Facilitating Infant Feeding as a Neurodevelopmental Skill

Feeding is a neurodevelopmental skill. Fragile infant feeders benefit from an infant-driven individualized approach to support safe oral feeding while acquiring positive feeding skills. Quality feeding is successful when the infant is engaged without signs of distress. The approaches outlined in SINC, POETri and the Oral Feeding Guideline support co-regulation between infant and caregiver and cue-based feeding during skill acquisition. Their key concepts may be leveraged for the ambulatory environment for infants with limited oral feeding when transitioning to home.

Feeding may be a challenging activity for some developing infants who require stability across the subsystems (physiologic, motor, state, and attention/interaction) within a stable nurturing environment. When an infant experiences a challenge in any of these subsystems, it has a profound effect on the others. Infants and fragile feeders are not always able to communicate physiological stability, engagement, and distress cues clearly. Examples of physiological changes indicating distress may include:

significant changes in heart rate
oxygen saturations outside normal limits for the child
significant changes in respiratory status, e.g. rate, grunting, nasal flaring, coughing
loss of postural tone
loss of state or alertness
a change in colour to pale, flushed, or grey

Engagement and disengagement (stress) cues may include:

engagement cues: may include eye contact, relaxed face and body, feeding smoothly
disengagement (stress) cues: may include frowning, arching, pulling away from bottle, crying, turning face away

Ongoing assessment of physiologic stability and engagement, using the infant’s communication from moment to moment, guides feeding. Continuous infant-guided interventions are provided based on the infant’s signs of engagement and signs of disengagement during feeding. A skilled healthcare provider can coach and support parents to successfully observe their infant’s communication cues during feeds and activate strategies to support safe oral feeding (National Association of Neonatal Nurses, 2013).

Establish and maintain parent’s milk supply if she wishes to offer human milk while the child is non-oral. If breastfeeding, the parent's milk supply can be negatively affected by prolonged non-oral feeding. Referral to a lactation consultant may be indicated if the parent has poor milk supply or considered proactively to prevent future supply issues.