How to Improve Oral Feeding Practice: Step 1

By Sue Ludwig and Kara Ann Waitzman


You’ve noticed right?

Deciding to advance your NICU’s feeding practice is a journey, not a task. You wish you could just cross it off your list by the end of March – but then it becomes March of next year, or the next. It’s a much bigger endeavor than anyone imagines.


Because feeding is complex. It doesn’t just begin around 33-34 weeks PMA. It doesn’t begin with the first breastfeeding or bottle feeding. Successful feeding begins at admission and includes the skillful execution of a multitude of practices. The challenge is that there are are so many caregivers, each with their own knowledge, skills, practices, and biases about feeding. This makes for a daunting journey toward consistency.

It’s overwhelming.

We talk to hundreds of NICU professionals every year who are in that overwhelmed place. They just want to know where to begin. They want to see some progress or traction, some evidence of forward movement toward this end goal. That’s where Step 1 comes into play.

Step 1: Evaluate your current feeding practices using our NICU Oral Feeding Practice Review to establish the need for improvement.

This may seem like an obvious first step, yet most units do not do it, and therefore find it difficult to advocate for change. Once your problem areas or challenges (typically out of date practices) are clearly identified, you can bring forth an objective request to the next level of administrators, supporters, and champions. You’ll also have fun celebrating what you do well.

Click here to access the NICU Oral Feeding Practice Review.


  1. Ask each member of your feeding team or group of champions to complete the review.
  2. Ask at least 5 staff members from EACH SHIFT to complete the review (practices and perspectives often vary by shift).
  3. Ask your neonatal therapists (OT, PT, SLP) to complete the review if not already included in #1.
  4. Ask at least 2 providers to complete the review.
  5. Compile, compare, contrast.

*In addition to noting areas in need of improvement, also note the inconsistencies in the evaluations themselves – note variances by individual, shift, and/or discipline. The inherent inconsistency between caregivers is a valuable observation to report. It’s difficult to improve any practice until there is a consensus on what the practice is and how it is enacted.

If you find that your unit’s feeding practice is stellar – congratulations! If you find you could use some help with next steps, we’re here to support you.

“The range of what we think and do is limited by what we fail to notice.” – R. D. Laing