Nipple Feeding Research Articles

Bolus Feeding Via Gastric Versus Oral Routes in Very Preterm Neonates.

We intend to investigate the association of bolus orogastric tube (BOG) and nipple bottle (N) feedings with postnatal growth in very premature neonates (VPN: gestational age between 28 and 33 weeks). The days of life (DOL) to achieve full combined oral and gastric enteral nutrition (FEN) and attain body weight (BW) of 2200 g (Wt22) and the length of hospitalization (LOH) were retrospectively associated with clinical and BOG and N feeding-related variables via multivariate regression analyses. Correlations were performed to ascertain the strength of associations. In a cohort of 127 VPN, FEN demonstrated negative associations with gestational age (GA) and LOH and Wt22 with birth weight (BW). FEN showed positive associations with nil by mouth and intravenous fluid-nutrition days and with DOL to start and achieve full nipple feeding. LOH was associated with days on antibiotics and DOL to start and achieve full nipple feeding. Wt22 was associated with DOL to achieve full nipple feeding. The start day of BOG feeding had no independent associations and weak, highly significant positive correlations with Wt22, LOH, and FEN. Bolus orogastric tube feeding has no independent implications for postnatal growth, duration of hospitalization, or chronological age to attain full enteral nutrition in VPN unless combined with nipple feeding to provide enteral nutrition. Oral bottle feeding accelerates postnatal catch-up growth and full enteral nutrition acquisition while reducing hospitalization duration. Initiating nipple feeding at 32 weeks of postmenstrual age may be safe in stable VPN. Antibiotic therapy increases hospitalization duration.

Effects of Infant Driven Feeding Program on Provision of Breast Milk in Very Low Birth Weight Infants.

Background: The ability to complete nipple feedings is one of the discharge criteria for most premature neonates. The Infant Driven Feeding (IDF) program suggests a system of objective promotion of oral feeds in premature infants. There is a lack of studies systematically studying the effects of IDF on the provision of breast milk. Methods: This was a retrospective study of all premature infants born before 33 weeks and birth weight of <1,500 g admitted to a level IV neonatal intensive care unit. Infants on IDF were compared with those not on IDF. Results: A total of 46 infants in the IDF group and 52 in the non-IDF group met the inclusion criteria. A higher number of infants in the IDF group breastfed at first oral attempt (54% versus 12%). Forty-five percent of IDF mothers completed a full 72 hours of protected breastfeeding at the start of oral feeds, and IDF infants had earlier removal of nasogastric (NG) tube. There was no difference in the provision of breast milk and/or breastfeeding on discharge between the two groups. There was no difference in the length of stay between the two groups. Conclusion: The IDF program attempts to streamline the promotion of oral feeds in very low birth weight infants. Higher incidence of breastfeeding at the start of oral feeds and earlier removal of NG tube did not translate into higher provision of breast milk on discharge in very low birth weight infants in the IDF group. Prospective randomized trials are needed to validate cue-based infant driven feeding programs and their effects on the provision of breast milk.

A STUDY TO ASSESS THE LEVEL OF FEEDING PERFORMANCE AMONG PRETERM BABIES IN GOVERNMENT HOSPITAL IN KUZHITHURAI, TAMIL NADU

Introduction: Preterm birth also known as premature birth is the birth of a baby at less than 37 weeks of gestation. Preterm babies are not fully prepared to live in the world outside their mother’s womb. When babies are born prematurely, their digestive systems may not be fully developed. As a result, many of these small infants experience feeding difficulties such as problems establishing nipple feedings at breast or with the bottle. Methodology: Descriptive research approach was adopted using descriptive research design. The sample consisted of 30 preterm babies with poor feeding performance .The samples were collected by using the non -probability convenient sampling technique. The level of feeding performance was assessed with the help of modified early feeding skill assessment scale for preterm babies. Results: Majority of 15 (50%) preterm babies had poor feeding performance, 12 (40%) preterm babies had average feeding performance and 3 (10%) had good feeding performance. It was not possible to compute chi-square test to find out the association between level of feeding performance and their socio-demographic variables, as the expected values are less than 5. Conclusion: The overall study clearly showed that there were poor and average feeding performances of preterm babies.

Short communication: Barrier characteristics of 3 external teat sealants to prevent bacterial penetration under in vitro conditions using rubber calf-feeding nipples

The main objective of this study was to evaluate the barrier characteristics of 3 external teat sealants for dry cows in preventing bacterial penetration by 3 common major mastitis pathogens (Escherichia coli, Staphylococcus aureus, and Streptococcus uberis) via a novel in vitro simulation model using rubber calf-feeding nipples. All feeding nipples were filled with a sterile cotton plug soaked in sterile broth heart infusion medium and were treated as follows: rubber teats 1 and 5 were sealed with Ubera Dry (Inovet, Arendonk, Belgium); rubber teats 2 and 6 were sealed with T-Hexx Dry (Huvepharma Livestock, St. Louis, MO); rubber teats 3 and 7 were sealed with Uddergold Dry (Ecolab Food and Beverage Division, St. Paul, MN); and rubber teats 4 and 8 remained unsealed and served as positive and negative controls, respectively. After the dips had dried, rubber teats 1 to 4 were immersed in a suspension of E. coli (experiment 1), Staph. aureus (experiment 2), or Strep. uberis (experiment 3; ≥1.5 × 108 cfu/mL) for 24 h, whereas rubber teats 5 to 8 were not exposed to the bacterial suspensions. All external teat sealants adhered well to the rubber teats. All cotton plugs collected from the teats that were not exposed to E. coli, Staph. aureus, or Strep. uberis (rubber teats 5 to 8) remained culture-negative, except for 1 (due to contamination). Of the rubber teats that were exposed to the major mastitis pathogens, all cotton plugs collected from the teats dipped with Ubera Dry and T-Hexx Dry remained culture-negative for the mastitis pathogen they were exposed to. The cotton plugs of the rubber teats that were sealed with Uddergold Dry and exposed to E. coli and Strep. uberis showed positive cultures for the respective bacteria, as demonstrated using strain-typing. The cotton plugs collected from the rubber teats that were not sealed with an external teat sealant and that served as positive controls became culture-positive for the mastitis pathogens they were exposed to. We conclude that Ubera Dry showed comparable and superior barrier performance against penetration of E. coli, Staph. aureus, and Strep. uberis compared with T-Hexx Dry and Uddergold Dry, respectively, under in vitro conditions using a novel in vitro simulation model. Although one should be aware that the method has not yet been validated to predict risk of intramammary infections, the proposed technique can be a meaningful starting point to evaluate and compare the barrier characteristics of external teat sealants in preventing bacterial penetration. A large-scale clinical trial is needed before any definite conclusions can be drawn as to the adherence, duration of adherence, barrier performance, and efficacy in protection against intramammary infections of the 3 external teat sealants under field conditions.

PSIII-3 The effects of feeding milk from a nipple or a bucket on performance, blood metabolism, rumen fermentation and behavior of dairy calves during preweaning period

Abstract The aim of this study was to evaluate the effects of two milk feeding methods on performance, blood metabolism, rumen fermentation and behavior of preweaning dairy calves. Forty newborn Holstein female calves were assigned to one of two treatments equally: nipple feeding (NF) and bucket feeding (BF). Gradual weaning commenced on d 35 and weaning occurred on d 56. Starter intake, fecal scoring, body weight and structural measurements (withers height, heart girth, abdominal girth, body length) were collected. Blood samples and Rumen fluid samples were collected on day 28 and 56, respectively. Ten calves from each treatment were selected randomly and instantaneous scan-sampling with 3 min intervals was used to collect the behavior data (licking nipple or bucket, manipulating objects, self-grooming, lying, standing). Observation were conducted twice per week (1 h session duration) and were centered around morning (0900 h), afternoon (1500 h), and evening (1700 h) milk feeding period. Data were analyzed by mixed effect model with treatment, time, and the interaction between them as fixed effects, and animal within treatment as a random effect. Results showed that body weight, average daily gain, starter intake and structural measurements were similar between two treatments. NF group had higher diarrhea frequency than BF group during week 6 (P = 0.03). NF group had higher concentration of insulin (P = 0.01), IGF-1 (P = 0.03) and β-hydroxybutyric acid (P = 0.04) than BF group on d 56. Rumen pH and volatile fatty acids were similar between two treatments. No differences between two treatments for behavior observation were found, except that NF group spent more time licking nipple than BF group (P = 0.001). In conclusion, nipple or bucket feeding had no effects on performance, starter intake and rumen fermentation, yet nipple feeding increased licking time and different feeding methods influenced blood metabolism.

A Baby Feeding Nipple: Simple, Cost effective, and Safe Technique for Removal of Denture

Abstract Introduction: Denture ingestion occurs commonly in the elderly and frequently impacted in the esophagus due to the sharp edges. This can lead to serious complications such as perforation. We are describing here a simple, cost effective and safe technique for removal of dentures. Material and methods: We used a handmade hood protector made from baby feeding nipple with rat-toothed forceps to safely remove ingested denture in two middle aged patients. Both patients had subcutaneous emphysema. Results: Dentures were removed successfully in both patients. Following denture removal, endoscopic examination of the esophagus did not show any sign of mucosal damage, ulceration, bleeding, or perforation. Conclusion: We successfully and safely removed denture from the stomach using handmade hood designed from a baby feeding tube. It may be beneficial for wide visual field and safety. It is an easy, effective, and safe design for the removal of sharp foreign bodies like dentures.

Somatosensory Modulation of Salivary Gene Expression and Oral Feeding in Preterm Infants: Randomized Controlled Trial.

BackgroundDespite numerous medical advances in the care of at-risk preterm neonates, oral feeding still represents one of the first and most advanced neurological challenges facing this delicate population. Objective, quantitative, and noninvasive assessment tools, as well as neurotherapeutic strategies, are greatly needed in order to improve feeding and developmental outcomes. Pulsed pneumatic orocutaneous stimulation has been shown to improve nonnutritive sucking (NNS) skills in preterm infants who exhibit delayed or disordered nipple feeding behaviors. Separately, the study of the salivary transcriptome in neonates has helped identify biomarkers directly linked to successful neonatal oral feeding behavior. The combination of noninvasive treatment strategies and transcriptomic analysis represents an integrative approach to oral feeding in which rapid technological advances and personalized transcriptomics can safely and noninvasively be brought to the bedside to inform medical care decisions and improve care and outcomes.ObjectiveThe study aimed to conduct a multicenter randomized control trial (RCT) to combine molecular and behavioral methods in an experimental conceptualization approach to map the effects of PULSED somatosensory stimulation on salivary gene expression in the context of the acquisition of oral feeding habits in high-risk human neonates. The aims of this study represent the first attempt to combine noninvasive treatment strategies and transcriptomic assessments of high-risk extremely preterm infants (EPI) to (1) improve oral feeding behavior and skills, (2) further our understanding of the gene ontology of biologically diverse pathways related to oral feeding, (3) use gene expression data to personalize neonatal care and individualize treatment strategies and timing interventions, and (4) improve long-term developmental outcomes.MethodsA total of 180 extremely preterm infants from three neonatal intensive care units (NICUs) will be randomized to receive either PULSED or SHAM (non-pulsing) orocutaneous intervention simultaneous with tube feedings 3 times per day for 4 weeks, beginning at 30 weeks postconceptional age. Infants will also be assessed 3 times per week for NNS performance, and multiple saliva samples will be obtained each week for transcriptomic analysis, until infants have achieved full oral feeding status. At 18 months corrected age (CA), infants will undergo neurodevelopmental follow-up testing, the results of which will be correlated with feeding outcomes in the neo-and post-natal period and with gene expression data and intervention status.ResultsThe ongoing National Institutes of Health funded randomized controlled trial R01HD086088 is actively recruiting participants. The expected completion date of the study is 2021.ConclusionsDifferential salivary gene expression profiles in response to orosensory entrainment intervention are expected to lead to the development of individualized interventions for the diagnosis and management of oral feeding in preterm infants.Trial RegistrationClinicalTrials.gov NCT02696343; https://clinicaltrials.gov/ct2/show/NCT02696343 (Archived by WebCite at http://www.webcitation.org/6r5NbJ9Ym)

Eating in "SINC": Safe Individualized Nipple-Feeding Competence, a Quality Improvement Project to Explore Infant-Driven Oral Feeding for Very Premature Infants Requiring Noninvasive Respiratory Support.

Oral feeding is a developmental task for all premature infants. often, independent nipple feeding is the last barrier to discharge home from the NICU. A relationship exists between consistent, infant-driven feeding management practices and improved feeding performance. Conversely, a random approach to feeding may contribute to poor short-term and long-term clinical outcomes. We report a quality improvement project that was undertaken across five NICUs in an urban setting. our aim was to safely initiate and advance nipple feeding for very preterm neonates (born at <32 weeks gestation) who had a respiratory morbidity requiring nasal continuous positive airway pressure therapy. A novel algorithm entitled "eating in SINC: Safe individualized nipple-Feeding Competence" was developed. Safe individualized nipple-feeding competence involves the baby, the parents, and the health care team by using infant-driven strategies, common language, and developmentally appropriate goals while supporting fragile neonates to be skilled feeders.

Legal Briefs: Aggressive Gavage Feeding and Gastric Perforation

Twins at 341/7 weeks’ gestation were born to a 33-year-old healthy mother with a pregnancy remarkable for in vitro fertilization, diamniotic, dichorionic twins, and preterm labor. After a full course of antenatal corticosteroids, the twins were born by cesarean delivery. Twin A was a 2,410-g male infant with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. His examination findings were normal, and his complete blood count was unremarkable. On day 1 an order was written to begin feeding the infant with either breast milk or premature formula (20 calories per ounce). The feedings were to be initiated by gavage or nipple feeding at 5 mL every 3 hours for two times and subsequently to increase by 3 mL every 3 hours to a maximum feed of 20 mL/kg every 3 hours; a concomitant order to decrease the intravenous fluid rate was written as the oral feeds increased. On day 1 the infant fed well, taking each feed by nipple within 20 minutes. By the end of day 1, he was nippling 17 mL. The mean heart rate (HR) was 131 beats per minute. The abdominal girth, measured 4 times, was 28 cm. Instead of losing weight at this point, he gained 60 g. On day 2 the infant was initially nippling his feeds well, but when the amount reached 30 mL, he began feeding poorly; he needed stimulation to suck, was sleepy, needed chin support, and required an increasing time to nipple feed. At this point the nurse decided to gavage feed the infant to keep up with the feeding schedule of an increase of 3 mL every feed. The nurse inserted a nasogastric tube. She did not document the depth of insertion. The nurse maintained at her deposition that she inserted the …

Infant Airway Protection Mechanisms During Swallowing

Infants have high caloric needs. Newborns will feed, on average, eight to 10 times per day and they depend exclusively on fluid intake to meet their caloric needs. Fluids represent the most commonly aspirated material. Understanding the high risk for aspiration due to proportion of liquid calories and the frequency with which the infant feeds, it is necessary for dysphagia professionals to understand the protective mechanisms available to the infant. The anatomic arrangement of the upper aerodigestive tract, resulting swallow physiology and laryngeal reflexes of the infant, optimally prepare the infant for safe swallowing during nipple feeding.

The development of a mother's internal working model of feeding

The purpose of the study was to describe changes in a mother's early internal working model of infant feeding. In this qualitative study, 12 maternal responses to the semi-structured internal working model interview were audio-recorded, once in the neonatal intensive care unit after infants began oral feeding and once 2 weeks post-discharge. Interviews were analyzed using directed content analysis. A change between mothers' early and later nipple feeding experiences was identified. Nurses and other clinicians can help mothers understand the infant's behaviors and focus on the infant's nutritional intake while simultaneously developing a relationship with the infant.

Transition From Gavage to Nipple Feeding for Preterm Infants With Bronchopulmonary Dysplasia

The transition from gavage to nipple feeding is difficult for preterm infants with bronchopulmonary dysplasia because of tachypnea and hypoxemia from chronic respiratory distress. The aim of this study was to test the hypothesis that preterm infants with bronchopulmonary dysplasia who transitioned from gavage to nipple feeding with the semidemand method would achieve nipple feeding sooner and be discharged from hospital sooner than control infants who received standard care. Forty-two infants were randomized to the control condition and 44 to the experimental protocol. Mean gestational ages and birth weights were 25 ± 1.5 weeks and 784 g for controls and 25 ± 1.4 weeks and 787 g for experimental infants. Control infants received standard care that included gradual increases in the number of nipple to gavage feedings per day. Experimental infants received the semidemand method that used infant behavioral and cardiorespiratory signs to regulate frequency, length, and volume of nipple feedings. General linear model procedures were used to compare study groups. Experimental infants achieved nipple feeding at M = 5.9 ± 0.7 days compared with control infants, M = 12.3 ± 0.8 (p < .0001). Length of hospitalization was not significantly different between groups. The semidemand method significantly shortened the time for infants to attain nipple feeding in a manner taking their respiratory distress into consideration.

Infant Nipple Feeding Assessment and Communication Tool: Face Validity and Inter-Rater Reliability Testing

Infant Nipple Feeding Assessment and Communication Tool: Face Validity and Inter-Rater Reliability Testing

Graphical Exploration of Dimensions of Preterm Infant Growth in Weight in Association With Biological, Nutritional, and Energy Expenditure Conditions

The small sample sizes of studies involving preterm infants limit the use of statistics for examination of multivariate conditions contributing to clinically important growth dimensions of weight: rate of weight gain, body composition (fat-free and fat mass), and weight relative to reference infants (z score). The authors used graphical analyses, including multivariate proportional matrix, parallel coordinates, and bivariate plots with regression lines and splines, to explore specific variables derived from a theoretical model of biological, nutritional intake, and energy expenditure conditions influencing growth dimensions. The sample included 28 infants in 4 birth-weight categories: extremely low (<1,000 g), very low/smaller (1,000-1,249 g), very low/larger (1,250-1,499 g), and low (1,500-1,750 g). The authors examined the rate of weight gain before and after nipple feeding initiation. Fat-free mass was estimated with total body water and fetal reference data, and fat mass with skinfold thicknesses. Despite infants achieving the expected rate of weight gain for a fetus of the same postconceptional age, by hospital discharge 13 infants showed growth restriction with weight <10th centile. Infants with respiratory distress syndrome history were highest in negative z-score change from regain of birth weight to discharge, despite higher ordering on protein intake and fat-free mass. Graphical analyses provided visual patterns of distributions and orderings of measures of multiple variables that, taken together, identified potential influencing conditions and raised questions for further study. Other variables, including feeding protocols and practices, infant feeding competence, and health status, may contribute to variability in weight growth dimensions and influence relationships with biologic, nutritional, and energy expenditure conditions.

Osteopathic Manipulative Treatment for the Treatment of Hospitalized Premature Infants With Nipple Feeding Dysfunction

Premature newborns and infants are usually required to successfully transition from gavage to nipple feeding using breast or bottle before discharge from the hospital. This transition is frequently the last discharge skill attained. Delayed acquisition of this skill may substantially prolong hospital length of stay. The authors describe a case of hospitalized premature twins who had considerable delays in attaining nipple-feeding skills. Because of their inability to take all feedings by nipple, preparation for surgical placement of gastrostomy tubes was initiated. Before the surgeries were scheduled, the inpatient osteopathic manipulative medicine service was consulted, and the twins received a series of evaluations and osteopathic manipulative treatment (OMT) sessions. During the OMT course, the twins' nipple feeding skills progressed to full oral feeding, which allowed them to be discharged to home without placement of gastrostomy tubes. The authors also review the literature and discuss the development of nipple feeding in premature newborns and infants and the use of OMT in the management of nipple feeding dysfunction.

Duodenal ileus caused by a calf feeding nipple in a cow

BackgroundThe aim of this report was to describe duodenal obstruction caused by a rubber foreign body in a cow.Case PresentationThe clinical, biochemical and ultrasonographic findings in a five-year-old Swiss Braunvieh cow with duodenal ileus caused by a calf feeding nipple are described. The main clinical signs were anorexia, ruminal tympany, decreased faecal output and abomasal reflux syndrome. Ultrasonographic examination revealed reticular hyperactivity and a dilated duodenum. A diagnosis of duodenal ileus was made and the cow underwent right-flank laparotomy, which revealed a dilation of the cranial part of the duodenum because of obstruction by a pliable foreign body. This was identified via enterotomy as a calf feeding nipple. The cow was healthy at the time of discharge four days after surgery and went on to complete a successful lactation.ConclusionsTo our knowledge, this is the first description of duodenal obstruction by a calf feeding nipple. This is an interesting case, which broadens the spectrum of the causes of duodenal ileus, which is usually caused by obstruction of the duodenum by a phytobezoar.

Swallow–Breath Interaction and Phase of Respiration with Swallow during Nonnutritive Suck among Low-risk Preterm Infants

This study describes swallow-breath interaction and phase of respiration with swallow during nonnutritive suck (NNS) in low-risk preterm infants. Suckle and swallow, thoracic motion, and airflow were measured in 16 infants during NNS. Logistic regression models were used to describe swallow-breath interaction and phase of respiration with swallow. One hundred seventy-six swallows occurred in 35 NNS periods. Swallow-breath interaction occurred as: central apnea (CA), obstructive apnea (OA), or attenuated respiration (AR). AR was associated with increased weeks post-first nipple feeding. OA occurred less often in males and with increased weeks post-first nipple feeding. In looking at the phase of respiration, more swallows occurred at beginning expiration with increased gestational age, increased weeks post-first nipple feed, and increased weeks before first nipple feed. More swallows occurred at midexpiration with more swallows per study, increased birth weight (BWT), and weeks before first nipple feed. Fewer swallows occurred at end expiration with increased weeks before first nipple feed. Fewer swallows occurred at midinspiration with increased swallows per study. Fewer swallows occurred at apnea with increasing BWT, more occurred with increased swallows per study. In low-risk preterm infants, swallow-breath interaction progresses from CA and OA to AR. The phase of respiration with swallow shows a maturation progression.

Evidenzbasierte Intervention für das Stillen und Füttern mit der Flasche in der neonatalen Intensivmedizin

Das Stillen und das Füttern mit der Flasche gehören zu den wichtigsten Behandlungszielen auf einer neonatalen Intensivstation (NITS; neonatal intensive care unit NICU). Die klinischen Aufgaben umfassen Angebote für den frühgeborenen Säugling mit einem typischen Entwicklungsverlauf, der spezielle Unterstützung benötigt, um die Fähigkeiten, welche für eine erfolgreiche orale Ernährung erforderlich sind, zu erlangen, und für die frühgeborenen wie auch reifgeborenen Säuglinge mit einer Dysphagie, die spezifische Diagnose- und Behandlungsverfahren benötigen, soweit diese verfügbar sind, um die Entwicklung des Saugverhaltens zu erleichtern und den Übergang zu einer oralen Ernährung zu ermöglichen. Der Übergang vom nonnutritiven zum nutritiven Saugen, die Reifung typischer wie auch untypischer Saug- und Schluckprozesse bei Säuglingen und Kleinkindern, Einschätzungsverfahren und unterstützende Behandlungsverfahren für den Aufbau des Saugverhaltens und den Abbau von Fütter- und Schluckproblemen sind zunehmend Gegenstand der Forschung. Aber die verfügbaren Informationen aus experimentellen Studien und Datenbankrecherchen zu diesen Themen sind bislang lückenhaft. Diese Lücken werden durch Expertenmeinung und klinische Erfahrungswerte ergänzt. Auf jeden Fall ist die zunehmende Zahl der klinisch relevanten, datenbasierten Informationen vielversprechend. Die Hauptziele bei der Behandlung von Säuglingen mit Nahrungsaufnahmeproblematik liegen in einer Erleichterung des Übergangs von der Sondenernährung zu oraler Ernährung und in der Entwicklung der Saug- und Schluckfertigkeiten zur Gewährleistung einer hinreichenden Nahrungs- und Flüssigkeitsaufnahme während des kindlichen Wachstums. Das Ziel des vorliegenden Artikels ist ein Überblick über aktuelle Forschungsbeiträge, welche eine Evidenzbasis für die klinische Praxis schaffen. Die Diskussion betrifft Forschung und Praxis des Umgangs mit klinischen und instrumentellen Diagnoseverfahren und mit therapeutischen Interven-tionen zur Vorbereitung des Säuglings auf ein Trinken aus dem Sauger/bzw. von der Brust der Mutter und zu weiteren Verbesserungen der Saug- und Schluckkompetenzen während der oralen Ernährung.

Development of swallowing and feeding: Prenatal through first year of life

The development of feeding and swallowing involves a highly complex set of interactions that begin in embryologic and fetal periods and continue through infancy and early childhood. This article will focus on swallowing and feeding development in infants who are developing normally with a review of some aspects of prenatal development that provide a basis for in utero sucking and swallowing. Non-nutritive sucking in healthy preterm infants, nipple feeding in preterm and term infants, and selected processes of continued development of oral skills for feeding throughout the first year of life will be discussed. Advances in research have provided new information in our understanding of the neurophysiology related to swallowing, premature infants' sucking and swallowing patterns, and changes in patterns from preterm to near term to term infants. Oral skill development as texture changes are made throughout the second half of the first year of life is an under studied phenomenon. Knowledge of normal developmental progression is essential for professionals to appreciate differences from normal in infants and children with feeding and swallowing disorders. Additional research of infants and children who demonstrate overall typical development in oral skills for feeding is encouraged and will provide helpful reference points in increasing understanding of children who exhibit differences from typical development. It is hoped that new technology will provide noninvasive means of delineating all phases of sucking and swallowing from prenatal through infancy. Further related topics in other articles of this issue provide a comprehensive review of factors influencing oral intake, growth, nutrition, and neurodevelopmental status of children.

Changing Feeding Documentation to Reflect Infant-Driven Feeding Practice

Nipple feeding is a complex task for most preterm or high-risk infants. It requires a skilled and observant caregiver to assist the infant in a pleasurable feeding experience that maximizes intake and minimizes stress. This article presents the traditional progression, method, and documentation routinely used in nurseries, as well as an infant-driven approach to feeding that is beginning to surface in nurseries. The article will review the goals for successful nipple feeding and present the Infant-Driven Feeding Scales to be used as an assessment, a guide for intervention, and a means for documentation of nipple feedings. The scale encompasses infant feeding readiness and quality of nippling, as well as caregiver techniques. The article includes parent use of the scale, as well as a case review using the Infant-Driven Feeding Scales.