Cross-Cultural Adaptation and Validation of the Mini-Eating and Drinking Ability Classification System for Korean Children with Cerebral Palsy Aged 18-36 Months

Abstract

Background/Objectives: Feeding and swallowing difficulties are common in young children with cerebral palsy (CP), yet no validated tool has been available in Korea for those under 3 years. The Mini-Eating and Drinking Ability Classification System (Mini-EDACS) was designed for children aged 18-36 months. This study aimed to translate the Mini-EDACS into Korean and evaluate its reliability and validity. Methods: Translation followed international guidelines, including forward-backward translation and Delphi consensus with experts in pediatric dysphagia. Forty-eight children with CP (mean age 27.1 +/- 5.0 months) were assessed. Caregivers and speech-language pathologists (SLPs) independently rated Mini-EDACS and assistance levels. Inter-rater reliability was examined using Cohen&apos;s kappa. Construct validity was tested by Spearman&apos;s correlations with the Gross Motor Function Classification System (GMFCS), Mini-MACS, the Communication Function Classification System (CFCS), the Visual Function Classification System (VFCS), and the Functional Oral Intake Scale for Children (FOIS-C). Results: Agreement between caregivers and SLPs was excellent (kappa = 0.90; weighted kappa = 0.98). Assistance-level ratings also showed almost perfect concordance (kappa = 0.97). Mini-EDACS correlated strongly with FOIS-C (rho = -0.86, p < 0.001) and with assistance levels (rho = 0.81, p < 0.001). Moderate-to-strong positive correlations were observed with GMFCS (rho = 0.56), Mini-MACS (rho = 0.64), CFCS (rho = 0.61), and VFCS (rho = 0.61), supporting construct validity. Conclusions: The Korean Mini-EDACS is a reliable and valid tool for classifying eating and drinking abilities in children with CP under 3 years. It enables standardized communication between caregivers and clinicians, complements existing functional classification systems, and may facilitate earlier identification and intervention for feeding difficulties.