Improving Feeding Practices for Infants Transitioning to Oral Feeds

Abstract

Problem: Approximately 30 feeding intolerance events including aspiration, bradycardia, and desaturation occurred within the large metropolitan pediatric center over one year. The adverse feeding events were related to quantity-based feeding, incorrect nipple selection, and the staff's lack of awareness of stress signs during oral feedings. Interviews with nursing staff reveal limited knowledge and hesitancy to educate parents about feeding techniques. Purpose: The quality improvement initiative aimed to promote cue-based feeding and appropriate nipple selection to prevent adverse feeding events and improve consistency in infant feeding practices in a step-down pediatric cardiac unit. Methods: A multidisciplinary team of stakeholders, including a lactation consultant, nurses, clinical nurse specialists, occupational therapists, speech-language pathologists, and nurse practitioners, was formed to improve feeding practices. An educational program including cue-based feeding, nipple selection, and feeding techniques was provided to the nursing staff. The nursing staff received education to document feeding cues, feeding techniques, time to feed, and feeding intolerance under the General Infant Feeding Assessment (GIFA) in the electronic medical record. Individualized feeding guides were developed by speech-language pathologists and occupational therapists for use at the bedside by the nursing staff and family. Signs were placed around the unit to increase awareness of the practice change. Results: Documentation compliance and use of feeding resources were low throughout implementation. Infants with inconsistent feeding assessments or nipple selection documentation were found to have signs of vital sign instability with oral feedings. Conclusions: The educational program and documentation of feeding assessments may improve feeding practices when used consistently.