By Sue Ludwig and Kara Ann Waitzman
‘Asking’ a preterm infant to go from breastfeeding to bottle feeding to tube feeding all in one session (the practice in some units) leaves him exhausted and gives the mother and staff a false impression that breastfeeding ‘takes too long’ or was not ‘successful’.
Consider this when NGT is still in place:
Use the same cessation/disengagement cues for breastfeeding as bottle feeding. When an infant fatigues or becomes disengaged at the breast, simply gavage the remainder while mom continues to hold him (he can certainly remain skin-to-skin). This ensures that he receives his necessary calories – per our supplementation algorithm and nursing discretion – while the experience remains focused on infant cues, bonding, feeding quality, and establishing breastfeeding. Additionally, he does not spend extra calories trying to ‘get more volume in’ via bottle for another 15 minutes and then finally receive the remainder by gavage. This pushes the session to 45-60 minutes – a long period of engagement for a preterm infant’s emerging endurance and developmental capabilities. Likewise, the mother now needs to pump, causing each session with her infant to be 60-90 minutes with little recovery time for her before starting the process again.
Traditional feeding culture fears that removing the bottle attempt from this scenario may slow down the transition to full feeds. The Infant-Driven Feeding® (IDF) Model of Practice supports safe, functional, nurturing, developmentally and individually appropriate feeding experiences, which has not been shown to slow down anything and is focused on long-term oral feeding success.
Once the NGT has been removed, due to quality eating and adequate intake for growth and nutrition, the above process will likely change a bit. It will be based on the individual infant’s nutritional needs, developmental progression and comorbidities as well as the mother’s milk production and presence for feeding. The key is understanding that this is not a simple black and white process, but one that NICU professionals can work through systematically when the whole team is on the same page.
We discuss all of the above in our comprehensive online course for oral feeding in the NICU, developed to provide unit-wide education to ensure true and lasting change.
Complex multi-faceted topics require specialized age appropriate education. Complex multi-faceted infants deserve specially educated caregivers.