**Background:** Feeding and swallowing disorders (FSD) are common in childhood, with an estimated prevalence of 25–45% in the general pediatric population and up to 80–85% in children with neurodevelopmental disabilities. As survival of high-risk newborns improves, the number of clinically complex children with FSD is rising, leading to longer hospital stays, increased healthcare costs, and worse health outcomes. Early identification of dysphagia is critical to prevent complications such as malnutrition, dehydration, and respiratory issues. Current guidelines recommend screening as the first step in identifying swallowing disorder risk, but existing pediatric screening tools are often age-specific, require direct swallowing tests, or need advanced expertise. The authors aimed to develop a screening tool that can be rapidly administered across all pediatric ages without food administration, to enable early identification of children with FSD in hospital settings.
**Methods:** The study was conducted at Bambino Gesù Children's Hospital (Rome, Italy) and approved by the hospital ethics committee (protocol number 2352_OPBG_2021). The PS–PED was developed in four steps. First, a group of researchers and allied health professionals with extensive FSD experience identified candidate items classified into three domains: clinical history, health status, and feeding condition. Second, a comprehensive literature review of the past 10 years was conducted, retrieving 1624 articles after deduplication, with 194 selected based on title and abstract, ultimately confirming 14 items. Third, a two-round modified Delphi study was conducted from September to December 2021 with an interdisciplinary panel of 50 Italian healthcare professionals (20 speech–language pathologists, 10 speech–language pathologists with a Master's in FSD, 10 nurses, 5 medical doctors, and 5 physiotherapists with a Master's in respiratory therapy; mean FSD experience 7.3 years). Consensus was defined as 80% agreement. The first round had a 62% response rate (31/50); the second round had a 94% response rate (28/31), achieving 97% agreement on the final version. Fourth, a pilot study tested the PS–PED on 60 children (24 boys, 36 girls; age range 13 months to 16 years) admitted to the hospital with various diagnoses. One child was excluded from analysis (final n = 59). All children had undergone or were scheduled for videofluoroscopy swallow study (VFSS). PS–PED information was retrieved from medical records. VFSS results were classified using the Penetration Aspiration Scale (PAS), dichotomized into group A (PAS level 1, no airway invasion) and group B (PAS levels 2–8, penetration/aspiration). Internal consistency was assessed with Cronbach's alpha (threshold > 0.70). Concurrent validity was assessed with Pearson's correlation coefficient between PS–PED and PAS scores. Discriminant validity was tested using an independent sample t-test comparing mean PS–PED scores between PAS groups, with significance set at p < 0.05.
**Key Results:** The final PS–PED consists of 14 items with dichotomous (yes/no) responses across three domains. Internal consistency analysis yielded a Cronbach's alpha of 0.731, exceeding the 0.70 threshold. Item–total analysis showed all items positively contributed to the total score. Concurrent validity analysis demonstrated a strong positive correlation between PS–PED and PAS scores, with a Pearson correlation coefficient of 0.824 (p < 0.01). Discriminant validity analysis showed significant differences in PS–PED scores between the PAS-negative and PAS-positive groups (p < 0.01). Descriptive analysis across diagnostic groups revealed that children with neurological/neuromuscular conditions (Group 1) and genetic syndromes (Group 5) had higher PS–PED scores than other diagnostic groups.
**Clinical Implications:** The PS–PED demonstrates strong preliminary psychometric properties as a screening tool for FSD in a heterogeneous pediatric hospital population. Key advantages include: administration time under 10 minutes, no requirement for specialized swallowing expertise, no food administration needed (eliminating aspiration risk during screening), applicability across all pediatric ages and diagnoses, and reliance on objective yes/no items to limit subjectivity. The tool can be administered by physicians during history-taking or by healthcare professionals with access to medical records. Early identification of FSD through screening could enable earlier referral for comprehensive swallowing assessment and intervention, potentially reducing complications such as malnutrition, dehydration, and respiratory issues, as well as decreasing hospital length of stay and healthcare costs. The authors acknowledge limitations including the small pilot sample (n = 59), the heterogeneous diagnostic groups precluding pathology-specific validation, and administration only by speech–language pathologists in the Dysphagia Unit. Future plans include validation in a larger sample and testing reliability across different healthcare professionals.