Infant and Toddler Feeding
Medically-fragile infants and preterm infants are at risk for long-term feeding problems (Samara, Johnson, Lamberts, Marlow & Wolke, 2009; Rudolph & Link, 2002). Treatment is often focused on avoiding the development of maladaptive feeding behaviors, reducing hospital stays, and improving the transition from alternative feeding to oral feeding. Treatment may incorporate compensatory supports, such as feeding position and feeding presentation. For infants who are able to take in oral feeds, but have great difficulty in accomplishing adequate oral intake, cue-based feeding may be appropriate. For newborns and infants who are unable to participate in oral feeding due to medical complications, kangaroo care and non-nutritive oral motor therapies may be employed.
Feeding Supports
Unable to comply with direct treatment protocols, infant feeding therapy is often compensatory. Treatment strategies may include changes in feeding position or external pacing of liquid intake, which can be achieved through changes in nipple, changes in liquid viscosity or changes in bottle presentation.
Feeding Positions
Feeding position can be altered to improve oral intake, direct bolus flow, or reduce the risk of aspiration. Box 4.45 demonstrates common feeding positions and their uses. The cradle hold is the most common feeding position and is used for infants without swallow deficits. For infants with difficulty latching on, a cross-cradle hold allows the mother to assist in the latch process by directing and stabilizing the infant’s head. A football hold allows for a more upright trunk and may be useful for infants with aspiration risk or reflux, but may be avoided in infants who have poor oral pressures and incompetent anterior containment. Props, such as a rolled towel, may be added to help stabilize infants with poor tone (Box 4.46).
Box 4.45: Common infant feeding positions
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Cradle Hold Most common infant feeding position. |
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Cross Cradle Hold Useful in breastfeeding when mother needs to stabilize or manipulate breast or provide pressure or control to infant’s head during feeding.Good for kids with difficulty latching on. |
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Football Hold Useful in breastfeeding for babies with reflux issues or aspiration risk, or mothers with good milk ejection or let down. |
Box 4.46: Rolled towel as support
For babies with poor tone and GI stress, a supportive roll behind the back may aid in improved posture for feeding.
External Pacing
External pacing is the manipulation of the environment or feeding strategy to alter the rate of the flow of milk to the infant. It may be employed when the feeder observes gasping, poor coordination between suck-swallow-breathe, or pulling away from feeding (Ludwig & Waitzman, 2007). External pacing can be achieved by changing the flow rate of the nipple, using dynamic feeding or bottle positions throughout the feeding, or changing the viscosity of the liquid.
Pacing is typically performed with the infant in a mo