Written, verbal, and non-verbal language is a powerful part of every culture. However, you can’t find cultural messages written down anywhere. In the NICU, you will not find cultural norms written into a policy or formally taught in orientation.
In fact, every day, fellow colleagues and families are unknowingly taught (even if just overheard) negative cultural messages about feeding.
#1: You (or parent) hear: “She just PO fed at 0900. She’ll be too tired to try again at noon.”
Cultural message it conveys: “Caregivers can predict (and pre-decide) feeding readiness without a real-time assessment of the infant,” which goes against all we know about assessing feeding readiness and individualized patient care.
#2: You (or parent) hear: “He took 15 mls in 8 minutes and then got tired. But I got him to take the rest over 20 minutes with lots of encouragement.”
Cultural message it conveys: Disinterest/fatigue/disengagement cues are not valid reasons to stop an oral feeding if desired volume intake has not yet been achieved”. In other words, volume is the only definition of success and it’s ok to ignore the infant’s cues. And, it’s okay to use whatever ways possible to “encourage” the infant to get the volume in, despite not being valid or evidence-based techniques.
We dedicated a whole chapter to culture in the Online IDF Course because your colleagues, orientees, NICU parents and families are listening to you. Your words are powerful and they have meaning. The solution: ensure that your language is positive and rooted in the latest evidence and best practice.
As NICU professionals, we have collectively spoken a certain way about feeding for decades and it takes intentional and continuous work to weed this language (and the practice it implies) out of our vocabulary. So be gentle with yourself. But take notice. Increase your awareness. Find and use new language which reflects best practice and watch the old culture shift, advance, and wholly support you, your team, and the babies and families in your care.