Developing a co-regulated, cue-based feeding practice: The critical role of assessment and reflection

Abstract

Assessment of early feeding skills of vulnerable infants is common practice in neonatal care centers. However, assessment is often merely an identification of feeding outcomes, rather than a description of the infant's capacities and methods of adapting to the feeding challenge. Descriptive assessment of the feeding process takes into account the dynamic nature of feeding and notes changes that occur as the infant matures and gains feeding experience. Assessment of the variability that occurs during the feeding as the challenge changes, due to fatigue or physiologic instability, are critical to understanding the infant's feeding skills. As individual components of the feeding are assessed, such as sucking, swallowing and breathing, a reflective process builds understanding of the patterns of coordination of system components in relation to one another. Taking the whole into account and considering the dynamics of the process is necessary if we are going to select appropriate interventions targeted to the individual infant's feeding skills. Using a very preterm infant case, this paper will illustrate assessment of early feeding skills and demonstrate how reflection on and integration of the components of the assessment identifies potential targets for co-regulated, cue-based feeding. KeywordsFeeding; Preterm; Feeding Skill; Assessment; Reflection; Intervention; Early Feeding Skills © 2013 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved. * Corresponding author: Carrington Hall, CB #7460, The University of North Carolina at Chapel Hill, Chapel Hill, NC 25799-7460, thoyre@email.unc.edu, T 919-966-8418, F 919-843-9969. Conflict of interest statement: There are no conflicts of interest with any of the authorsPublisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Selecting appropriate feeding interventions requires assessment that facilitates identification of the infant's feeding difficulties. Too often, feeding interventions are applied generically. As examples, when infants have poor feeding endurance we might limit the number of feedings offered or use a pre-set feeding schedule rather than identify potential reasons for poor endurance within the feeding itself. When we assess low intake or poor feeding efficiency we may assume the infant has weak oral motor functioning and provide chin and cheek support, oral stimulation prior to feeding, or another intervention aimed at enhancing oral-motor functioning, rather than considering alternatives, such as the impact of the infant's breathing on their ability to engage in sucking. While any of a numbe...

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