• About Me
    • Disclosure and Disclaimer Policy
  • Blog
  • Shop Ebooks
  • Recommended Products

Pediatric Feeding News

Dedicated to up to date pediatric feeding and dysphagia information

Welcome!

Hi, I'm Krisi Brackett, PhD, CCC-SLP,C/NDT. This blog is dedicated to current information on pediatric feeding and swallowing issues. Email me at feedingnewsletter@gmail.com with questions.

Read More About Me Here...
  • Feeding Flock
    Research
  • For Parents
    & Caregivers
  • View The
    Resources
  • Pediatric Feeding
    & Dysphagia Newsletter
    • Volume 1
    • Volume 2
    • Volume 3
    • Volume 4
    • Volume 5
    • Volume 6
    • Volume 7
    • Volume 8
    • Volume 9
    • Volume 10
  • Workshops &
    Presentations
  • Work
    With Me
  • Links
    We Like

Question About Feeding Preterm Infants in the NICU

August 26, 2017 by Krisi Brackett 3 Comments

Question to the Blog About Feeding Preterm Infants in the NICU:

My observation, like other therapists, is that many of the micro preemies and/or babies that have had very involved respiratory issues and complex treatment needs because of these issue, often require increased sensory input related to feeding (temperature variance, thickened consistency).  What we have observed is that these babies often benefit from increased FIO2 during feeds despite having adequate O2 levels.  Do you have any thoughts on this matter?  Our primary Neonatologist says that there is no physiological reason that this rational would be helpful.  I believe the extra flow provides the sensory input that these babies often need, especially while learning to feed.

 

Answered by:  Sue Thoyre, PHD, RN, FAAN,Francis Hill Fox Distinguished Term Professor , School of Nursing, The University of North Carolina at Chapel Hill

Oxygen is a stabilizer of the smooth muscles of the pharynx. Another reason it may be helping is that RR decreases overall by 5-10 breaths per minute during feeding so oxygen reserves are quickly depleted.

I do not agree with giving thickener – this is altering the infant’s microbiome and leading to a need for a larger bore nipple which increases the bolus size, increases the need for swallowing and reduces the opportunity for breathing.

Prioritize support on the respiratory system with good postural/diaphragm support, resting within the first minute of the feeding and often thereafter, pacing individualized to the child’s respiratory rate (higher rate, less duration of sucking), low flow nipples, side lying.

 

Share this:

  • Click to share on Twitter (Opens in new window)
  • Click to share on Facebook (Opens in new window)

Related

Filed Under: Feeding Treatment Tagged With: bottle, feeding problem, NICU, oxygen and feeding, preterm feeding

Comments

    Leave a Reply Cancel reply

    Your email address will not be published. Required fields are marked *

  1. Catherine Shaker, MS/CCC-SLP, BCS-S, NDT/C says

    August 27, 2017 at 7:22 pm

    A few thoughts. “Flow ” and Fi02″ are two different parameters. Due to the concern for the potential adverse effects of oxygen (Fi02), many NICU infants in need of increased respiratory support are weaned to 21% Fi02 with flow. That flow can be delivered via NCPAP, HHFNC, and low flow nasal cannulae. The flow rate itself (PEEP or LPM), has been shown to often help prevent pharyngeal collapse and facilitate maintenance of functional residual capacity (FRC). These two parameters to some extent are likely part of the underpinnings for effective feeding, when WOB and respiratory stability permit PO. However, when an infant is requiring significant Fi02 at baseline, one might question his/her readiness for the aerobic demands of feeding. Depending on the “extra flow” you describe (typically that means for example, PEEP or LPM), it may also create possibly an unsafe feeding environment, as what a conclusion of the recent study by Ferrara et al. See Ferrara, L., et al. “Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates.” Journal of Perinatology 37.4 (2017): 398-403. The answers are not fully in but this well done paper suggests certain flow may clearly be worrisome for particular infants.

    Regarding thickening feedings in the NICU – As I travel and teach across the US about feeding preemies, I am consistently finding that thickened feedings are viewed only as the final consideration after position change, further slowing the flow rate and use of increasing strict co-regulated pacing. The potential adverse effects of thickened feedings are many, and require us as to be “clinical scientists”, i.e., carefully weigh the risk-benefit ratio for each preterm infant, and create a unique algorithm for that infant’s plan of care, in collaboration with the NICU team. Each infant’s history, co–morbidities, respiratory history, and current clinical picture and as well as the impact on the infant’s swallowing physiology, must be carefully considered and weighed. We have such a complex job when it comes to supporting safe and neuroprotective feeding. We lack the research to fully guide us, so in addition to evolving research, I think our critical thinking, living in the “grey zone”(having more questions than answers) and dialogue with the medical team are our current optimal strategies.

    I hope this is helpful.

    Reply
    • Patricia Boyle says

      August 27, 2017 at 10:28 pm

      Excellent response Catherine. It is such a grey zone. When we approach these tiny clients with a one size fits all mentality we create so many problems.
      Our little clients are our teachers, we need to individualize our approach to them and learn from them.

      Reply
    • Krisi Brackett says

      August 28, 2017 at 10:53 am

      Thank you Catherine!

      Reply

Work with Krisi

Professional Consulting
Individualized Professional Training
Caregiver/Family Coaching

Girl Image
Click here for more infomation

Cart

Products

  • When Your Child Can't Or Won't Eat When Your Child Can't Or Won't Eat $10.00

Recent Posts

  • Purees and Baby Led feeding Strategies
  • Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • A Gold Standard for Meals with Children Using NG Tubes
  • Feeding Matters – Get Curious!
  • Universal Aspects in Feeding Intervention

Recent Comments

  • Kat on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • Taralee Morgan on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • Debbie Frierson on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • NEYTZA RODRIGUEZ on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • Tara Wiley on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar

Purees and Baby Led feeding Strategies

By Marsha Dunn Klein. OTR/L, MEd., FAOTAhttps://blwday.comThere are lots of opinions out there about purees and baby led feeding strategies.  Have you heard you can “never” use a spoon in baby led feeding? Or that purees are a “no, no”?  These are myths.  Let’s break it down.Central to the idea of baby LED feeding is that the baby shares the family meal and is a partner in the Keep Reading >>

Feeding Treatment

Universal Aspects in Feeding Intervention

Let's talk about universal aspects in feeding interventionThis is any idea I have been playing around with for awhile now. We all know that there are different strategies and philosophies in feeding treatment. This is a good thing- we need many Keep Reading >>

Understanding Parenting Styles in Feeding Therapy

As feeding therapists, we work closely with caregivers and parents. Perhaps our biggest success in feeding intervention is helping a parent be able to feed their child. One way we do this is to help caregivers understand their child's cues and how to Keep Reading >>

Involving Caregivers in Feeding Therapy

Feeding children is a dyad between the child and their caregiver who is responsible to buying, preparing, and presenting food. In all of my classes whether it be for professionals or graduate students, I talk about the importance and benefits of Keep Reading >>

Adapted Baby Led Weaning

Information from Jill Rabin CCC-SLP/L, IBCLCI wanted to share some resources for adapted baby led weaning from Jill Rabin. I was lucky enough to catch a free seminar last month from Jill which inspired me to add in some of these techniques to my Keep Reading >>

More This Way

Swallowing

Implementing FEES for Infants in CVICU & NICU

BackTable / ENT / Podcast / Episode #165Implementing FEES for Infants in CVICU & NICU with Olivia Brooks, SLPIn this episode, pediatric speech language pathologist (SLP) Olivia Brooks (University of Florida Shands Hospital) shares her experience Keep Reading >>

What is a MBSS- video for kids

I wanted to share a video we made to help children coming to UNC for a modified barium swallow study. Please share with your clients if you think it is helpful. It's also on our feeding team page Keep Reading >>

Swallowing Difficulties May Be Caused by Misfiring Neurons

in Genetic Engineering & Biotechnology News (GEN)Pediatric dysphagia (swallowing difficulties) is a frequent and serious clinical complication in a large number of clinically defined neurodevelopmental disorders including the genetic childhood Keep Reading >>

Swallow: A Documentary- Dysphagia

Nice Documentary on Dysphagia from the National Foundation of Swallowing Disorders. Keep Up the Good Work Everyone! Keep Reading >>

Oral-Motor and Sensory

Impact of Oral Motor Impairment in Infants with Poor Feeding Webinar

Impact of Oral Motor Impairment in Infants with Poor Feeding Presented by Debra Beckman, MS, CCC-SLP, https://www.beckmanoralmotor.com/A few weeks ago I had the pleasure of attending a wonderful free webinar presented by Debra Beckman, MS, Keep Reading >>

Musculus masseter pars coronidea

Scientists Just Identified a Brand New Muscle Layer in The Human Jaw DAVID NIELD23 DECEMBER 2021 It turns out there are still exciting new discoveries to be made in a field as well-studied as human anatomy: researchers have confirmed the existence of Keep Reading >>

Poster: Child Cain’t Chew

This poster from 2018 was shared with me by Sally Asquith who gave permission to post here. The objective of this study: REVIEW CURRENT LITERATURE PERTINENT TO THE ROLE OF ORAL-MOTOR DEVELOPMENT IN DX AND TX OF PFD. COMPLETE A RETROSPECTIVE CHART Keep Reading >>

The Sensory-Motor Approach to Modified Baby-Led Weaning for Babies with Feeding Challenges

by Jill Rabin & Lori Overland Baby-Led Weaning has become “all the rage” with many parents choosing this method of transitioning their little ones to solid foods. Everyone is jumping in, with speech pathologists, dietitians, occupational Keep Reading >>

More This Way

Case Studies

Challenging case with advice from Suzanne Evans Morris, PhD

In this post, I have described a challenging case  and solicited advice from Suzanne Evans Morris, PhD, one of the experts in our field. Suzanne graciously provided commentary and advice and challenged me to look differently at the feeding Keep Reading >>

Complex Case – Changing Therapy Strategies When Needed

Complex Case - Changing Therapy Strategies When Needed*I shared this case with Suzanne Evans Morris and she provided some   guidance and analysis at the end. Hope you enjoy John is a 6 year old male with a complex medical history:Downs Keep Reading >>

Feeding Harley

I am excited to share Harley’s story, written by his Mother about her journey to help her son wean from his g-tube and become an oral feeder. Thank you Liz for sharing and inspiring us all to continue looking for answers! I feel I do need post a Keep Reading >>

Cases From Clinic

Cases From Clinic This is my second post highlighting some of our kids and how we provide multidisciplinary intervention using a medical/nutritional/behavioral approach. I post this hoping it might give some treatment ideas to clinicians. There Keep Reading >>

More This Way

search

Categories

Recent Posts

  • Purees and Baby Led feeding Strategies
  • Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • A Gold Standard for Meals with Children Using NG Tubes
  • Feeding Matters – Get Curious!
  • Universal Aspects in Feeding Intervention

Recent Comments

  • Kat on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • Taralee Morgan on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • Debbie Frierson on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • NEYTZA RODRIGUEZ on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar
  • Tara Wiley on Special Considerations in the Treatment of Pediatric Feeding Disorders in Autistic Patients (2.5 Hours)- Free webinar

Archives

search

Categories

Archives

My Account | Shop | Shopping Cart
Copyright ©2025, Pediatric Feeding News. All Rights Reserved. Custom design by Pixel Me Designs
 

Loading Comments...