Feeding - disorganised feeding patterns in the neonate
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Preventing and overcoming feeding resistance
Feeding disorders can be categorised into three areas:
- Slow to establish feeds
- Disorganised feeding
- Dysfunctional feeding.
Contributing factors to disorganised/dysfunctional feeding patterns and feeding resistance:
- Delayed introduction of oral feeds.
- Birth Asphyxia.
- Neurological problems.
- Prolonged respiratory distress.
- Cardiac anomalies.
- Averse oral stimulation.
- Multiple caregivers.
- Retching when fluid enters the mouth or pharynx.
- Desaturation, cyanosis, tachypnoea, tachycardia, periodic respirations.
- Turning head away, tuning out.
- Arching, squirming, fussing, gagging.
- Tongue thrusting when teat or nipple in mouth.
- Falling asleep when feeding attempted.
- Irritability - panic.
- Unable or refusal to suck.
Follow the steps below to encourage normal feeding patterns:
- Encourage non-nutritive sucking especially during nasogastric feeding or prolonged episodes of NBM. Be gentle - do not forced. Consider NNS on mothers pre-expressed breast. See Non-nutritive Sucking in relevant Developmental Supportive Care guideline.
- Promote developmental supportive care. See relevant Developmental Supportive Care guideline.
- Commence oral feeding as soon as infant has cardio-respiratory stability. For unstable, extubated infants the decision to commence feeding should be a multi-disciplinary one.
- Promote hand to mouth activity.
- Minimise invasive procedures of and around the mouth.
Nasally intubated babies should have size 6 feeding tube down free nostril.
Non ventilated babies, pass size 6 feeding tube nasally unless respiratory condition does not allow.
Hudson CPAP babies require oral size 6 feeding tube.
Rationalise oral suction - only suction PRN. Insert suction catheter gently the required distance.
- Optimise the association of oral stimulation with social activity.
- Some infants will require respiratory support. Oxygen and oxygen saturation levels will be maintained as charted. Oxygen is a drug and any pre-planned increases during feeding must be charted by Doctor/NS-ANP.
- Observe for feeding cues and act on them. Do not force feed.
- Encourage gentle oral stimulation to elicit sucking action as per following instructions.
Enhancing feeding response
Follow the steps below to ensure feeding enhancement (improve response).
- Conducive environment is maintained, i.e., low visual stimuli and noise levels.
- Assess state of the baby, i.e., drowsy, active and alert. Gently rouse baby if appropriate. See Breastfeeding the preterm infant.
- It may be necessary to restrict length of feeding. Rest periods may be needed to be included in this time frame. Usually 30-40 minutes depending on the infant's ability to recover.
- Ensure baby is swaddled gently and loosely (a muslin cloth is best for this).
- Ensure baby is correctly positioned, upright, slight flexion of neck. Flexed posture and arms midline.
- Ensure correct type of teat is used as documented in care plan by LC or SLT.
- Consistency is maintained with continuity of care and adhering to individualised care plans. Do not change teats or feeding plan without consultation SLT, LC, FLN or CCN and mother.
- Provide oral stimulation as per feeding plan. Mother should be taught and encouraged to do this. Refer to Breastfeeding the preterm infant
Pre-feed Oral Stimulation
Follow the steps below to provide pre-feed oral stimulation and elicit sucking action.
Note: is a very gentle procedure. Do not use undue force. If infant shows signs of distress then oral stimulation exercises should stop.
- Ensure hands are washed. Health professionals will wear gloves however, family members do not need to.
- Elicit a rooting reflex by stroking both checks. Start at the earlobe, moving towards corners of the mouth.
- Stroke around the mouth 10 times or until baby begins some lip smacking activity.
- Stroke the back of the index finger gently up across the baby's lips to encourage a gaping response.
- Introduce your little finger into baby's open mouth with the soft pad up to the roof of the mouth (fingernail down), and stroke 3 times. Watch for a response. Repeat at least 5 times.
- Turn your finger over and stroke the tongue 3 times and wait for a response. Repeat at least 5 times.
- Document the procedure and response from the baby.
Cleft Lip and Palate
- Hawdon, J., Beauregard, N., Slattery, J., & Kennedy, G. (2000). Identification of neonates at risk of developing feeding problems in infancy. Developmental Medicine & Child Neurology, 42, 235-239.
- Palmer, M. (1993). Neonatal oral-motor assessment scale: A reliability study. Journal of Perinatology, 8(1), 28-35.
Did you find this information helpful?
- Date last published: 31 December 2004
- Document type: Clinical Guideline
- Services responsible: Neonatology
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
- Review frequency: 2 years
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