Infant Feeding Style Questionnaire – Brazilian Version

Authors

Purpose

Understanding how Parents feed their infants goes far beyond simply tracking caloric intake; it involves complex psychological and behavioral interactions that can either foster healthy autonomy or disrupt innate hunger cues. Historically, Brazilian researchers studying pediatric feeding behaviors had to rely on instruments like the Child Feeding Questionnaire, which is only validated for children over the age of two. This left a critical measurement gap during the complementary feeding phase (6 to 12 months), a period when infants first transition to solid foods.

The IFSQ-Br fills this void by offering clinicians and researchers a standardized method to quantify early feeding styles. By identifying nonresponsive feeding patterns—such as pressuring an infant to finish a bottle or restricting access to certain foods—healthcare professionals can design targeted early interventions to prevent Childhood Obesity and promote responsive parenting before maladaptive habits solidify.

Construct

The psychological construct of infant feeding styles encompasses the overarching attitudes, beliefs, and specific behaviors Caregivers exhibit during feeding interactions. The IFSQ-Br operationalizes this construct into distinct typologies based on the degree of parental control and responsiveness. The responsive style represents the ideal balance, characterized by high reciprocity where the caregiver actively monitors diet quality while respecting the infant's satiety signals.

In contrast, nonresponsive styles deviate from this equilibrium. The laissez-faire approach reflects a lack of structure and interaction, whereas the restrictive and pressuring styles involve excessive parental control over the amount of food consumed or the urgency to finish meals. These styles are further broken down into specific sub-constructs, such as using food for soothing or adding cereal to bottles, allowing for a highly granular assessment of the feeding environment.

Validity

To establish validity, the researchers employed a comprehensive Cross-cultural adaptation process that included forward translation, expert panel review, and back-translation, ensuring semantic equivalence for the Brazilian context. Content validity was further reinforced through a pre-test phase, which led to culturally relevant modifications, such as incorporating local examples of ultra-processed foods and sugary drinks.

Construct validity was rigorously tested using Confirmatory Factor Analysis on a sample of 465 mother-infant pairs. The structural models demonstrated acceptable to excellent fit, with Comparative Fit Indices (CFI) ranging from 0.86 to 1.00 and Root-Mean Squared Error of Approximation (RMSEA) values falling between 0.00 and 0.09. While some items with low factor loadings had to be trimmed and error covariances added to optimize the models, the overall findings strongly support the theoretical structure of the adapted scale.

Reliability

The internal consistency of the IFSQ-Br was evaluated to ensure that the items within each sub-construct reliably measured the same underlying behavioral patterns. The overall instrument demonstrated adequate reliability, yielding a Cronbach's alpha of 0.73. When examining the specific sub-constructs, the alpha coefficients ranged from 0.42 to 0.75.

While the restrictive and pressuring subscales showed stronger internal consistency, some of the other sub-constructs exhibited lower alpha values. In psychometric terms, lower alphas can sometimes occur in scales with a small number of items per sub-construct or when measuring highly heterogeneous behavioral constructs. Nevertheless, the overall reliability indicates that the IFSQ-Br is a dependable tool for capturing Maternal Feeding Practices, though researchers should interpret the lower-performing subscales with appropriate methodological caution.

Factor Analysis

The underlying architecture of the IFSQ-Br was examined using Confirmatory Factor Analysis (CFA) via the Asymptotic Distribution Free method, which is particularly useful for non-normally distributed behavioral data. The analysis aimed to verify if the Brazilian data mapped onto the original multi-dimensional structure proposed by the scale's creators.

The initial models for several sub-constructs, such as pressuring/soothing, showed excellent fit without any need for adjustment. However, to achieve optimal fit in other areas, the psychometricians had to make theoretically sound modifications. For instance, the laissez-faire/diet quality model was significantly improved by removing poorly performing items and allowing error terms between highly similar items to covary. These structural refinements resulted in robust final models, confirming that the distinct feeding styles operate as independent but related latent variables within this population.

Subscales

Instrument

Infant Feeding Style Questionnaire – Brazilian Version Items

Sample

465 mothers of infants aged 6 to 12 months recruited from 20 Primary Health Centers in the Federal District, Brazil. 41.6% had a family per capita monthly income lower than or equal to half the Brazilian minimum wage, and 61.9% did not have access to higher education.

Permissions & Test Year

Permission was obtained from the corresponding author of the original questionnaire to conduct the Cross-cultural adaptation and validation.

Test Year: 2021