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7 Mistakes NICUs Make with Oral Feeding Practice Every Day

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All Rights ReservedCopyright © 2013 – Infant-Driven Feeding, LLC. All rights are reserved. You may not distribute

this report in any way. You may not sell it, or reprint any part of it without written consent from the

authors, except for the inclusion of brief quotations in a review.

DisclaimerThe following information is an introduction to a complex topic and is in no way a substitution for

professional education.

WARNING: This eBook is for your personal use only. You may NOT Give Away, Share Or Resell

This Intellectual Property In Any Way.



The Authors

Sue Ludwig OTR/L LI

Sue Ludwig is the President and Founder of the National Association of Neonatal Therapists (NANT), an organization that supports neonatal occupational therapists, physical therapists and speech language pathologists. Sue is also the Co-Founder of Infant-Driven Feeding®. She has been a practicing occupational therapist since 1993 at the University of Cincinnati Medical Center and has been a neonatal therapist there since 1996.

Sue is a sought after international speaker, consultant, writer and educator. She is passionate about changing the culture and practice of oral feeding in the NICU. She has published articles related to infant-driven feeding®, oral feeding and the late preterm infant, and quality analysis of developmental care, and been a guest editor for Newborn and Infant Nursing Reviews. Sue co-developed the Infant-Driven Feeding Scales©, a widely used assessment and documentation tool for the NICU.

Sue has earned the Neonatal Developmental Care Specialist Designation from the National Association of Neonatal Nurses (NANN) and is certified in Neonatal Touch and Massage. She received the Laura Edmunds Lectureship Award from UMass Memorial Medical Center in 2012.

Sue is a member of the American Occupational Therapy Association (AOTA) and serves as AOTA’s media expert for neonatal therapy. She’s an ex-officio member of NANN’s Education Provider Committee and leads the NANT Professional Collaborative.

Sue is a published author and poet. She lives in Cincinnati, Ohio, with her husband and 2 children.



Kara Ann Waitzman OTR/L, CIMI, NTMTC

Kara Ann has been a neonatal therapist for over 25 years in a level III NICU and serves as the nursery’s developmental specialist. Kara Ann is president of Creative Therapy Consultants, Founder of the Neonatal Touch & Massage Certification (NTMC), and Co-Founder of Infant-Driven Feeding®.

She is certified in NTMC, is Pediatric Neurodevelopmental Therapy (NDT) trained, certified in NIDCAP, and earned the Neonatal Developmental Care Specialist Designation through NANN. She served on AWHONN’s Continuum of Care Advisory Board, and currently serves on National Association of Neonatal Therapists’ Professional Collaborative as well as the March of Dimes Program Services board.

Kara Ann has been a nationally sought after speaker, educator, and consultant for over a decade and has published articles on positioning and feeding, and written a chapter on Neuromotor Development and Massage. She developed and sells DVDs on Massage, Skin-to-Skin, and Swaddled Bathing.

Kara Ann has received professional awards including the Ohio Occupational Therapy Pediatric Model Practice Award, the March of Dimes Healthcare Worker of the Year Award, and the 2011 MVH Excellence in Service Award.



Introduction(*Throughout this ebook “oral feeding” refers to both breast and bottle feeding.)

We’ll never forget what this nurse said.

After spending a whole day teaching NICU staff about neonatal feeding, we were led into the unit to consult with staff members.

One of the nurses who attended our seminar, we’ll call her Jackie, motioned us to come to the bedside of her current patient. Jackie had a huge grin on her face as she began to notice the infant slowly coming to an alert state and begin rooting. He eagerly took his pacifier when offered. When she began feeding him a few minutes later she shook her head, almost laughing.

We asked her what she was thinking, why the big grin?

She said, “I can’t believe I’m admitting this. I mean, I’ve been a NICU nurse for over 15 years. But I have never paid this much attention to a baby during feeding. We’re always so busy that when I sat down to feed a baby, I was just happy to be sitting down! I’d use that time to think about what I had to do next, what meds were due etc.”

She observed the infant as he ate and continued, “I mean, I watched the baby eat, of course, and stopped him if he looked like he was in trouble, but I wasn’t aware of the more subtle signs of stress. I never knew just how attentive I had to be to keep him safe and help him enjoy this. And to think how often we tried to make the babies eat even when they clearly didn’t want to! Arrrghh! I’m actually just pleasantly surprised that I have a whole new perspective. I’m relieved.”

She went on to explain that like most NICUs, they’d never had any specific orientation or education related to oral feeding. She fed babies like her preceptor taught her to feed babies 15 years ago. Period.



Jackie isn’t alone here.

It’s only through highly specialized education and awareness that you, as a NICU professional, can fully appreciate the short and long-term risks of sustaining outdated practice, an unsupportive culture and inconsistent communication. AND realize the power you have to improve it!

The seven risky mistakes you’re about to read are going to help you get clear about your current feeding practice. When you begin to consistently address these issues, your unit’s practice and culture will improve and the old mistakes will fall away. Just like Jackie, you’ll see things through a new lens.

This clarity changes things.

You won’t ever go back.



Medical Model MentalityKcals/kilo/day.

Is and Os.

Aspirates.

Reflux.

PO intake.

Abdominal girth.

These are just some of the ways we’re taught to address feeding, nutrition, ‘gut health’ and weight gain in the NICU.

And appropriately so.

This information is vital to safe and effective feeding. So it’s not a stretch to understand why you, as a NICU professional, think about feeding with a medical model “mentality.” You were raised that way. The language, skills, measurements, and calculations are all part of providing objective data upon which to base clinical care.

And for the most part, this works out well.

You provide nourishment, slowly increase volume and/or calories and closely monitor your patients for improvements in growth and nutrition.

There’s just one problem: there are more variables involved once an infant begins to orally feed. Feeding is no longer a passive interaction on the infant’s part. He actually gets to participate – and this changes everything.

That’s when a medical model “mentality” fails us.

The infant’s feeding progress suddenly looks less like a math problem and more like a series of mini developmental milestones no one ever taught us about. Milestones that occur during a critical period of brain development.

Does this sound familiar?

#1



When NICUs are stuck in a medical model mentality with ORAL feeding practice they often:

1. Talk about, report, focus on and educate about feeding as if volume intake is the only factor in feeding success.

“Let us know when she takes one full bottle then we’ll increase her to 2x/day.”

2. Address feeding based on PMA rather than understanding that developmental skill acquisition is an individual journey.

“Ok, so he’s not eating well, but he’s a stable 34-weeker. He doesn’t need an NGT. Just keep attempting. He’ll come around.”

Frequently, when an infant transitions from tube to oral feeding, the medical model “mentality” doesn’t shift to support the developmental aspects of this milestone. The mistake that results is that oral feeding often remains physically, socially and psychologically sterile for staff and parents.

The mistake is believing that volume is the only measure of a successful feeding.

The risk with this mentality is it removes you from the nurturing experience that oral feeding truly is, and leaves the infant less attentively supported in what may arguably be one of his most vital developmental stages. It may also perpetuate staffing practices that don’t allow bedside caregivers to assess, respond and optimally support infants during this transition.

If you’re reading this, you’ve probably been working to change this very mentality in your own NICU or maybe even at the national level.

We’re with you. It’s time.

Online Infant-Driven Feeding® education supports the medical components of oral feeding while teaching you the often dismissed but vital neurodevelopmental, social and psychological aspects that propel infants and families toward lifelong feeding success.



Scattered Agendas

Who are we kidding? We’ve all been there.

Whether you’re a bedside nurse, NNP, neonatologist, neonatal therapist, lactation consultant, dietician, respiratory therapist – you’ve been there. The great thing is each discipline brings a different and valuable perspective to the table.

The risk is failing to unify the team around a set of shared feeding goals and, therefore, remaining scattered and inconsistent.

#2

You’re standing in rounds discussing one of your patients, Sydney

Born at 25 weeks GA, now 38 weeks PMA, she has chronic lung disease and still requires oxygen. You’ve known her and cared for her since admission. You know her as an individual, her subtleties. You’ve always noticed she starts to fuss right before she desats, that she’s calm when held by her mom and that she loves to eat even though her work of breathing makes it difficult on occasion.

You’re grateful that you work with a multidisciplinary team. But at the moment, everyone has a different perspective when discussing Sydney’s oral feeding progress.

The flood of input from multiple disciplines might sound something like

this:

“Should we increase her FiO2 or flow? Do we increase calories so we can decrease volume? But what will that do to her motility? And her hunger? Maybe we should wean her off her oxygen because she’s close to being on room air? Would she take more volume if we decreased her calories or is she fluid restricted? What have her feeding quality scores been for the last 2 days – is she improving? Does she still occasionally brady with feeds? How much is too much liter flow for PO feeding? We don’t want her to go backwards with her respiratory status or her feeding. And her parents really want her home soon. They’re at the end of their rope.”

Whew!



The mistake is thinking that when entering the NICU, everyone received the same (or any) education about neonatal oral feeding.

The bigger mistake is never providing any.

One conversation, one meeting, one lecture, one course. It doesn’t matter where you start.

Just begin.

Online Infant-Driven Feeding® education gets everyone on the same page – finally! Not for a day, week or month, but systematically, even as new staff come on board. From admission through discharge, you will understand the goals and systems of Infant-Driven Feeding®. Each discipline will understand their incredibly powerful role in oral feeding practice.



Competitive FeedingHere’s a question.

In the history of neonatology, when exactly did feeding become a competitive sport?

“I got her to take all 60mls every feeding last night, but I’m not sure how she’ll do for you.”

“Oh, let Jennifer feed him. She can feed a rock!”

“You can’t get him to take the last 10mls? Here, give him to me. I’ll get him to finish it.”

You won’t find this written in any policy or procedure: “Make the infant take the last 8mls of a feeding even though he’s completely asleep and disengaged.” But it happens. Every day.

No one tells you that you’ll be heralded as a great nurse or therapist if you can ‘get’ an infant to take more volume than the last caregiver did. But you will be.

We like to tell ourselves that feeding practice has changed. That it’s cue based after all. And in some cases, that’s true.

In most cases, however, the feeding policy changes on the outside while the old culture remains. The competitive culture. A culture that serves no one, least of all, the infant. It erodes the very changes you’ve already implemented.

Practicing in our own units and years of consulting brought us inside the fray. Inside that culture of feeding.

During live seminars, we occasionally show a video that’s available online. In this video a former NICU mom explains the significant feeding problems her son had and with which he continues to struggle.

#3



The video shows her son still gagging throughout his repeated attempts to eat. The mother is in tears, burdened by the fact that “she didn’t (initially) listen to her baby’s cues.” There wasn’t a dry eye in the room. The staff watching the video said they had no idea what some parents were dealing with regarding long-term feeding issues nor what they, as NICU staff, could do to positively affect those outcomes.

The risky mistake is perpetuating a culture of feeding that not only doesn’t serve its patients but, in fact, can lead to sensory-based feeding problems for years to come.

Yes, we need awareness, permission, education, and support to let go of that old competition. We also need to understand there’s no shame in being where we are.We do what we think is best until we know better.

The mistake is thinking that we, as NICU professionals, aren’t ready for change.

Bring it on.

Online Infant-Driven Feeding® education teaches you how and why to let go of the old feeding culture and replace it with new mindsets and goals. We educate you about the short and long-term impact of negative sensory experiences around feeding and what you can do TODAY to improve those experiences.

And we get what it’s like to work at the bedside. No impossible-to-implement practices here.



Task-Oriented Care“Please take responsibility for the energy you bring into this space.”

Dr. Jill Bolte Taylor

My Stroke of Insight: A Brain Scientist’s Personal Journey

You park your car and begin the morning walk into the hospital.

It’s dark. People walk silently alongside you, trying to remember if they packed their daughter’s lunch that morning or threw that last load of laundry in the dryer.

There’s a collective rush to clock in on time. A collective distraction too. Work is just part of your life, and there’s a whole lot of other stuff going on at home.

You shove a few things into your locker, cram your lunch in the fridge next to night shift’s leftover pizza and clock in. You try to ramp up and get ready to be productive and empathetic today. Wow – some days it’s sure harder than others.

But then you think about your primary – Jordan. He’s a tough little guy and usually has good days when you take care of him. You hope he’s part of your assignment today.

You get report, find out you do have Jordan, and go straight to work. You have a 3 patient assignment that day. One ventilated, one on CPAP and Jordan, who has now earned ‘feeder-grower’ status.

Charlie, who is on the vent, and Jordan are on the same feeding/care time schedule. You begin with Charlie because Jordan is still sleeping and you know that feeding Jordan will take extra time.

#4



You’re running a little late by the time you get to Jordan’s bedside. Charlie didn’t tolerate care so well and you spent extra time making sure he was stable and comfortable. By the time you take Jordan’s vitals he’s getting fussy. One of your colleagues approaches and says staffing is short at 3pm, and asks if you’d be willing to stay. The resident appears and wants to quickly assess Jordan while he’s awake. Jordan’s mom calls to say she’ll be in later that morning.

By the time you sit down to feed Jordan, it’s now 8:40am. He was supposed to be fed around 8am. Even though he seems to be eating well enough right now, you wonder if he’ll be hungry enough to eat for mom when she comes in at the 11am feeding time. Ugh.

Suddenly Jordan chokes a little. You observe his color change to pale and support him through this moment. As he recovers you also notice his sweet eyes and newly formed double chin. You realize it’s the first time you’ve really looked at him. You think about everything you did for him before sitting down to feed him.

You assessed all of his systems thoroughly. You double checked his blood pressure because it seemed higher than what had been reported. You remembered to warm the breastmilk he’s eating now and made a mental note to let mom know how much was left in the freezer. You took expert care of him.

And, naturally lost in all of the important tasks that needed to be completed, you just didn’t SEE him. Not him as Jordan, your primary for months, now up to 4 pounds, off oxygen, wearing his dad’s favorite outfit today, the one with ‘Daddy’s boy’ on the front and ‘When mommy’s not around’ on the back.

You take a deep breath.

You realize that besides the little choke he just experienced, he’s also lost a lot of breastmilk out of the corners of his mouth; his washcloth now heavier and wet.



You talk to him. You swaddle him with his hands to his face so he has better support. You look at him and watch how his sucking bursts alternate with his breathing. With a little external pacing he stops losing so much breastmilk. He has no more choking episodes and disengages with just 9mls left, which you gavage while holding him close. This humanity and attention – this is what his system is wired for. This is the good stuff.

The mistake is becoming so entrenched in the task of caring that you feel automatic and rushed as you check off your list of things to do. Meanwhile, Jordan’s system is taking notes about this experience called feeding, over and over again.

The risk may be compromised safety or reinforced negative experiences.

The risk is feeling numb to the acts of human connection that you loved about this profession in the first place.

You resolve to be more present next time you feed him.

INTENSIVE care and intensive CARE.

(Jordan says thanks for noticing his weight gain. He’s been working on it.)

Online Infant-Driven Feeding education isn’t limited to anatomy, physiology and practice guidelines. We want you to consider the intention with which you provide care. That might sound strange for a feeding course, but that’s because feeding is more than A&P, more than sucking patterns and more than breast versus bottle. How we consider our influence on every aspect of care, how we support bonding and human interaction, HOW we do everything matters. You’ll have no doubt this is true after taking this course.



Inconsistent Everything“Feeding practices likely vary from nursery to

nursery and may even vary caregiver to caregiver within the same unit as the result of subjective

assumptions on the part of the caregiving team.”(McGrath JM, Medoff-Cooper B, Hardy W, and Darcy AM. Oral feeding and the high-risk infant.

In: Kenner C, McGrath JM, eds. Developmental Care of Newborns and Infants: A Guide for Health Professionals. Glenview, IL: National Association of Neonatal Nurses; 2010;313-348.)

Has this ever happened in your NICU?

This is just one simple example of the inconsistent messages and oral feeding practices infants and parents experience while in the NICU. With few exceptions, this type of inconsistency is pervasive.

We must simply aspire to improve this.

Consulting in NICUs all over the US taught us a very important lesson about oral feeding practice: there is no standard. No standard education, practice or documentation.

#5

Yesterday, baby Jones was progressing with oral feeding in an age appropriate manner. She engaged in both breast and bottle feeding and used a slow flow nipple when bottle feeding. She remained autonomically stable during feeding.

Today, you notice that all of the slow flow nipples have been removed from

her bedside and she’s reportedly having bradys with feeds. The mother says to you, “I’m only going to breastfeed once a day now because another staff member told me that if I let my baby take more bottles she’d go home sooner. Oh, and the same staff member got rid of those slow flow nipples because they were slowing her down as well.”



We’ve noted poor consistency between NICUs and within NICUs regarding:

• Criteria by which to initiate oral feeding

• Breastfeeding as first oral feeding

• Criteria or system by which to advance oral feeding

• Documentation of oral feeding readiness and quality

• Documentation of caregiver interventions or support

• When and why to move to demand feedings

• Definition of a successful feeding

• Acceptable flow rate per nasal cannula with oral feeding

• Which feeding interventions are helpful versus potentially harmful

• Bottle/nipple selection for preterm infants

• When and how to involve and educate parents

• Staff education related to oral feeding

• Beliefs about the effects of respiratory compromise/disease on oral feeding

This is an incomplete list to be sure, but an accurate start.

This is, in part, why it’s difficult to conduct research related to oral feeding – too much variation within NICUs and between NICUs.

The mistake is failing to see that oral feeding practice needs not only research, but systems. Not only education but actionable results.

The risk, as with anything inconsistent, is less safety, less efficiency, more spending, more days in the hospital and more readmissions.

Of course there will be changes in care, fluctuations in the plan and some degree of parental frustration, but it need not be due to our lack of congruence.

We owe it to our patients and families to standardize and systematize our practice without losing the ability to individualize it.



It’s a big goal. And it’s worthwhile and achievable.

“A journey of a thousand miles begins with a single step.”Lao-tzu

We’ll be right with you for all of them.

Hands-down, the greatest relief that IDF education clients report is that they finally have consistency. Consistency of message to parents, consistency of practice, knowledge and documentation. And that it’s simple and intuitive.

One hospital who studied parent satisfaction after IDF education reported a significant decrease in parent complaints about feeding.

We could go on and on, but you’ll find out soon enough!



Outdated & Faulty InterventionsAs NICU caregivers, remember when we used to:

• Tape black and white cards to the inside of incubators because we thought we were aiding visual development?

• Provide chin and cheek support during feeding automatically, just because that’s how we were taught to help premature infants eat?

• We used all sorts of methods (going way back) to stimulate infants out of apneic episodes?

• Avoid using positioning aids because we couldn’t ‘see’ the baby?

• ‘Get’ the infant to take his full volume by pumping the nipple, twirling the nipple, tapping on the bottle, unswaddling the infant to make him ‘wake up’?

• Use high flow nipples under the pretense that premature infants had a weak suck and we had to make it easier on them? (We weren’t even thinking about swallowing coordination yet right?)

• Wait until the infant could bottle feed safely before initiating breastfeeding?

Yea. Those sound familiar.

And ya know what? We were doing the best we could with the information we had at the time. Same as we’re doing now. It’s just the information has changed, the evidence is more convincing and the infants we feed now in the NICU are not the same infants we fed 20+ years ago. Survival rates have revamped the landscape.

#6



There were several things going on in that scenario:

• She was using ‘techniques’ to ‘get the infant to eat’ that are outdated and, in fact, dangerous.

• She clearly had seen this modeled by other caregivers as the ‘right way’ to get him to eat.

• She likely didn’t understand the short and long-term effects of the sensory input she was providing.

• The infant wasn’t stable enough to continue eating but the culture of feeding taught her to keep trying.

• The more experienced caregiver advocated for the infant in the face of eye rolling and unspoken criticism from her coworkers.

This was an incident we witnessed many years ago while touring in a NICU:

While walking with one staff member, we noticed another caregiver bottle feeding an infant. As the feeding progressed, the infant desatted several times, each time going a bit lower and lasting a bit longer. The caregiver sometimes noted this and stopped feeding him for a couple of minutes, patting him on the back while talking with her colleague across the aisle.

Once the oximeter stopped alarming, she resumed feeding him without any real assessment of his state, tone, interest or color. He was pale now. He was barely engaged in sucking. So she began pumping the nipple against his tongue then the roof of his mouth. He swallowed sometimes.

A more knowledgeable caregiver finally educated her about why it would be great to stop the feeding. Thankfully.



• There’s tolerance for oral feeding to be viewed as a benign, simple activity, one that requires little attention, skill or knowledge.

Valid strategies and techniques that support infants during oral feeding do exist!

The mistake is not finding out which ones they are.

The risk is continuing to utilize interventions that may contribute to physiologic instability, increase the risk of aspiration and contribute to long-term sensory and feeding issues.

The risk is assuming that feeding culture is separate from this issue rather than intertwined with it.

Once caregivers fully understand WHY, HOW and WHEN to provide valid and supportive techniques, they do so.

They drop the outdated and faulty interventions like hot potatoes!

Yes, even THOSE caregivers, the ones who hate any kind of change. (Every unit has them. J) Often, they become the most passionate advocates for change.

It’s not enough to say what to do and what not to do when it comes to feeding techniques. What matters more is teaching you to strategize about them.

Online Infant-Driven Feeding® education helps you develop critical thinking skills related to oral feeding practice. This kind of knowledge aids you long after the course is over. The information becomes part of your expertise. And considering the amount of time you spend engaged in or discussing oral feeding on any given day, we believe this level of knowledge should be standard.

It’s what age-appropriate care is all about.



One and DoneOne Champion

Paula is a neonatal therapist.

She attended a national conference about 2 years ago and one of the topics was cue based feeding. She was thrilled to learn about this practice she’d been reading about for so long.

She returned to her NICU and set up inservices about feeding readiness cues, disengagement cues and parental involvement. Her colleagues loved the new information and practice began to change- for a while.

About one year after those inservices, the unit experienced a huge turnover in staff. The progress Paula initiated began to erode. She was overwhelmed and frustrated that the education she’d provided didn’t ‘stick’ in the long term.

The mistake is assuming Paula can be a lone wolf (even if she’s a passionate one!). There are too many variables for one person to address.

The risk is losing ground once again. Paula, although knowledgeable and passionate, may give up. And then what?

One Seminar

We met Dave several years ago when presenting a live seminar on Infant-Driven Feeding® in his NICU.

He was a nurse educator and a rock star when it came to organizing and following through with this new feeding practice.

#7



We spent 3 days educating over 90% of his NICU staff and some ancillary staff as well. We left there knowing we’d done our best for them.

Or had we?

Of course we did our best as presenters. But here’s what happened next:

Dave had the daunting task of finding anyone who hadn’t been able to attend the live seminar and educating them, somehow, on the 6 hours of content we’d presented. Oh, and then there were some physicians who couldn’t attend and they wanted to know the scoop too.

And one of the neonatal therapists had been on maternity leave and needed to be included as well.

Now Dave, though grateful for the huge wave of education, was left trying to tie up all the loose ends. Not to mention a year later when their hospital organization made some changes and the NICU experienced a huge turnover in nursing staff. Ugh.

Infant-Driven Feeding® had become standard practice for their NICU. Problem was, over time, fewer people understood the WHY behind many of the practices. They were, therefore, less passionate about the nuances of the practice and frankly, less educated about them.

We learned a lot from Dave. About what we did well and what the world needed.

We felt the sting of that. Of knowing we did something great, but wanting to serve better, smarter and more effectively. We wanted to leave NICUs with less work, more tools and the ability to maintain their gains.

Paula’s mistake and our mistake were the same –

One and done.



One champion, one presentation (even to 100% of the current staff!), one shot at getting everyone on board.

The mistake is assuming you can complete education, brush off your hands and be done with it.

The risk is losing the power of that practice change, the power of hundreds of educated, inspired caregivers.

The risk is giving up and allowing suboptimal practice to continue - a practice that clearly doesn’t support infants and families in the NICU to the tune of thousands of dollars in post-NICU feeding therapy.

Life teaches us that change is the only constant.

And we learned that in order to truly create lasting change in the lives of infants, families and caregivers we had to grow.

We had to grow in educational access, scope, mission and delivery.

Our desire is to serve the most fragile patients in healthcare through the most powerful vehicle available – you. The whole global team of you.

We thought presenting live seminars was enough. It wasn’t.

Online Infant-Driven Feeding® education provides a solution we couldn’t before. No more lone wolves, no more “one and done.” Infant-Driven Feeding: Advancing Oral Feeding Practice in the NCIU was created to be sustainable over time. New employee? No problem. 3 people on maternity leave? They can take it when they return if not from home.

And educators can breathe a sigh of relief. No more trying to recreate the effect of IDF education. It’s all right there.



Summary

When you take responsibility for your own education and practice (any education, any practice) you not only turn the infant’s life around, but your own. You impact the world.

Infant-Driven Feeding® education was created with you in mind.

It was 7am as we were prepared for a 6-hour presentation on Infant-Driven Feeding®. We noticed, as always, a group of NICU staff seated in the back row, arms crossed, furrowed brow – the familiar demeanor of people who have no idea why they have to attend this event when they’ve been feeding babies for 30 years.

Understandable.

After a great day of spirited conversations and new education one of the ‘back row’ staff stopped us before she left for the day. We’ll call her Sandra.

She excitedly stated, “I’ve been a NICU nurse for over 30 years. And surprisingly, until today, I’ve never been officially taught how to feed a premature baby. I never knew there was so much to consider. So thank you.”

We’re thrilled when anyone feels this way after a day of education, but even more so because Sandra was incredibly experienced.

Here’s the best part:

The following day we received a guided

tour of their NICU. As we walked through, we saw Sandra waving to us from the bedside of her first patient of the day. The infant’s mother was present as well. To our surprise, the course syllabus was lying within arm’s reach.

Sandra introduced us to this mother and then said to her, “Remember all that I taught you the other day about feeding your son?” The mother nodded in agreement. Sandra smiled and continued, “Well, scrap it! We’re starting over today. I can’t wait to teach you what I learned yesterday.” They both laughed and Sandra dove right in explaining signs of feeding readiness.

We walked away and said to each other, “What an amazing nurse.” Not because she loved what we taught. But because after 30 years, she was willing to set her preconceived notions aside, listen and be open to new practices. She took it a step further and immediately implemented what she’d learned AND began teaching parents.

Now THAT is what we call success.

Success in attitude, collaboration and high level integration.



Practical and based on current evidence, there’s nothing else like it in the world.

Decide to be part of the solution.

For over a decade we’ve provided live education on the culture and practice of feeding in neonates.

What we didn’t realize was that somewhere along the way it became a mission. And we couldn’t resist the notion that we could do better.

After all, the babies are waiting.

Infant-Driven Feeding®: Advanced Oral Feeding Practice in the NICU is available online for individuals and entire NICUs! This course is distributed via HealthStream, Inc. Since you’ve shown interest in this topic, we’ll include you in a special list that will be first to receive all updates related to this course as well as live events at which the authors are scheduled to speak about Infant-Driven Feeding®.

Stay tuned!

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