Dispelling One Common Myth about Feeding in the NICU

By Sue Ludwig and Kara Ann Waitzman

Infants in the NICU need to ‘graduate’ from a slow-flow nipple to a ‘regular’ nipple before leaving this hospital.
The #1 goal of Infant-Driven Feeding® practice is that the feeding must be safe.

As an infant begins and then progresses  with oral feeding in the NICU, one of our roles as professional caregivers is to decide which equipment (i.e. bottles, nipples, nipple shields for breastfeeding etc) best supports the infant’s safety and development while eating. This is a multi-factorial decision. It is based on the ongoing assessment of the infant’s ability to safely and effectively coordinate the suck, swallow, breathe sequence – among many other things.

For example, we know it’s not safe or supportive to feed a premature infant with a fast flow nipple. This is true conceptually and clinically. Clinically, the infant may demonstrate his inability to manage the flow rate in several ways such as excessive liquid loss, choking, feeding induced apnea and so on. Alternately, the same infant with a slower flow nipple/bottle system may demonstrate improved coordination, thereby mitigating or eliminating the problems he had with a faster flow rate, resulting in improved safety and, of course, a more nurturing experience.

In order to maintain patient safety, we must choose the equipment and processes that best support the individual infant. If the infant eats safely and effectively using a slow-flow nipple/bottle system, then he does not need to ‘graduate’ to a faster flow nipple before discharge to ‘prove’ that he is ready. Making the decision to change the equipment and/or flow rate must be based on an actual assessment of the infant’s feeding quality. This assessment must be individualized and ongoing.

Therefore, whatever equipment is chosen by the caregiver or team must simply meet the infant’s needs in real time throughout his NICU stay, including the transition to home.