Individualizing Oral Feeding Assessment and Therapies in the Newborn

Abstract

Oral feeding competency is a milestone most infants must achieve prior to discharge. It is a developmentally complex task that requires integration of multiple sensory inputs, central nervous system maturation, motor coordination, and respiratory stability. While ensuring safety during oral feeding is important to reduce morbidities, we must optimize developmental windows to expedite feeding maturation. Currently, many of the assessments and therapies related to oral feeding skills focus solely on nutritive and non-nutritive sucking. Yet, this essential reflex is only one component of oral feeding. Specific challenges faced by individual newborns are often unique, and delays in development in any one of the many systems involved in oral feeding can lead to prolonged oral feeding maturation. Expanding the field to go beyond targeting oral motor skills to consider all aspects of feeding maturity, inclusive of sensory integration and hunger signaling, is needed to advance care. As technology continues to develop at a rapid pace, the field must compare the efficacy of these clinical and technologic assessments and therapies. In this review, we will address the complexity of neonatal feeding, review assessment tools and interventions for feeding safety and developmental readiness, and propose an individualized, multi-faceted approach to oral feeding evaluation and intervention.