A Global Perspective on Feeding Assessment in the Neonatal Intensive Care Unit

Abstract

A comprehensive assessment of feeding performance of infants in the neonatal intensive care unit (NICU) includes not only the traditional approaches of evaluating oral motor control and sensory responses but also evaluation of other factors. Infant feeding is a highly complex and integrated process involving numerous body systems. A global assessment would determine the infant's feeding function in the key areas of state and behavior, tactile responses, motoric control, oral motor function, physiologic control, and coordination of sucking, swallowing, and breathing. Information is obtained through skilled clinical observation as well as from technological monitors or medical tests and procedures. This article provides an overview of a comprehensive assessment that occupational therapists may use when providing service to infants in the NICU.

Manejo clínico das disfunções orais na amamentação

“…1,2,5,35,36 Immediately after birth, some NBs show incoordinated oral reflexes, requiring some days to develop a more mature pattern, which may occur concomitantly with milk let-down, on the third or fourth day after delivery. Oral anatomical dysfunctions can also occur in the baby (high-arched palate, retracted jaw, or short or excessively tight frenulum ankyloglossia -, resulting in inappropriate latch-on) and in the mother (inelastic, flat, inverted or too long nipples).…”

“…In these cases, it is necessary to help babies latch onto the breast properly and suck correctly. 3,5,36 Another factor that may lead to oral dysfunction is the so-called nipple confusion, due to the early contact of infants with artificial teats (bottle nipples, pacifiers or nipple shields). Due to the NB s restricted ability to adapt to different oral configurations, nipple confusion may establish itself, leading to early weaning.…”

“…These oral motor exercises are known as suck training. 12,35,36 Righard et al, 26 on assessing the breastfeeding technique in the first week of life, showed that the proper sucking technique has a strong effect on the duration of breastfeeding. The authors studied 82 mother-infant dyads in Sweden, with an improper sucking technique (nipple sucking only).…”

“…The clinical management of breastfeeding allows improving these situations. 5,15,27,36 The clinical management of oral dysfunctions often employs suck training, which consists in stimulating the sucking reflex again and again, in synchronization with the baby s pace, as described in the nonnutritive sucking technique. 1,35 All exercises that include oral stimulation should be always performed before breastfeeding, taking advantage of the baby s alertness and hunger.…”

“…Precautions with orofacial exercises should be concerned with the severity of oral dysfunctions, state of awareness, baby s global behavior, parent-infant bonding, duration and use of the exercises and conditions for reassessment and followup, if necessary. 9,34,36,37 The exercises should be performed while the baby is alert, 32 in an organized manner, and stimulation should last for 2 to 5 minutes, not exceeding this time limit to avoid making the baby tired and stressed. Table 1 describes maneuvers and orofacial exercises recommended for simple oral dysfunctions, which are common in clinical practice.…”