management- infant feeding

common challenges with prematurity

• Poor state regulation

• Weak suck, fatigue

• Incoordination of suck-swallow-breathe

management focus for prematurity

• Ensure physiologic stability before oral feeds

• Optimize nipple flow rate, positioning, and pacing

• Use cue-based feeding vs. rigid schedules

breastfeeding strategies for preterm infants

• Use positioning to support feeding

• Consider hand expressing/pumping to "let down" to reduce fast flow

• Nipple shields

• Consider lactation consult if initial interventions are unsuccessful

common challenges with breastfeeding for preterm infants

• immature latch or suck

• sleepiness, poor endurance

• difficulty coordinating NNS or transitioning to nutritive suck

Benefits of breastfeeding for preterm infants

include immune protection, GI health, and bonding (increased skin-to-skin contact)

POSSIBLE signs that the flow is TOO slow:

• High suck:swallow ratio (2-3:1)

• Prolonged feeding times

• Signs of frustration, hunger and fussiness

• Fatigue

POSSIBLE signs that the flow is TOO fast:

• Gulping, choking, coughing

• Anterior spillage

• Refusal, pulling away

• Eye widening, "overwhelmed" look

what is used to prevent "events" (bradycardia, oxygen desaturation), fatigue, and aspiration?

pacing

Infants, especially premature infants, rely on US to do what?

impose breathing breaks as their lungs are immature

INFANT-based pacing

preferred-watch the INFANT, not the clock

how to do pacing

Tip the nipple downwards to empty and imposes a breathing break and establish a rhythmical pattern to encourage the suck:swallow:breathe behavior.

You can also ___________ to pace, however you do not want to ___________ if possible.

remove the bottle completely; interrupt or break the latch

treatment strategies

• Cheek support (bilateral/unilateral)

• Jaw/chin support

• *Facial boundaries (cheek support + jaw support)

• Resistance on bottle or pacifier

• Upward/Downward pressure towards palate

Assists in building good intraoral pressure, maintaining latch or organization

Cheek support (bilateral/unilateral)

Assists when unable to achieve proper latch, particularly for those that are tongue-tied, have retro or micrognathia or are very disorganized

Jaw/chin support

Assists when unable to maintain latch or organization to nipple to initiate sucking pattern

*Facial boundaries (cheek support + jaw support)

Assists in encouraging larger jaw excursions for improved bolus extraction, engagement in feed

Resistance on bottle or pacifier

Assists with engagement in feed and providing anchor to latch

CAN be reflexive in nature

Upward/Downward pressure towards palate