Knowledge Bank

Background/Purpose: Newborns with congenital heart disease (CHD) often lack effective fluid management and sufficient engagement while feeding. Occupational therapists (OT) are specifically trained to support difficult-to-feed infants and teach inexperienced parents about best feeding techniques. Best feeding practice to enhance fluid management is to hold the nipple steady while the newborn is engaged in feeding. Various feeding methods are used during periods of infant disengagement to limit difficulties managing fluid. The purpose of this study was to describe differences in bottle movement between the OT as the feeder and the mother as the feeder. Methods: This is a descriptive observational case study of one feeding for each of two post-operative infants. Bottle feedings were videotaped and coded using the Dynamic Early Feeding Skills assessment loaded into the Noldus Observer system. Mothers were taught supportive feeding techniques by the OT. Infants with CHD were fed by the OT in the morning and the mother in the afternoon. Feeding activity was defined as any form of oral stimulation or bottle movement by the feeder to elicit a suck response. The percentage of feeding activity during each session was recorded and compared by feeder. Results: Two infants were fed by the same OT and by their mothers. The average percentage of the feeding with the nipple held steady was 60% by the OT and 67% by the mother. The OT tipped the bottle down to slow the flow of milk on average 28% more often than the mothers. The OT also spent an average of 9% less feeding time on oral stimulation with the nipple compared to the mothers.
Conclusions: Findings demonstrated better use of bottle movement to limit fluid management difficulties when the OT was feeding. We found that the mothers applied some of the feeding techniques taught by the OT. However, there were noticeable differences in bottle movement interventions between the feeders. Further research is needed on the optimal way to teach mothers supportive feeding techniques for these difficult-to-feed infants with CHD and to ensure nursing involvement in modeling these feeding techniques with the parents.