Behavioral Pediatrics Feeding Assessment Scale (BPFAS) Overview
The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) is a parent-report questionnaire designed to identify feeding difficulties in young children by measuring the frequency of undesirable mealtime behaviors and the degree to which parents perceive these behaviors as problematic. 1
Purpose and Structure
The BPFAS serves as a screening tool to distinguish children with clinically significant feeding problems from typically developing children through standardized parent reporting. 2 The scale has demonstrated:
- High test-retest reliability over a 2-week period 2
- Strong internal consistency across multiple validation studies 1
- High specificity in detecting feeding difficulties, making it particularly useful for ruling out feeding disorders when scores are normal 2
Key Components Assessed
The BPFAS evaluates two primary dimensions:
Frequency of Feeding Behaviors
Parents rate how often specific mealtime behaviors occur, capturing patterns such as:
- Food refusal behaviors during meals 3
- Rapid eating patterns 3
- Chewing difficulties 3
- Food selectivity (limited dietary variety) 3
- Vomiting episodes 3
- Food-stealing behaviors 3
Problem Perception
Parents indicate which behaviors they perceive as problematic, providing insight into the impact on family functioning. 2 Typically developing children display few undesirable feeding behaviors, and parents report few concerns; therefore, any child with a large number of reported problems warrants immediate multidisciplinary evaluation. 2
Clinical Interpretation
The BPFAS demonstrates significant discrimination between typically developing children and those with feeding difficulties, with statistically significant differences in both frequency scores (P < 0.01) and problem perception scores (P < 0.01). 2
Responsiveness to Intervention
The scale is sensitive to treatment effects, with all subscales showing improvement following therapeutic intervention:
- Scores decrease from clinically significant ranges to levels comparable with non-feeding-problem children after targeted treatment 4
- Problem scores on the BPFAS predict 15% of variance in improved dietary variety following intervention 4
Comparative Performance
The BPFAS has the most comprehensive reliability and validity data of any parent-administered feeding questionnaire for preschool children. 1 When compared to other feeding assessment tools:
- More predictive and concurrent validity data exists for the BPFAS than most alternative measures 1
- Australian, Canadian, and UK normative data show comparable performance across international samples 2
- The scale maintains reliability across diverse populations including children with autism, other special needs, and typically developing children 3
Clinical Application
Given its simplicity of administration, high reliability, and high specificity, the BPFAS is recommended as a screening tool for physicians working with young children. 2 The scale should be used:
- As an initial screening instrument to identify children requiring further evaluation 2
- To monitor treatment progress in children with established feeding disorders 4
- In conjunction with multidisciplinary assessment including medical, nutritional, occupational therapy, and physical therapy evaluations when feeding problems are identified 5
Important Caveats
Parent report through the BPFAS captures feeding behaviors in naturalistic home environments over time, providing advantages over time-limited clinic observations. 1 However:
- The scale relies on parent perception, which may be influenced by parenting style—overly permissive parental actions explain over 34% of links between feeding problems and poor outcomes 3
- Positive screening results require comprehensive follow-up assessment rather than serving as definitive diagnostic tools 2
- The BPFAS should be integrated with direct behavioral observation and medical evaluation for complete assessment of feeding disorders 5