Translation and validation of Neonatal Feeding Assessment Scale (NFAS) in Persian

Document Type : Original Article


1 Department of Speech therapy, Faculty of Paramedical Sciences and Rehabilitation, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Feeding difficulties and dysphagia can lead to malnutrition, dehydration, pneumonia, prolonged hospitalization, and even death in neonates. Accordingly, it should be recognized as soon as possible to provide necessary medical care, nursing, and rehabilitation. This study aimed to translate the Neonatal Feeding Assessment Scale (NFAS) into Persian and determine its psychometric properties in Iranian neonates.
Methods: After receiving permission from developers, the main version of NFAS was translated into Persian. Face validity of NFAS was assessed by 10 qualified speech and language pathologists in the field of pediatric swallowing. In order to define the internal consistency of the items, 52 infants were evaluated using the Persian version of NFAS, and the correlation between the items was determined using Kuder-Richardson 20. The test-retest and inter-rater reliabilities were also calculated by Cohen's Kappa coefficient in 30 and 40 infants, respectively. The convergent reliability between NFAS and Early Feeding Skills (EFS) was calculated by point-biserial correlation in 30 infants.
Results: According to experts, all translated items were transparent and understandable. The internal consistency score was obtained at 0.76. Moreover, Cohen's Kappa coefficients were calculated at 0.96 and 0.87 for test-retest and inter-rated reliabilities, respectively. Point biserial correlation between Persian NFAS and EFS was estimated at 0.63.
Conclusion: Persian version of NFAS is a valid and reliable tool to assess feeding problems and oro-pharyngeal dysphagia in infants and make clinical decisions.


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