Some Common Problems and Solutions
Developmental Aspects of Feeding
The Feeding Relationship
Some preterm infants make a straightforward progression from specialized hospital feedings to feeding at the breast or with the bottle without difficulty. For a number of reasons though, rates of feeding problems are higher in low birth weight infants. Parents often report that feeding was the most important problem they faced with their infants after discharge (see What Parents Tell Us). In many families, problems with feeding and the feeding relationship continue into childhood. The information on these pages about feeding is based on the common problems that parents have reported to us.
All infants who present with feeding problems should have an initial feeding assessment.
Some feeding problems are due to immaturities of the preterm infant, neurodevelopmental problems, or diseases of prematurity. Other feeding problems may stem from early aversive experiences such as GER, respiratory distress with feeding, noxious treatment interventions to the oral and facial areas, and aversive effects of interventions such as mechanical ventilation. Whatever the initial cause of feeding concerns, the impact on the family and the risk of ongoing disorders in the feeding situation must be considered. Health care providers should strive to ensure that support and advice about nourishing preterm infants will contribute to the long term success of the feeding relationship.
The full-term infant is born with the ability to efficiently extract milk from the breast (or bottle). Physical and neurological development allows the full-term infant to maintain efficient posture for feeding, generate appropriate oral pressure for milk extraction, coordinate suck-swallow-breathing while nippling, and regulate sleep-wake cycles in a manner that facilitates demand feeding. In contrast, the infant born prematurely has low tone, decreased muscle and fat mass, does not effectively coordinate suck-swallow-breathing, and does not sustain prolonged wake states. This places the infant at a disadvantage for being an efficient feeder.
Nipple feeding may be attempted in the stable infant of at least 33-34 weeks gestation, possibly earlier for breastfeeding infants (Meier, 1996). The transition from tube feeding to nipple feeding is a gradual process and often takes place in the hospital. Historically, the infant was considered ready for discharge when he or she demonstrated the ability to nipple all feedings and sustained appropriate growth. For the stable infant, without medical, gastrointestinal, and neurological complications, this may occur between 35-38 weeks gestation. However, the transition from tube to nipple feeding may be delayed, feeding may continue to be difficult, or continued feeding assistance may be necessary in infants with the following conditions:
The transition home is a time of adjustment, learning and stress. The parents and infant must develop ways of interacting that facilitate nourishing and nurturing. The feeding interaction supports nurturing and development. Disruptions in this process may have psychosocial as well as growth consequences (See Satter, 1994). With support, reassurance, and time, the stress of this difficult time passes as the infant matures and makes a successful transition. For some families, however, feeding difficulties may persist.