Therapeutic bottle feeding is a critical skill for speech-language pathologists (SLPs) managing the increasing and medically complex neonatal intensive care unit (NICU) and early intervention caseloads. Thus, we explored the role of a high-emotion preterm simulator, known as "Paul," to increase knowledge, skills, and confidence related to infant feeding management for speech-language pathology graduate students. A randomized controlled study compared learning outcomes of 27 participants following either a 1-hr lecture or 1-hr training with a preterm simulator. Outcomes included knowledge demonstrated on written examination, accuracy in identifying stress cues during simulated feeding, and self-reported anxiety levels related to clinically assessing infant feeding. No baseline group differences were found on written examination or during a simulated bottle feeding. Both groups improved in written examination scores and identification of stress cues (p < .001). Gains in written examination scores did not significantly differ between groups; however, after training, the simulator group correctly identified more stress cues during a simulated bottle feeding (p < .001), and the lecture group reported reduced anxiety related to clinically evaluating infant feeding compared to simulator-trained students (p < .05). All students demonstrated gains in written knowledge and identification of stress cues; however, simulation-based training was superior in developing the feeders' ability to identify stress cues during a hands-on simulated bottle-feeding scenario. Lecture-based training may have inflated students' perceptions in their clinical skills as they were less accurate in identifying stress cues during a simulated feeding but reported significantly reduced anxiety for administering a clinical evaluation of infant feeding compared to simulation-trained students. Hands-on training using high-fidelity simulation may capitalize on experiential learning to better build clinical feeding skills for future SLPs who may serve in NICU and early intervention settings, while eliminating the risk of potential errors during learning that could affect fragile neonates.