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Feeding in the NICU and Issues That Influence Success

Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado
Denver, CO

Premature infants are both medically fragile and immature; both of these factors influence their ability to safely feed. Speech-language pathologists (SLPs) working with these infants must recognize normal development of feeding skills as well as diagnose feeding problems and develop individualized treatment plans. Assessments should include all three phases of swallowing (oral, pharyngeal, and esophageal) in the context of overall stability, and interventions need to be individualized to the unique needs of each infant. Decreasing the flow rate of fluid and providing pacing are frequently used strategies to support the medically fragile infant. Therapeutic programs that do not appreciate the role of both individual developmental progression and medical comorbidities are not appropriate, given that volume is not the only goal of feeding. Rather, SLPs must focus on skill acquisition for long-term success within the larger context of parental nurturing. Medical comorbidities significantly influence both the initiation and the progression of oral feeding in this population. The individual variation in development, as well as the medical fragility in this population, challenges the neonatal intensive care unit (NICU) therapist to appreciate the complexity of feeding and to work in collaboration with the other members of the team.