Parental Feeding Practices and Perceptions of Feeding Issues of Their Children With History of Prematurity in the First 2 Years of Life

BACKGROUND AND PURPOSE: Despite a high prevalence of feeding problems in infants with prematurity, relatively little information in the literature describes preterm infants’ feeding behaviors after hospital discharge. Little is known about parental feeding practices with preterm infants after discharge from the initial neonatal intensive care unit stay. Few studies have reported on feeding practices during food transitions or introduction of supplementary foods. Moreover, little is known about the relationship between parent-perceived feeding issues and parenting stress through the first 2 yr of these infants’ lives. The aims of this study were to explore parental feeding practices with preterm infants, to examine feeding issues during the first 2 years of the infants’ lives, and to examine the relationship between feeding issues and maternal distress levels.

METHOD: An exploratory descriptive study was conducted using data on 420 Taiwanese mother–infant pairs, distinguishing within the preterm and full-term groups infants fed only with milk and infants fed with supplementary food.

For the preterm infant–parent pairs, we recruited parents who currently had children age <2 yr with a gestational age <37 wk and birthweight ≤1,500 g. They were recruited from a developmental follow-up clinic for preterm children at a large urban hospital in the southern region of Taiwan that accepted referrals of preterm infants from six regional hospitals. The full-term infant–parent pairs were recruited from outpatient well-baby clinics for comparison to their preterm counterparts.

Two outcome measures, a behavior-based feeding questionnaire and the Parenting Stress Index, were used to assess perceived feeding issues and parental distress. Comparison of feeding questionnaire scores between preterm and full-term groups was performed using analysis of covariance with adjusted age and maternal education as covariants. Significance was set at p < .05.

RESULTS: The preterm infants tended to start supplemental food later in life and with more limited experiences in food variation than their full-term counterparts. Parenting stress was more prevalent in parents with preterm infants, and parenting stress was associated with the frequency of feeding issues, especially at later ages when supplementary foods were being introduced.

CONCLUSION: Occupational therapy practitioners need to understand how parents with preterm infants progress their infants’ feeding in order to provide relevant recommendations. Our findings have important clinical implications. Parent-perceived feeding issues could be a major source of parenting distress, regardless of whether the infants were born preterm or full term. Mothers reacted to the perceived feeding issues of their infants differently depending on the issue. Infants who had feeding issues such as oral–motor problems or difficulty in accepting new food may have been interpreted as demanding or less adaptable, and mothers may have reflected this further by feeling depressed, isolated, and inadequate. Parents of preterm infants reported experiencing more feeding difficulty with their children, and they tended to advance their feeding with much more reluctance. Parents may benefit from increased anticipatory guidance about feeding dysfunction before hospital discharge. Practitioners should screen for parental discomfort with infant feeding and discuss adaptations for caring for premature infants.

References

Lutz, K. F. (2012). Feeding problems of neonatal intensive care unit and pediatric intensive care unit graduates: Perceptions of parents and providers. Newborn and Infant Nursing Reviews, 12, 207–213. https://doi.org/10.1053/j.nainr.2012.09.008

Migraine, A., Nicklaus, S., Parnet, P., Lange, C., Monnery-Patris, S., Des Robert, C., . . . Rozé, J. C. (2013). Effect of preterm birth and birth weight on eating behavior at 2 y of age. American Journal of Clinical Nutrition, 97, 1270–1277. https://doi.org/10.3945/ajcn.112.051151