed and viscous, but not solid textures could be used for children without disabilities; in children with eating impairments, substitutes for viscous and solid, but not pureed textures could be used. Conclusion. Children with eating impairments may be more sensitive than children without disabilities to small changes in food consistencies or other characteristics of the food. Thus, in standardized testing, food textures should not be arbitrarily interchanged.

Normative data on skills of the tongue used in eating are presented. Normal children 5 to 8 years old were studied regarding their preference of placing food either on the right or left side of the mouth when starting to eat. A developmental curve spanning 2 to 8 years was generated by including data from an earlier study. Data of oral side preference were correlated with data of preferred hand use. In addition, the ability to move a small piece of food from one side of the mouth to the other was studied. It was found that normal children undergo a transition from placing solid food predominantly on the right side at 2 years of age to placing it on the left side at 4 years of age. The left side preference persists until at least 8 years of age for both viscous and solid food textures. Oral side preference did not correlate with hand preference. The ability to move food from one side of the mouth to the other (lateralizing) was found to undergo a developmental progression: The inability to lateralize in a third of 2-year-olds gave way to rolling movements. Concomitantly, a consistent increase in slow and then smooth movements was found to occur from 2 to 8 years of age. These data provide the clinician with a normative baseline against which eating-impaired children can be compared.

In this study tongue movements of 103 normal 5-, 6-, 7-, and 8-year-old children were measured and compared. The 5-year-olds were compared with children of an earlier study and data were combined for 2- to 8-year-old children. Two different tongue positions were measured as three standard textures of food were presented: first, the position of the tongue as the food was 5 cm away from the lips, and second, the position of the tongue or other oral characteristics as the food was swallowed. For the anticipation of food a significant age–texture (p < .001) as well as an age–sex–texture interaction was noted (p < .035). For swallowing, significant age (p < .0001), texture (p < .0001), and sex–age interactions (p < .0001) were found. Although food is anticipated in a similar fashion by both sexes, age and texture differences must be taken into account when swallowing is evaluated. A preliminary developmental curve for the two eating behaviors is presented for children 2 to 8 years old.

Chewing movements of normal 5-, 6-, 7-, and 8-year-old children were measured and compared across age, food textures, and gender. Applesauce, graham cracker, and raisins were used. Measures were taken on 98 children: eighteen 5-year-olds (9 boys, 9 girls); thirty-five 6-year-olds (16 boys, 19 girls); twenty-six 7-year-olds (13 boys, 13 girls); and nineteen 8-year-olds (10 boys, 9 girls). Comparisons were made with data of another twenty 5-year-olds (10 boys, 10 girls) from a previous study. Chewing movements were measured by time, number of cycles, and a time/cycle ratio. Food texture affected time, cycle, and the time/cycle ratio. Age affected time and cycles. Data from earlier studies are used to describe the development of chewing between the ages of 2 and 8 years. Results indicate that eating skills for different food textures mature at different rates. Skills for eating solid foods mature before skills for eating viscous and pureed foods mature. Thus, the consistent use of food textures is important when children’s eating skills are evaluated. The normative data presented here may be used by clinicians evaluating children within the given age group.

Normative data on skills of the tongue used in eating are presented. Normal children 2 to 5 years old were studied regarding their preference of placing food either on the right or left side when eating, and they were compared with age-matched Down’s syndrome children. In addition, the ability to move food from the right to the left side of the mouth was studied. Normal children underwent a transition from predominantly placing food on the right side at 2 years of age to predominantly placing it on the left side at 4 years of age. Among Down’s syndrome children females preferred the right side, and males preferred the left side. The ability to move food from right to left (lateralizing) undergoes a developmental progression from tilting the head to rolling, followed by slow and eventually by smooth movement from one side to the other. Only 15% of the 5-year-olds were able to move food smoothly from side to side. These data provide a baseline against which children with eating problems can be compared.

Chewing movements of normal 2-, 3-, and 4-year-old children were measured. Chewing movements of 2- and 3-year-olds were compared with those of 4- and 5-year-olds. Measures were taken on 56 children: 17 were 2 years old (8 female, 9 male); 19 were 3 years old (10 female, 9 male); and 20 were 4 years old (10 female and 10 male). Data of twenty 5-year-olds (10 males, 10 females) were taken from a previous study (9). Chewing movements were measured by time (seconds), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. Total time from the moment food was placed in the mouth until the final swallow occurred was divided by the number of cycles counted for the same period. The type of food eaten affected time, cycles, and the time/cycle ratio, but age and sex did not. A comparison of younger (2- and 3-year-olds) and older children (4- and 5-year-olds) showed significant time differences. During maturation, time was shortened. It was shown earlier that under pathologic conditions (Down’s syndrome) time was prolonged. Thus, the time/cycle ratio is an excellent indicator of the developmental status of a child.

Chewing movements of Down’s syndrome children were measured and compared with those of normal preschool children. Twenty-six Down’s syndrome children were monitored: 14 were 4 (8 males, 6 females) and 12 were 5 years old (6 males, 6 females). Chewing movements were measured by time (in seconds), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. The time/cycle ratio is the total time, from the moment food was placed in the mouth until the final swallow occurred, divided by the number of cycles counted for the same period. The childrens’ ages and gender did not affect time, cycles, or the time/cycle ratio. However, the measures were strongly affected by the type of food eaten. Children with Down’s syndrome chew at a rate comparable to that of normal children. However, the duration of chewing is significantly prolonged per bite of food. This may be attributed to these childrens’ lack of chewing vigor or their inability, at the ages studied, to chew solid foods. Time/cycle ratios are an excellent index to document such differences. How much sensory differences or deficits contribute to these findings is not known.

This study describes tongue movements of 4- and 5-year-old Down’s syndrome children during eating and then compares the movements to those of age-matched normal children. The study is the second in a long-term project to develop a standardized eating assessment for children. Tongue movements were monitored in 26 children: 14 were 4 years ± 2 months (8 males, 6 females) and 12 were 5 years ± 2 months (6 males, 6 females). Two different tongue positions were quantified: 1) as food was presented to the child when the food was 5 cm from the lips; and 2) as food was swallowed. The childrens’ ages and gender along with the type of food affected tongue position on food presentation; however, only the childrens’ ages and gender affected tongue position on swallowing. In general, most tongue positions of Down’s syndrome children were characterized by 1) a forward placement of the tongue in the mouth, and 2) the absence of the maturational changes in normal children of the same age.

Eating movements in the preschool child undergo change between the ages of 2 and 5 years. There is a lack of objective clinical data from normal children against which eating movements of feeding-impaired children can be compared. In this study, chewing movements were measured to complement tongue movements described in an earlier study. The movements were monitored in 40 children: 20 were four years old and 20 were five years old. Each group had ten boys and ten girls. Chewing movements were measured by time (sec), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. Total time from the moment food was placed in the mouth until the final swallow occurred was divided by the number of cycles counted for the same period. Age and sex did not affect time, cycles, or the time/cycle ratio. However, the measures were strongly affected by the type of food eaten. These findings suggest that the texture of food strongly influences both the number of chewing cycles performed and the time used for chewing. The occupational therapist administering eating evaluations to children should carefully choose the foods offered for initial evaluations and use the same food consistently during reevaluations.

This study describes tongue movements of normal preschool children during eating, and is the first phase in a long-term project to develop a standardized eating assessment for children. It is hoped eventually to fill the need for an objective measurement tool in pediatric occupational therapy practice. The movements were monitored in 40 children; 20 were 4 years ± 1 month, and 20 were 5 years ± 1 month. Each group consisted of 10 boys and 10 girls. Two different tongue positions were quantified: First, as food was presented to the child when the food was 5 cm from the lips; and second, as food was swallowed. Tongue position upon food presentation and upon swallowing was affected by age, sex, and type of food. Both responses showed maturational changes from 4 to 5 years. It is proposed that important maturational changes take place between 4 and 5 years of age, but that adult patterns of swallowing are attained later in development.