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Feeding Issues in the NICU Graduate

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While there are many criteria for discharge from the neonatal intensive care unit (NICU), eating well enough to gain weight and do so without significant physical distress are two commonly used criteria to determine readiness to discharge home. However, infant competency with the task of eating is variable and feeding continues to be a source of concern after discharge for many families. Infants may be discharged with supplemental tube feedings prior to achieving full oral feeding, or eating with poor coordination. The assumption is often that feedings will improve naturally after discharge.

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Earlier born preterm infants are later at achieving full oral feedings while in the NICU, and demonstrate increased difficulty with eating compared to more mature, preterm infants. However, studies indicate feeding problems in the first years of life are more common for all infants born preterm compared to full-term counterparts. After discharge, preterm infants are slower to develop eating skills required to transition to a wide variety of age-appropriate foods. Additionally, parental reports of feeding problems are prevalent, and parents frequently introduce solids to their infants earlier than recommended in an attempt to improve weight gain.

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I. Patterns of development

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  1. Eating

    1. Refers to the abilities of the child.

    2. Considered a neurodevelopmental process that follows a predictable sequence of acquisition of skills. However, the timing of acquisition is variable in much the same way as in other areas of development.

    3. Requires the infant to organize

      1. Autonomic function

      2. Oral-motor skills

      3. Muscle tone and movement patterns

      4. Behavioral state

      And, have the ability to regulate all of these processes simultaneously.

    4. This task becomes increasingly challenging as the demands increase with the introduction of solid foods.

    5. Infants with greater severity of illness or number of medical interventions are at greater risk of feeding problems and demonstrate greater delay in acquisition of eating skills.

    6. While the infant establishes a rudimentary foundation for eating within the NICU setting, eating skills continue to develop and new skills must be acquired by the infant in order to transition to a wide variety of age-appropriate foods by age 3.

      1. Oral-motor anatomy and skills undergo multiple transitions across the first 3 years of life.

      2. Gross motor and fine motor skills are increasingly necessary to transition to self-feeding.

      3. As the infant matures and becomes more aware of themselves as an individual, food preferences begin to develop.

      4. At each of the major transition points infants may struggle to consolidate the new skills required.

    7. Providers often believe that the infant is not at further risk of feeding problems when the infant is discharged from NICU to home if they leave without the need for supplemental feedings via a nasal-gastric or gastrostomy tube. However, given the neurodevelopmental nature of eating, it is evident that eating a prescribed volume while in the NICU is not a predictor of successful eating after discharge.

      1. Extremely premature infants are 3.6 times more likely than ...

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