Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oralmotor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers-notably nurses and parents-need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant's developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.Neonatal clinicians, clinicians who work with families during the early postdischarge period, and parents of preterm infants are in an important position to observe and support the development of an emergent motor skill: oral feeding. Oral feeding skills have commonly been conceptualized by health care providers as an infant's ability to organize and coordinate oralmotor functions to efficiently consume enough calories for growth. Early feeding skills are much more complex than this, however. They also involve the infant's ability to (1) engage and remain engaged in a physiologically and behaviorally challenging task, (2) organize oralmotor movements so as to have long-term functional benefits, (3) coordinate breathing with swallowing to avoid prolonged apnea or aspiration of fluids, and (4) regulate the depth and frequency of breathing to maintain physiologic stability.Motor skill development corresponds to changes in an infant's brain, body, and experience. 1 According to research, two factors affect progression in ability to feed orally: the infant's state of health 2-6 and oral feeding experience. [7][8][9][10][11] According to other research, neuromaturation of the following contributes to an individual infant's skill in feeding: the ability to regulate oxygen, 11,12 development of alertness, 13-15 and development of sucking strength and organization of the sucking pattern. 16,17 External influences can also change the nature of the task. These include the size and speed of flow of the fluid bolus, 18-20 the impact of nasogastric tubes in place during feeding, 21 and the type of feeding support provided by the caregiver. [22][23][24][25][26] During its emergent phase, motor skill expression varies considerably. 27 Early feeding skills can vary from feeding to feeding and even across a given feeding. Some infants adapt and improve in skill as the feeding pro...
Although studies have shown cue-based feeding can lead to earlier achievement of full oral feeding, the successful implementation of cue-based feeding has been constrained by the volume-driven culture, which has existed for many years in the NIC U. This culture was built on the notion that a "better" nurse is one who could "get more in," and infants who are "poor feeders" are ones who "can't take enough." The infant who feeds faster is often viewed as more skilled in this task-oriented approach. The feeding relationship and the infant's communication about the experience of feeding may not be nurtured. This article will explain the central role of the preterm infant's communication in successful cue-based feeding. When the infant is perceived as having meaningful behavior (i.e., communicative intent), the focus changes from a volume-driven to a co-regulated approach, through which the infant guides the caregiver. This is cue-based feeding.
Background: Supporting infants as they develop feeding skills is an essential component of neonatal and pediatric care. Selecting appropriate and supportive interventions begins with a thorough assessment of the infant's skills. The Early Feeding Skills (EFS) tool is a clinician-reported instrument developed to assess the emergence of early feeding skills and identify domains in need of intervention. Purpose: The purpose of this study was to identify the factor structure of the EFS and test its psychometric properties, including internal consistency reliability and construct validity. Methods: EFS-trained interprofessional clinicians in 3 settings scored 142 feeding observations of infants 33 to 50 weeks' postmenstrual age. Redundant and rarely endorsed items were removed. Factor analysis methods clustered items into subscales. Construct validity was examined through the association of the EFS with (1) concurrently scored Infant-Driven Feeding Scale-Quality (IDFS-Q), (2) infant birth risk (gestational age), and (3) maturity (postmenstrual age). Results: Principal components analysis with varimax rotation supported a 5-factor structure. The total EFS demonstrated good internal consistency reliability (Cronbach α= 0.81). The total EFS score had construct validity with the IDFS-Q (r =−0.73; P < .01), and with gestational age of a subsample of premature infants (r = 0.22; P < .05). Implications for Practice: As a valid and reliable tool, the EFS can assist the interprofessional feeding team to organize feeding assessment and plan care. Implications for Research: The strong psychometric properties of the EFS support its use in future research.
Many NICU infants present with complex issues that affect the transition to full nipple feeding. At a time when length of stay is critical, this transition can be facilitated by an individualized, developmentally supportive approach. The approach described in this article involves (1) observing the infant for behavioral cues of stability or stress during nippling, as reflected in change in color, state of alertness, breathing, and swallowing; (2) individualizing intervention to help the infant regain and maintain coordination; and (3) facilitating parents' competence and confidence in feeding their infant. Contingent interventions are used to promote physiologic homeostasis and self-regulation.
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