Development Of Feeding Skills Research Articles

Effect of Educational Intervention on Neonatal Nurses Practices Regarding Oral Motor Stimulation on Early Transition from Tube to Oral Feeding in Preterm Infants

Nurses working in neonatal nursery units play a crucial role in assessing the preterm infants feeding readiness cues for initiation of oral feeding and implementing the evidence-based intervention to support the development of feeding skills. Objectives: To assess the effect of educational intervention on neonatal nurses’ practices regarding oral Motor stimulation on early transition from to oral oral feeding in preterm infants. Methods: A quasi-experimental single group study conducted in Children Hospital Lahore from May to July 2023. Pre and post intervention data was collected through the observational checklist from 36 nurses working in Neonatology. Nurses were educated through PowerPoint presentation and direct demonstration on infants. Results: Descriptive statistics showed that Majority of nurses were having diploma in nursing, 4-10 years’ experience and belonged to 31-45 years age category. In inferential statistics Paired sample t-test revealed that the majority of nurses (100%, n=36) had incompetent practices before training which were improved (91.6%, n=33) after educational intervention with significant p-value<0.05. Conclusions: The nurses who received training revealed competent practices so we conclude that educational intervention was effective to improve the nurses’ practices.

The “FEEDS (FEeding Eating Deglutition Skills)” over Time Study in Cardiofaciocutaneous Syndrome

Feeding, eating and deglutition difficulties are key concerns in patients with cardiofaciocutaneous syndrome (CFCS). This study intends to quantify the development of feeding skills from birth to adulthood in patients with CFCS. Twenty-seven patients (eight males; mean age: 16.7 ± 8.3 years; median age: 15 years, age range: 1.5–38 years) with molecularly confirmed clinical diagnosis of CFCS were prospectively recruited from the Rare Disease Unit, Paediatrics Department, Fondazione Policlinico Agostino Gemelli-IRCCS, Rome, Italy, over a one-year period. Pathogenic variants along with key information regarding oro-motor features were collected. Sialorrhea was quantified using the Drooling Quotient 5. Feeding abilities were screened using the Italian version of the Montreal Children’s Hospital Feeding Scale (I-MCH-FS). The oral sensory processing section of the Sensory Profile completed the assessment. Mild-to-profuse drooling was experienced by 25% of patients, and food taste selectivity was a constant during infancy (65%), with persistence even beyond adolescence. Nineteen percent of participants with long-term enteral feeding dependency had BRAF, KRAS and MAP2K1 mutations. These findings document that mealtime challenges in CFCS do not remain restricted only to the paediatric age, and that supportive care until adulthood plays a key role.

What to Expect of Feeding Abilities and Nutritional Aspects in Achondroplasia Patients: A Narrative Review.

Achondroplasia is an autosomal dominant genetic disease representing the most common form of human skeletal dysplasia: almost all individuals with achondroplasia have identifiable mutations in the fibroblast growth factor receptor type 3 (FGFR3) gene. The cardinal features of this condition and its inheritance have been well-established, but the occurrence of feeding and nutritional complications has received little prominence. In infancy, the presence of floppiness and neurological injury due to foramen magnum stenosis may impair the feeding function of a newborn with achondroplasia. Along with growth, the optimal development of feeding skills may be affected by variable interactions between midface hypoplasia, sleep apnea disturbance, and structural anomalies. Anterior open bite, prognathic mandible, retrognathic maxilla, and relative macroglossia may adversely impact masticatory and respiratory functions. Independence during mealtimes in achondroplasia is usually achieved later than peers. Early supervision of nutritional intake should proceed into adolescence and adulthood because of the increased risk of obesity and respiratory problems and their resulting sequelae. Due to the multisystem involvement, oral motor dysfunction, nutrition, and gastrointestinal issues require special attention and personalized management to facilitate optimal outcomes, especially because of the novel therapeutic options in achondroplasia, which could alter the progression of this rare disease.

Feeding at 6-12 months in infants with CHD.

Feeding difficulty is common in infants with CHD. The purpose of this study was to describe the feeding skills and behaviours of infants with CHD at 6-12 months of age and explore relationships between feeding, gastrointestinal distress, and gastroesophageal reflux. Parents of 30 infants with CHD completed online surveys when their infant was 6, 8, 10, and 12 months old. Surveys included parent-report measures of feeding skills (Child Oral and Motor Proficiency Scale), feeding behaviours (Pediatric Eating Assessment Tool), symptoms of gastrointestinal distress (Infant Gastrointestinal Symptoms Questionnaire), and gastroesophageal reflux (Infant Gastroesophageal Reflux Questionnaire-Revised). We found that 95, 32, 67, and 30% of infants were delayed in their feeding skill development at 6, 8, 10, and 12 months, respectively. Symptoms of problematic feeding behaviours were similarly high, with 90, 62, 29, and 38% of infants meeting criteria for problematic feeding at 6, 8, 10, and 12 months, respectively. Feeding skills and behaviours were related but unique contributors. Feeding behaviours were related to both gastrointestinal distress and gastroesophageal reflux, but feeding skills were rarely related to either. Delayed acquisition of feeding skills and problematic feeding were common in infants with CHD. Infants with more gastrointestinal and gastroesophageal reflux symptoms had more symptoms of problematic feeding behaviours. Comprehensive assessment, targeted interventions, and early involvement of feeding specialists are important to support feeding in infants with CHD through at least the first year of life.

Clinical validation of the infant-driven feeding scales© in Turkey

BackgroundSupporting the development of feeding skills among preterm infants is an important component of neonatal care. The selection of appropriate and supportive feeding interventions begins with a comprehensive assessment of the infant's skills. PurposeThis study aimed to adapt the Infant-Driven Feeding Scales© (IDFS) to the Turkish language. MethodsThis was a methodological, observational, single-center cross-sectional study. The study included 80 infants born at a gestational age ≥ 32 weeks, consecutively admitted to a tertiary Neonatal Intensive Care Unit (NICU). Research data were collected using a premature infant descriptive information form (IDIF), IDFS, and LATCH Score for Breastfeeding Assessment. For the Turkish validity-reliability of the IDF, the translate-back translate method was used with the content validity index (CVI) assessed. ResultsThe scale had CVI values between 0.90 and 1.00 with a mean CVI = 0.96. For measures 1 and 2, there were significant positive and high-level correlations between IFDS-R and IFDS-Q correlation values (r = 0.553–0.958; p = 0.001) and significant negative, low-level correlations between IFDS-R and IFDS-Q with the LATCH scale (r = 0.439–0.532; p = 0.001). According to inter-observer compatibility analyses, the kappa value was 0.94–1.00 for the first measure and 0.96–1.00 for the second measure (p = 0.001). There were negative significant correlations between IDFS-R points with gestational age and postmenstrual age (PMA) (p = 0.001), and gestational age and PMA were explanatory factors for 13.8% of IDFS-R points (F = 7.30, p = 0.001). ConclusionsThe IDFS is recommended for use as a valid and reliable tool to ease the safe and successful development of oral feeding skills in preterm infants and to plan evidence-based interventions. Implications for practiceThe IDFS appears to be a beneficial measurement device for use in assessing the state of readiness of preterm infants for oral feeding and for early determination of risks that may occur due to delayed feeding independence of infants.

Social Validity of Paediatric Feeding Treatment across Goals, Processes, and Outcomes

Social validity of treatment for paediatric feeding disorders can be defined as the extent to which caregivers find treatment goals and procedures acceptable, and the level of satisfaction with the outcomes of treatment. However, there are few studies which examine social validity data, or that evaluate social validity against key treatment variables. The aim of this report was to compare caregiver ratings of treatment acceptability and satisfaction against treatment variables. Social validity measures were obtained from the caregivers of all children consecutively admitted to a home-based behaviour-analytic treatment programme for paediatric feeding disorders (N = 32) in Australia. All children (M = 6 years, range 2–13 y) had severe feeding problems and most had mealtime skill deficits and autism and developmental delays or intellectual disabilities. Social validity measures included treatment acceptability and satisfaction surveys. In a retrospective analysis, social validity scores were compared against variables including participant characteristics and goals, treatment procedures, and treatment outcome. The retrospective analysis identified no significant correlations. In this sample, caregiver social validity ratings were very high, and data-based treatment outcomes for all children showed high levels of clinical significance including consumption, food variety, and feeding skill development. This report is the first to examine social validity in a data-based manner. With the exception of duration of treatment, no further relations were identified. Whilst the findings may be impacted by little variability/ceiling effects, this further communicates that the empirically-supported treatment for a paediatric feeding disorders is highly effective, and highly valued by caregivers of children. It is recommended that further data-based research continue to examine further measures and determinants of social validity.

Children with Feeding Difficulties Present Changes in the Development of Feeding Skills: A Study with a Control Group

Abstract Introduction Feeding skills (FS) are important to child development, as the delay in their presence could suggest feeding difficulties (FD) symptoms. The aim of the present study was to compare the development of three types of FS (autonomy to eat, posture at meals, and adequate use of cutleries) among children with FD and without FD. Methods This was a case-control retrospective observational study. The sample consisted of 316 children from case and control groups in accordance with the presence (or not) of FD. The control group was recruited by convenience (verbal approaching at the emergency care unit), and the case group was based on the medical records collected at the reference center. A same-structured questionnaire was used for both groups. Results Children with FD (63.2%) used baby-bottles in an inadequate way with a higher frequency after 24 months of age. Inadequate posture at meals was observed with higher frequency in children with FD (78.1%). Children without FD (89.1%) had more autonomy to eat. In children > 18 months old, this frequency was higher (90.6%). Conclusion Children with FD showed changes on the development of FS. Inadequate posture at meals was associated with a 36-fold higher risk of having FD. Not eating alone after the age of 18 months was associated with a 6-fold higher risk of having FD, while not using baby bottles was associated with a lower risk (52%) of FD complaints. Delays in FS can be predictors of FD during childhood.

Association between parental feeding practices and shared family meals. The Food4toddlers study.

BackgroundParental feeding practices and family meals are important determinants for infants’ diet and health. Still, there is no previous research of the association between feeding practices and family meals in infants.ObjectiveExplore potential associations between feeding practices and family meals among infants.DesignWe present cross-sectional results (baseline) from the Food4toddlers study. In total 298 parents of 1-year-olds, recruited from all over Norway, filled in a questionnaire regarding frequency of shared family meals (breakfast, lunch, dinner) and feeding practices using the validated instrument Comprehensive Feeding Practices Questionnaire. Logistic regression was used to explore the associations between having family meals every day and feeding practices (10 dimensions).ResultsThe children included were about 11 months old, and 55% were boys. Parents were highly educated. Most children had family breakfast and dinner (60–65%), while fewer had family lunch every day (35%). We found that eating family breakfast and lunch every day was associated with use of the positive feeding practices: encourage balance and variety, environment and modelling (ORs ranging from 1.15 to 1.37), while eating family breakfast and family lunch less often was associated with the negative feeding practice pressure to eat (OR, 95% CI: 0.90 (0.83, 0.96) and 0.91 (0.84, 0.97), respectively). Eating family dinner every day was associated with more use of the positive feeding practice balance and variety (OR, 95% CI: 1.21 (1.06, 1.38), while having family dinner less often was associated with use of the negative feeding practices pressure to eat and restriction to health (OR, 95% CI: 0.89 (0.83, 0.96) and 0.94 (0.87, 1.01), respectively).Discussion and conclusionIn this group of infants, having family meals every day was associated with positive feeding practices, while having family meals less often was associated with negative feeding practices. Shared family meals provide an important setting for healthy eating, development of feeding skills and dietary habits formation.

Mothers and fathers improve immature baboon foraging success

Abstract For many animal species, immatures are less efficient foragers than their adult counterparts and must use multiple strategies to fulfill their nutritional needs through effective learning of social and feeding behaviour. To overcome these challenges, young animals are predicted to rely on adult relatives to gain foraging competency, partly because kin are more likely to tolerate the proximity of immatures, upon which socially facilitated learning of food selection and foraging skills depends. While evidence suggests that mothers improve the foraging success of their offspring, little is known about the potential contribution of fathers to the development of feeding skills. Here, we investigate the influence of both mothers and fathers on the foraging behaviour of young olive baboons (Papio anubis) in Laikipia, Kenya. Behavioural data were gathered via focal animal sampling and genetic relatedness was determined by microsatellite genotyping of non-invasively collected faecal DNA samples. We also conducted analyses to assess the nutritional and energetic content of staple foods consumed by the baboons. We found that, compared to when feeding near unrelated adults or alone, immatures were more likely to consume high energy foods when they were near their mothers and preliminary results suggest access to similar effects when near fathers. These data advance well-documented maternal influences on the foraging competence of offspring in a matrilocal society, and additionally suggest the importance (and possible long-term fitness benefits) of associations between offspring and their fathers.

Dietary management of food protein–induced enterocolitis syndrome during the coronavirus disease 2019 pandemic

As communities struggle to adapt to life under the threat of the global pandemic, COVID-19, those living with Food Protein-Induced Enterocolitis Syndrome (FPIES) must adapt with additional difficulties. Social distancing and shelter-in-place strategies have been implemented, resulting in fewer supermarkets trips, stockpile-purchasing behaviors in up to 74.5% of those surveyed(1), and shortages of staple food items all with potential impact on the availability of foods for those on limited diets. Concern about allergic reactions make exploring alternative or new ingredients undesirable or untenable. Remaining safe at home is important to avoid trips to the emergency department where families may be exposed to the COVID-19 virus and medical attention can be limited due to the burden on global health systems. Parents of children with FPIES are also understandably concerned about meeting their child’s nutritional needs during these times of sheltering-in-place. Now more than ever, advice on what foods to serve and when to serve them is critically important.

Sleep-Wake States and Feeding Progression in Preterm Infants.

Previous studies demonstrated a short-term relationship between infant sleep-wake states and oral feeding performance, with state being an indication of infants' neurobehavioral readiness for feeding. However, the relationship between sleep-wake states and feeding skills has not been evaluated longitudinally during hospitalization. The purpose of this study was to examine preterm infants' sleep-wake state developmental trajectories and their associations with feeding progression during hospitalization. This descriptive and exploratory study was a secondary analysis using data from a longitudinal two-group, randomized controlled trial evaluating the effects of early and late cycled light on health and developmental outcomes among extremely preterm infants who were born ≤28 weeks of gestational age. Sleep-wake states were assessed for two 2-hour interfeeding periods per day (day and night hours), 30 weeks postmenstrual age, and every 3 weeks until discharge. Occurrences of active sleep, quiet sleep, and waking were recorded every 10 seconds. Feeding progression was assessed based on an infant's postmenstrual age at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. Trajectory analyses were used to describe developmental changes in sleep-wake states, feeding progression patterns, and associations between feeding progression and sleep-wake trajectories. Active sleep decreased while waking, and quiet sleep increased during hospitalization. Two distinct feeding groups were identified: typical and delayed feeding progression. In infants with delayed feeding progression, rates of active and quiet sleep development during the day were delayed compared to those with typical feeding progression. We also found that infants with delayed feeding progression were more likely to be awake more often during the night compared to infants with typical feeding progression. Findings suggest that delays in sleep-wake state development may be associated with delays in feeding progression during hospitalization. Infants with delayed feeding skill development may require more environmental protection to further support their sleep development.

Validation of the Early Feeding Skills Assessment Scale for the Evaluation of Oral Feeding in Premature Infants

Background: Feeding difficulties are common and important in premature infants. In order to identify neonatal feeding difficulties, clinicians and nurses require assessment tools to conduct an objective evaluation of infant oral feeding (breast/bottle-feeding). Early identification of infants with feeding difficulty is critical to implement appropriate therapies and optimize the infant’s nutrition and oral feeding skill development. The aim of this study was to validate the Early Feeding Skills (EFS) Instrument for the Evaluation of Oral Feeding in Premature Infants. Methods: In this descriptive cross-sectional study, the researcher initially got permission from the designer of the tool through email. Then, the main version of this tool was translated into Persian using the standard backward/forward method. Subsequently, the formal and content validity of the questionnaire was confirmed. After visiting a neonatal specialist, the assessment of preterm infants' oral feeding skills was performed using the EFS Instrument by observing the infants (n=180) during feeding. The exploratory factor analysis and Cronbach’s alpha were utilized to determine the construct validity and assess the reliability of the instrument, respectively. Results: All items of the EFS Instrument had formal validity. Two items were removed from the instrument, based on content validity. On the basis of factor analysis, the items with a minimum factor load of 0.4 were evaluated and according to the factor load of all items (above 0.4), EFS Instrument had the appropriate construct validity. The Cronbach's coefficient of the instrument was obtained 0.88. Conclusion: The EFS Instrument obtained the required reliability and validity for the evaluation of preterm infants oral feeding.

The Evidence Surrounding Recent Technologies Used in Neonatal Intensive Care Units to Assess and Treat Feeding Development in Premature Infants

Purpose Premature infants are at risk for sucking, feeding, and gastroesophageal issues that can require a prolonged neonatal intensive care unit stay. Although feeding skill development is of crit...

Nutrition For Healthy Infants And Toddlers

Feeding and eating are essential to life. As the infant grows into a toddler, the child goes through transitions with feeding, starting with breast milk or formula, transitioning to complementary feeding between the ages of 4 and 6 months, and then advancing to table foods. It is important to provide adequate nutrition to meet the growing needs of the child from a macronutrient and micronutrient standpoint through infancy to childhood. Throughout this time, anthropometric measurements are obtained to assess proper growth. Feeding is a dynamic part of a child’s life that varies at each stage of childhood, which comes with challenges such as avoiding choking hazards, preventing potential food allergies, providing a varied diet to meet macronutrient and micronutrient needs, and supporting advancement in textures for appropriate development of feeding skills and avoiding issues with picky eating. Providing proper nutrition from quality, quantity, and texture standpoints at each stage of childhood is essential to ensure adequate nutrition to promote healthy and expected growth and development. This review contains 4 figures, 10 tables and 43 references Key words: breast milk, complementary feeding, food, food safety, formula, growth, infant, micronutrients, neophobia, nutrition, oral health, physical activity, toddler

Delayed Development of Feeding Skills in Children with Feeding Difficulties-Cross-sectional Study in a Brazilian Reference Center.

Delays in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere in the development of feeding skills (FS); and-therefore-in the success of the process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of FS. Assessment of five FS in Brazilian children with FD, and search of associations with types of FD. Cross-sectional study with 70 children below 10 years old. Data were obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment, and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and FD diagnosis. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%. There was no difference in FS (p > 0.05) or in the number of FS inadequateness (p = 0.84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; 1/3 presented delays in more than half of the FS. The most prevalent inadequacies in FS were inadequate feeding position (73.5%), prolonged bottle feeding (56.9%), and inadequate self-feeding practices (37.9%). Feeding complaints first appeared at 10.9 ± 11.4 months, and picky eating was the most prevalent type of FD (37.1%). Most children were fed in inadequate environments (55.2%), without the company of adults (78%). Transition to solid foods occurred at 16 ± 5.6 months. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p = 0.95), and from complementary feeding to solid foods (p = 0.43) did not vary according to FD diagnosis. FS development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD.

Development of feeding skills in preterm infants: a critical literature review

ABSTRACT Infants born prematurely have problems in developing feeding skills due to their immaturity. To describe this, a critical review of national and international literature was carried out from May to September 2016. The information was reviewed from Scielo, Pubmed and Cochrane, and also specialized journals using the following key words: “Feeding development preterm”, “feeding skills preterm infants”, “feeding transition preterm”, “lumpy food babies”, “solid food preterm”, “transition solid food infant”, “preterm children weaning food”, “solids in preterm infants”, also searched in Spanish and Portuguese. Publications were included if they shared similar purpose as the present revision, and published in the last 5 years, encompassing articles of systematic literature review or researches which studied preterm children aged between 0 and 10. Studies showed that transition food started earlier in preterm infants, who also showed more feeding problems. It is necessary to have common criteria in terms of assessment methodologies in order to be able to characterize this group in a better way. Parents of preterm infants would benefit from advise and information about developing eating skills, resulting in earlier intervention and management of feeding and eating problems.

Infant-Guided, Co-Regulated Feeding in the Neonatal Intensive Care Unit. Part I: Theoretical Underpinnings for Neuroprotection and Safety.

The rapid progress in medical and technical innovations in the neonatal intensive care unit (NICU) has been accompanied by concern for outcomes of NICU graduates. Although advances in neonatal care have led to significant changes in survival rates of very small and extremely preterm neonates, early feeding difficulties with the transition from tube feeding to oral feeding are prominent and often persist beyond discharge to home. Progress in learning to feed in the NICU and continued growth in feeding skills after the NICU may be closely tied to fostering neuroprotection and safety. The experience of learning to feed in the NICU may predispose preterm neonates to feeding problems that persist. Neonatal feeding as an area of specialized clinical practice has grown considerably in the last decade. This article is the first in a two-part series devoted to neonatal feeding. Part 1 explores factors in NICU feeding experiences that may serve to constrain or promote feeding skill development, not only in the NICU but long after discharge to home. Part II describes approaches to intervention that support neuroprotection and safety.

Complementary Foods: Guidelines and Practices.

Complementary feeding, the transition from a breast milk-based diet to inclusion of other sources of nutrition in an infant's diet, is a major milestone in infant development. This transition period is important as it is a time when infants are vulnerable to developing nutritional deficiencies and occurs during a developmental stage when important food-related behavioral patterns are being established. As under- and overnutrition may coexist in children from the same country, it is important that advice provided by complementary feeding guidelines meets the needs of all children helping them to grow and develop into healthy adults. Many consistent and important themes emerge when comparing complementary feeding guidelines from different countries: complementary foods at or around 6 months of age; continued breastfeeding; nutrient-dense complementary foods; hygienic food practices; development of feeding skills that foster long-term healthy eating habits, and prevention of non-communicable diseases such as obesity. Complementary feeding guidelines that promote good eating during the first year and beyond recognize that nutrition, particularly during the first 1,000 days, has an important influence on immediate growth and development, but also an important role in setting up taste preferences and behavioral patterns which inform an infant's susceptibility to development of disease later in life. However, guidelines in many countries are not always followed, particularly during the second year of life, and innovative methods are needed to increase compliance.

Oralinės stimuliacijos įtaka neišnešiotų naujagimių maitinimosi įgūdžiams

Lietuvoje kasmet gimsta apie 6 procentus neišnešiotų naujagimių, tarp jų ~15,5 procentų - iki 32 gestacijos savaitės. Žindimas yra įgūdis, kurio įgijimas neišnešiotam naujagimiui gali būti labai sudėtingas. Ankščiau nei 32 savaitę gimę naujagimiai dėl motorinės ir nervų sistemų nebrandumo yra maitinami per zondą. Stimuliacija, kuri paskatina čiulpimo ir kitų valgymui reikalingų įgūdžių formavimąsi, gali palengvinti perėjimą prie nepriklausomo oralinio maitinimo, turėti teigiamą poveikį valgymo kokybei, naujagimio raidai ir sumažinti hospitalizacijos trukmę.

Does parental involvement affect the development of feeding skills in preterm infants? A prospective study

BackgroundFeeding difficulties frequently occur in preterm infants, thus contributing to delayed growth and hospital discharge. AimsTo evaluate the effect of Kangaroo mother care implementation and parental involvement in infants' feeding on the timing of achievement of full oral feeding in preterm infants.Study design.Prospective, observational, single-centre study. SubjectsA total of 81 infants born at a gestational age ≤32weeks, consecutively admitted to a tertiary neonatal unit between June 2014 and May 2015.Outcome measures.The timing of the achievement of full oral feeding of preterm infants. ResultsFull oral feeding was achieved at a mean postmenstrual age of 35.5±2.1weeks. A multiple linear regression analysis showed that a low birth weight, the occurrence of bronchopulmonary dysplasia, and the need for gastrointestinal surgical procedures were associated with a higher postmenstrual age at achievement of full oral feedings. By contrast, the earlier that parents fed their infants and the earlier that Kangaroo mother care was started, the lower the postmenstrual age at the achievement of full oral feeding. ConclusionsThese findings indicate that an early start of Kangaroo mother care and early parental involvement in infants' feeding positively affect the achievement of independent oral feeding.