Pediatric Eating Assessment Tool (PediEAT)

Pediatric Eating Assessment Tool (PediEAT)

Physiologic Symptoms

Pediatric Eating Assessment Tool (PediEAT)

Directions: We are interested in learning about the eating behaviors of your child. The items below may not apply to every child. When filling this out, think about what is typical for your child at this time.
Physiologic Symptoms
Child's Name *

First Name Last Name
KEY:

0=Never

1=Almost Never

2=Sometimes

3=Often

4=Almost Always

5=Always

My Child... *

	0	1	2	3	4	5
Gets watery eyes when eating
Gets red color around eyes or face when eating
Coughs during or after eating
Sounds gurgly or like they need to cough or clear their throat during or after eating
Sounds different during or after a meal (for example, voice becomes hoarse, high-pitched, or quiet)
Chokes or coughs on water or other thin liquids
Moves head down toward chest when swallowing
Has food or liquid come out of nose when eating
Gets pale or blue color around his/her lips during meals
Breathes faster or harder when eating
Needs to take a break during the meal to rest or catch their breath
Gets tired from eating and is not able to finish
Sweats/gets clammy during meals
Tilts head back while eating
Burps more than usual while eating
Throws up during mealtime
Throws up between meals (from 30 minutes after the last meal until the next meal)
Arches back during or after meals
Gags when it is time to eat (for example, when they see food when placed in high chair)
Gags with smooth foods like pudding
Gags with textured food like coarse oatmeal
Gags, coughs, or vomits when brushing teeth (if your child does not have teeth, select Never. If your child will not allow you to brush his/her teeth, select Always)
Gets bloated tummy after eating
Turns red in face, may cry with stooling
Has gas
Drools when eating
Has a hard time eating due to a stuffy nose

If you would like to explain any of your responses, please do so here:

Problematic Mealtime Behaviors *

	0	1	2	3	4	5
Avoids eating by playing or talking
Has to be told to start eating
Has to be reminded to keep eating
Won't eat at meals, but wants food later
Stops eating after a few bites
Refuses to eat
Shows more stress during meals than during non-meal times (whines, cries, gets angry, tantrums)
Likes something one day and not the next
Insists on food being offered in a certain way (such as, how food is on the plate or what dish or spoon is used, or where they sit)
Insists on being fed by the same person(s)
Becomes upset by the smell of food
Throws food or pushes food away
Prefers to drink instead of eat
Prefers crunchy foods
Eats better when entertained
Takes more than 30 minutes to eat
Needs mealtime to be calm
Wants the same food for more than two weeks in a row

Key:

5= Never

4= Almost Never

3= Sometimes

2= Often

1= Almost Always

0= Always

If you would like to explain any of your answers, please do so here:

Selective/Restrictive Eating *

	5	4	3	2	1	0
Will eat mixed texture foods
Will eat food warmer than room temperature
Is willing to feed self (if younger in age, holds cup, feeds self crackers)
Keeps food in mouth when eating (food means non-liquids)
Keeps liquids in mouth when drinking
Keeps their tongue inside mouth during eating
Acts hungry before meals

For the following items, if your child is younger than 15 months and is not offered these foods, select 0. If your child is over 15 months and not offered these foods or refuses to eat these foods, select 5. *

	5	4	3	2	1	0
Will eat foods that need to be chewed
Will eat textured food like coarse oatmeal
Will eat frozen food, like ice cream
Chew their food enough
Moves food in their mouth when chewing without help
Sniffs food or objects
Spits food out
Eats too fast

If you would like to explain any of your responses, please do so here:
Key:

0= Never

1= Almost Never

2= Sometimes

3= Often

4= Almost Always

5= Always

Oral Processing *

	0	1	2	3	4	5
Stores food in their cheek or roof of mouth
Gets food stuck in their cheek or roof of mouth
Prefers smooth foods like yogurt
Puts too much food in mouth at one time
Puts fingers in mouth to move food
Prefers strong flavors
Bites down on the spoon or fork and does not release it easily
Grinds teeth when awake (if your child does not have teeth please select Never)
Chews on toys, clothes, or other objects

For the following items, if your child is younger than 15 months and is not offered chewable foods, select 0. If your child is over 15 months and not offered these foods or refuses to eat these foods, select 5. *

If you would like to explain any of your responses, please do so here:
Should be Empty:

Likes to eat

Eats a variety of foods (fruits, vegetables, proteins, etc.)

Is willing to stay seated during mealtime

Opens their mouth when food is offered

Is willing to touch food with their hands