Supporting oral feeding in fragile infants: an evidence-based method for quality bottle-feedings of preterm, ill, and fragile infants

Abstract

Successful oral feeding of preterm and other ill and fragile infants is an interactive process that requires (1) sensitive, ongoing assessment of an infant's physiology and behavior, (2) knowledgeable decisions that support immediate and long-term enjoyment of food, and (3) competent skill in feeding. Caregivers can support feeding success by using the infant's biological and behavioral channels of communication to inform their feeding decisions and actions. The Supporting Oral Feeding in Fragile Infants (SOFFI) Method is described here with text, algorithms, and reference guides. Two of the algorithms and the reference guides are published separately as Philbin, Ross. SOFFI Reference Guides: Text, Algorithms, and Appendices (in review). The information in all of these materials is drawn from sound research findings and, rarely, when such findings are not available, from expert, commonly accepted clinical practice. If the quality of a feeding takes priority over the quantity ingested, feeding skill develops pleasurably and at the infant's own pace. Once physiologic organization and behavioral skills are established, an affinity for feeding and the ingestion of sufficient quantity occur naturally, often rapidly, and at approximately the same postmenstrual age as volume-focused feedings. Nurses, therapists, and parents alike can use the SOFFI Method to increase the likelihood of feeding success in the population of infants at risk for feeding problems that emerge in infancy and extend into the preschool years.

Figures

Figure 1. SOFFI Method Algorithm for Bottle-Feeding

Beginning at START, the SOFFI Bottle Feeding Algorithm guides the caregiver through a sequence of assessments, decisions, and actions to realize a safe, high quality feeding that builds competent feeding behaviors and enjoyment of food and feeding. Letters in the algorithm indicate identically lettered sections in The SOFFI Reference Guides: Text, Algorithms, and Appendices: A Manualized Method for Quality Bottle Feedings. (Philbin & Ross, in review). The SOFFI Reference Guides provide details of assessment observations, decision explanations, and clinical action options. The algorithm is more easily followed in an enlarged format and printed in color. Contact the authors for a color copy. “No” decisions are shown in red and “yes” decisions in green. “STOP” indicates ending or pausing a feeding to stabilize the infant. The algorithm should be learned away from the bedside. Newly trained clinicians and parents may want to use the algorithm for a quick reference glance while feeding, but attention should be focused primarily on the infant and on the caregiver’s own behavior. The figure is used here with permission of the authors.