The Effects of a Slow and Controlled Feeding Protocol for the Introduction of Oral Feeding for Infants

SIGNIFICANCE: Occupational therapists (OTs) in the acute hospital setting are asked to assess infants status post (s/p) cardiac surgery. These infants are known to have deficits in nutritive sucking strength, endurance, and coordination in swallowing that affect attainment of full oral feedings, which frequently results in their receiving a gastrostomy tube and places them at increased risk for serious complications. This preliminary research shows significant benefits of a protocol that introduces oral feeds after cardiac repair in a slow and controlled manner. The infant feeder trainer (IFT) was the method used to offer the initial feeds, and it was found to be a preventative approach, supporting improvement in the feeding and hospital outcomes of these infants.

INNOVATION: The slow and controlled early introduction of feeding mimics the natural way that an infant learns to feed. After birth, an infant’s first feeds are colostrum, which is thick and small in volume. This novel way of offering a hospitalized infant a similar opportunity for gradual progression with oral feeds challenges the typical clinical practice and is linked with improved outcomes.

APPROACH: This study attempted to answer the following research question: Is the early introduction of oral feeds in a slow and controlled manner associated with better feeding and hospital outcomes for infants with congenital heart defect (CHD)? Infants born with CHD are at increased risk for poor feeding. Research currently supports the need for therapeutic intervention with this population. Clinical data suggest benefits to a slow and controlled method of introduction of oral feeding, similar to the natural progression that a baby would experience while breastfeeding from birth to the first 3 to 5 days of life. One way to produce a very slow flow rate is to use the IFT. This study is investigating feeding outcomes in infants with CHD while following this protocol.

METHOD: A quasi-experimental approach with a nonequivalent group design was used. The comparison group had typical therapy. The comparison and treatment groups were matched for diagnosis (whether they received surgical intervention), birth weight, and age.

All participants were recruited at the Children’s Hospital Los Angeles. The intervention group (n = 30) was offered feeds with the IFT if determined appropriate and indicated by the medical team when demonstrating readiness signs as determined by the therapist. Data for the comparison group (n = 14) were obtained through retrospective review of medical records. The following data were collected: (1) length of days to full oral feeds; (2) whether the infant received a gastrostomy tube (GT); and (3) whether feeding coordination was evaluated as poor, fair, or good.

Descriptive statistics were used to determine averages for preliminary outcome measures including, but not limited to, days to full oral feeds and quality of oral motor coordination. The groups will be compared using appropriate parametric or nonparametric statistics.

RESULTS: Preliminary results support the need for quality-driven advancement of oral feeds. This approach can lead to better results for feeding and hospital outcomes. This research supports the use of the IFT for the purpose of early introduction of feeds.