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Selection of reference foods for a scale of standards for use in assessing the transitional process from milk to solid food in infants and pre-school children

European Journal of Clinical Nutrition volume 57, pages 803–809 (2003)Cite this article

Abstract

Objective: This paper describes the development of a reliable scale of standards for use in evaluating the progress of the transition from milk to solid food in infants and preschool children. The maturation of chewing and swallowing behavior in infants and young children, which enables processing of solid food, varies, and a scale would assist not only in the instruction of mothers and nurses but also in preventing delay in the introduction of solid food.

Design: A range of 159 reference foods were selected on the basis of intake during the period of transition from liquid to solid food. These foods were listed in our previous study, Validity and reliability were tested to create a scale.

Methodology: Foods were selected on the basis of 50% of the subjects studied being able to eat them, and on the food groups classified by cluster analyses using the Varclus procedure of SAS. Validity, of the scale was tested by using Pearson's correlation coefficient between the scale score of selected food items and the total score of all 159 food items. The total score of 159 food items was calculated using the general linear models (GLM) procedure of SAS. Reliability was tested using Cronbach's coefficient α.

Setting: Public health centers in Aomori, Tokyo, Saitama, Nagano, and Okinawa (Japan).

Subjects: Five hundred and eighty healthy mothers and children from 2 to 46 months were randomly selected and 470 (81.0%) completed the study. To avoid regional bias, subjects were drawn from northern to southern prefectures in Japan, namely Aomori, Tokyo, Saitama, Nagano, and Okinawa.

Results: Twenty food items were selected. By analyzing the score correlation using Pearson's correlation coefficient (R=0.97, P<0.001) and GLM (R2=0.95, P<0.001), it was confirmed that these 20 food items adequately represented the original 159. The reliability was also found to be sufficient (Cronbach's coefficient α=0.96).

Conclusions: The findings demonstrate that a scale of standards for measuring progress in chewing ability can be created using 20 food items. Such a standard will provide a useful basis against which to assess delay of solid food introduction in childhood.

Sponsorship: Grant-in-Aid for Scientific Research, provided by the Japanese Ministry of Education, Science and Culture, Project No. 07838030.

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Acknowledgements

The authors express their sincere appreciation for the co-operation of mothers and children. They are also indebted to the directors, Public Health nurses and staff at Public Health Centers in each district for their kind cooperation and support. They are grateful to Theya Molleson (The Natural History Museum, UK) for comments on an earlier version of this paper and Veronica Hunt (The Natural History Museum, UK) for the refinement of English.

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Author notes

  1. N Inoue: Retired from Department of Medicine, The University of Tokyo.

Authors and Affiliations

  1. Department of Nursing Physiology and Anatomy, College of Nursing Art and Science, Hyogo, Japan

    R Sakashita

  2. Department of Medicine, The University of Tokyo, Tokyo, Japan

    N Inoue

  3. Department of Orthodontics, Faculty of Dentistry, Iwate Medical College, Morioka, Iwate, Japan

    T Tatsuki

Authors
  1. R Sakashita
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  2. N Inoue
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  3. T Tatsuki
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Contributions

Guarantor: R Sakashita.

Contributors: RS participated in the study design, collected the data, did the statistical analysis, participated in the discussion of results and wrote the paper. NI participated in the study design, coordinated the study participated in the discussion of results and reviewed the paper. TT coordinated the study, and participated in the discussion of results.

Corresponding author

Correspondence to R Sakashita.

Appendix

Appendix

Table 4

Table 4 Fifty percentile months after birth and cluster group of 159 food items are given in Table 4.
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Sakashita, R., Inoue, N. & Tatsuki, T. Selection of reference foods for a scale of standards for use in assessing the transitional process from milk to solid food in infants and pre-school children. Eur J Clin Nutr 57, 803–809 (2003). https://doi.org/10.1038/sj.ejcn.1601612

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