Parent-infant interaction during feeding when the infant has congenital heart disease.

This article examines parent-infant interaction (PII) during feeding when the infant has congenital heart disease (CHD) using the Nursing Child Assessment Feeding Scale (NCAFS) and compares the NCAFS scores of the infants with CHD with those of healthy controls. Twenty mother-infant dyads, 10 with CHD and 10 controls, were studied. Infants with CHD scored significantly lower than controls on both infant subscales, Responsiveness to Caregiver and Clarity of Cues, of the NCAFS. Mothers of CHD infants scored significantly lower on the Social Emotional Growth Fostering subscale. These findings suggest specific behavioral differences in infants with CHD during feeding and support the need for more information about feeding interactions in infants with CHD.     

Mothers'' working models of infant feeding: description and influencing factors

This study examined four aspects of mothers' working models of infant feeding: (1) infant behaviour that cues feeding decisions; (2) infant self-regulative behaviour; (3) importance of infant self-regulative behaviour and maternal effort directed to it; and (4) maternal effort and value given to task-oriented and efficient feeding. The relation of these aspects to maternal experience, age, formal education, family income, and feeding method was also explored. Subjects were 122 mothers of healthy, term infants between 14 and 60 days old. A telephone interview obtained demographic and attribute data and assessed the four aspects with 30 scaled items. Crying before and sleepiness during feeding were relatively compelling cues for maternal action. Most mothers gave only moderate ratings to the importance of infant self-regulative behaviour and to task-oriented and efficient feeding. Parity and feeding method affected response to specific items, with primiparae more concerned about length and regularity of feedings. Mothers who bottle-fed their infants were more concerned about maintaining a feeding once initiated than mothers who breast-fed their infants. Four-factor analysis yielded two item clusters with good internal consistency: Cluster a. Maternal Effort to Accomplish Feeding Goals; and Cluster b. Importance of Infant Self-Regulative Behaviour. Cluster a. and b. were strongly correlated. Feeding method influenced both clusters, and the interaction of parity and feeding method had an effect on Cluster a. Mothers with lower family income had higher scores on Cluster b; multiparae with lower family income on Cluster a. How and when infant self-regulation develops as a goal is a question in need of study.     

Regional neonatal oral feeding protocol: changing the ethos of feeding preterm infants

The Calgary Health Region Neonatal Oral Feeding Protocol is the culminating work of a broad range of healthcare professionals, including staff nurses, nurse practitioners, nurse educators, nurse managers, dietitians, lactation consultants, clinical nurse specialists, and occupational therapists. The protocol represents a synthesis of research evidence and expert opinion pertaining to the introduction and management of oral milk feedings for high-risk infants in the neonatal intensive care unit. This evidence-based neonatal oral feeding protocol is presented to share knowledge and skill required to create positive feeding experiences while assisting high-risk infants to achieve full oral feedings. Goals of this project include promoting consistent neonatal nursing feeding practices and changing the ethos in relation to feeding interactions between caregiver and infant in the neonatal intensive care unit. This culture change will assist nurses to identify what is unique about their professional practice, which is of particular importance given the skill mix resulting from hospital understaffing and a growing nursing workforce shortage.     

Reliability of the Nursing Child Assessment Feeding Scale during toddlerhood

The quality of the maternal-child feeding interaction has been proposed to be an important contributor to a child's being overweight, yet assessment of this proposition has been hindered by a lack of age-appropriate instrumentation. The primary aim of this study was to examine the reliability of the Nursing Child Assessment of Feeding Scale (NCAFS) if extended to use during toddlerhood. A longitudinal design was used to assess NCAFS reliability at 12, 24, and 36 months. The NCAFS was used to code videotaped feeding observations of 116 mother-toddler dyads collected as part of a larger study examining mother-child interactions and adaptations of toddlers. Reliability was explored through the assessment of interrater reliability, internal consistency of the various subscales and the scale as a whole, and stability of the scale measurements over time. At each age, interrater reliability was generally quite good whereas the NCAFS' internal consistency was low. Maternal contributions to feeding interaction quality were stable over time but dyadic and child contributions were not. The lower internal consistency estimates were likely due to relatively low levels of variance among the dyads within each age. Another probable contributor to diminished internal consistency was the attrition of several behavior items due to zero variance. Possible explanations for this restriction of variance and several approaches for improving the NCAFS internal consistency during toddlerhood are considered. With revision, the NCAFS could be useful in assessment of feeding interaction quality during the transition to toddlerhood when issues of control and autonomy become increasingly prominent.     

Birth order effects on breastfeeding self-efficacy,parent report of problematic feeding and infant feeding abilities

The goal of this prospective study was to identify effects of birth order on breastfeeding self-efficacy, parental-report of infant feeding behaviors, infant non-nutritive sucking and oral feeding skills in full-term infants at 3-months. Mothers were separated into primipara and multipara groups, and infants were grouped into siblings and no siblings groups. Parents completed the Breastfeeding Self-Efficacy Scale-Short Form, and Neonatal Eating Assessment Tool–Breastfeeding and Bottle-feeding scales. Non-nutritive sucking was assessed using a custom research pacifier and researchers completed the Oral Feeding Skills scale to assess feeding performance. Fifty-six mother-infant dyads (55% male infants) were included. Primipara mothers reported significantly lower breastfeeding self-efficacy and more feeding problems across breast and bottle-feeds on the Neonatal Eating Assessment Tool. There were no significant differences in non-nutritive sucking or oral feeding skills between infant groups. First-time mothers require more feeding support as they exhibited lower breastfeeding self-efficacy and reported more problematic infant feeding behaviors.     

Effect of early skin-to-skin contact on mother–preterm infant interaction through 18 months: Randomized controlled trial

BackgroundPreterm birth often negatively influences mother–infant interaction. Skin-to-skin contact postbirth has positive effects on maternal feelings toward their preterm infants and on infant development and family interaction. However, little is known about the long-term effects of skin-to-skin contact on mother–late preterm infant interaction when skin-to-skin contact was experienced early postbirth and intermittently throughout the next five days.ObjectiveThe purpose of this report was to examine the effect of skin-to-skin contact on mother–late preterm infant interaction through 18 months.DesignRandomized controlled trial with follow-up.SettingTwo hospitals in the United States of America.Participants100 mothers and their late preterm infants, 32 to <37 weeks’ gestation, were recruited. Mother–preterm infant interactions were assessed in 69, 70, and 76 dyads at 6, 12, and 18 months.MethodsMothers and their preterm infants were videotaped during a feeding session at 6 and 12 months, and a teaching session at 6, 12, and 18 months. Their interactions were then scored using the Nursing Child Assessment Satellite Feeding Scale and Teaching Scale.ResultsSkin-to-skin contact and control dyads had comparable feeding scores at 6 and 12 months. Skin-to-skin contact infants had lower infant teaching scores at six months, a difference that disappeared thereafter.ConclusionsThese inconclusive results call for additional studies with larger doses of skin-to-skin contact, larger sample sizes, and other outcome measures of mother–late preterm infant interactions. Such measures include the Parent–Child Early Relational Assessment and behavioral coding during play.     

Changing Feeding Documentation to Reflect Infant-Driven Feeding Practice

Nipple feeding is a complex task for most preterm or high-risk infants. It requires a skilled and observant caregiver to assist the infant in a pleasurable feeding experience that maximizes intake and minimizes stress. This article presents the traditional progression, method, and documentation routinely used in nurseries, as well as an infant-driven approach to feeding that is beginning to surface in nurseries. The article will review the goals for successful nipple feeding and present the Infant-Driven Feeding Scales to be used as an assessment, a guide for intervention, and a means for documentation of nipple feedings. The scale encompasses infant feeding readiness and quality of nippling, as well as caregiver techniques. The article includes parent use of the scale, as well as a case review using the Infant-Driven Feeding Scales.     

Factors contributing to preterm infant engagement during bottle-feeding

BACKGROUND: Preterm infants have difficulty maintaining engagement throughout early oral feedings, which can lead to less efficient feeding and prolonged feeding skill development. OBJECTIVE: To examine contributions of the infant, mother, and feeding context to infant engagement during bottle-feeding. METHODS: Bottle-feedings of very-low-birthweight infants (n = 22) by their mothers were observed. Infant and maternal behaviors were coded and synchronized with physiologic measures. At completion of the feeding, the mothers were interviewed, and their working model of feeding coregulation was scored. Feedings were subdivided into feeding episodes (n = 114). Using multilevel linear regression analyses, four dyadic characteristics (working model of the caregiver's role as coregulator, birthweight, postconceptional age, baseline oxygen saturation) and five episode characteristics (readiness at episode onset, episode baseline oxygen saturation, mean oxygen saturation during the episode, maternal feeding behavior, and phase of feeding) were examined as potential predictors of feeding episode engagement. RESULTS: Conditions observed during the feeding observation explained most of the variation in engagement. Engagement was more likely to occur during the early phase of feeding (p <.05), during feeding episodes that began with infant readiness (p <.05), and during feeding episodes with higher mean oxygen saturation during the episode (p <.05). Feeding episodes with less jiggling of the nipple had a significantly greater amount of engagement (p <.05). CONCLUSIONS: The ability of the preterm infant to maintain engagement during bottle-feeding cannot be explained by characteristics of the infant or by the prefeeding condition of the infant alone. Rather, engagement is coregulated by the caregiver and the infant throughout the feeding. Strategies to assist infants in maintaining physiologic stability during bottle-feeding and further study of effective and contingent caregiver feeding behaviors are needed.     

Caries risk assessment tool and prevention protocol for public health nurses in mother and child health centers,Israel

Objectives

Dental caries is the most prevalent chronic disease in children. Caries risk assessment tools enable the dentists, physicians, and nondental health care providers to assess the individual's risk. Intervention by nurses in primary care settings can contribute to the establishment of oral health habits and prevention of dental disease. In Israel, Mother and Child Health Centers provide free preventive services for pregnant women and children by public health nurses.

Materials and Methods

A caries prevention program in health centers started in 2015. Nurses underwent special training regarding caries prevention. A customized Caries Risk Assessment tool and Prevention Protocol for nurses, based on the AAPD tool, was introduced. A two‐step evaluation was conducted which included a questionnaire and in‐depth phone interviews.

Results

Twenty‐eight (out of 46) health centers returned a completed questionnaire. Most nurses believed that oral health preventive services should be incorporated into their daily work. In the in‐depth phone interviews, nurses stated that the integration of the program into their busy daily schedule was realistic and appropriate. The lack of specific dental module for computer program was mentioned as an implementation difficulty.

Discussion

The wide use of our tool by nurses supports its simplicity and feasibility which enables quick calculation and informed decision making. The nurses readily embraced the tool and it became an integral part of their toolkit.

Conclusion

We provide public health nurses with a caries risk assessment tool and prevention protocol thus integrating oral health into general health of infants and toddlers.     

Evaluating the Precision of Clinical Assessments for Feeding Intolerance

Feeding intolerance is a common occurrence in preterm infants, yet there are no precise measures for clinically assessing this potentially serious manifestation. This article reports the results of a study designed to evaluate neonatal intensive care (NICU) nurses’ precision in abdominal and emesis assessments, considered the most objective, observable signs of feeding intolerance. Forty-six NICU nurses participated in the study by observing pictures of preterm infant abdomens and pictures of “staged” emesis. There was little agreement among the participants regarding the infant abdomen pictures or the amount of emesis observed in the pictures. There was no relationship between years of NICU experience nurses’ assessments. The ability of nurses to assess clinical signs of potentially serious complications in preterm infants is critically important. Standardized education and training as well as precise assessment tools are needed.     

Feeding readiness in preterm infants: the relationship between preterm behavioral state and feeding readiness behaviors and efficiency during transition from gavage to oral feeding

PURPOSE: The purpose of this secondary analysis was to assess whether alert behavioral states were associated with an increased number of feeding readiness behaviors (FRBs) and whether the number of FRBs were associated with subsequent feeding efficiency in healthy premature infants born between 29 to 35 weeks gestation. STUDY DESIGN AND METHODS: The data were collected as part of a larger study designed to compare the frequency of FRBs and feeding efficiency between control and experimental groups. Data from 21 stable premature infants were included in this secondary analysis. Infants were videotaped immediately prior to each of the first three oral feedings, from which infant behavioral state (IBS) and FRBs were assessed. Feeding efficiency was determined by calculating the ratio of feeding intake to feeding duration. RESULTS: IBS was not a significant predictor of the number of FRBs. The number of FRBs was predictive of feeding efficiency (p <.05). Group assignment was a marginally significant predictor of feeding efficiency (p < .10). Infant sex (p < .05), birthweight (p < .01), gestational age at birth (p <.01), and gestational age at entry (p < .05) were identified as significant predictors of the number of FRBs. Group assignment was marginally significant (p < .10). CLINICAL IMPLICATIONS: Feeding efficiency may be predicted by the increased number of FRBs immediately prior to feeding. An infant's attributes (sex, birth-weight, and gestational age) may relate to feeding efficiency and should be assessed when instituting oral feeding. Assessment of FRBs can be easily incorporated into routine clinical practice.     

Benefits of Infant Massage for Infants and Parents in the NICU

Infant massage is an ancient therapeutic technique used around the world. For infants who experience painful procedures, are exposed to the stressful NICU environment, and are separated from their parents, infant massage has been promoted as a method to reduce stress and promote bonding. In this article, we review the current literature on infant massage in the NICU. There is evidence that infant massage has beneficial effects on preterm infants in the NICU, including shorter length of stay; reduced pain; and improved weight gain, feeding tolerance, and neurodevelopment. Parents who performed massage with their infants in the NICU reported experiencing less stress, anxiety, and depression. Neonatal nurses can obtain education and certification in infant massage and can teach parents infant massage techniques, thereby promoting the health and well-being of parent–infant dyads.     

The SOFFI Reference Guide: text, algorithms, and appendices: a manualized method for quality bottle-feedings

The Support of Oral Feeding for Fragile Infants (SOFFI) method of bottle-feeding rests on quality evidence along with implementation details drawn from clinical experience. To be clear, the SOFFI Method is not focused on the amount of food taken in but on the conduct of the feeding and the development of competent infant feeding behavior that, consequently, assures the intake of food necessary for growth. The unique contribution of the SOFFI method is the systematic organization of scientific findings into clinically valid and reliable, easily followed algorithms, and a manualized Reference Guide for the assessments, decisions, and actions of a quality feeding.A quality feeding is recognized by a stable, self-regulated infant and a caregiver who sensitively (responsively) adjusts to the infant's physiology and behavior to realize an individualized feeding experience in which the infant remains comfortable and competent using his nascent abilities to ingest a comfortable amount of milk/formula. The SOFFI Reference Guide and Algorithms begin with prefeeding adjustments of the environment and follow step by step through a feeding with observations of specific infant behavior, decisions based on that behavior, and specific actions to safeguard emerging abilities and the quality of the experience. An important aspect the SOFFI Reference Guide and Algorithms is the clarity about pausing and stopping the feeding on the basis of the infant's physiology and behavior rather than on the basis of the amount ingested. The specificity of each observation, decision, and action enables nurses at all levels of experience to provide quality, highly individualized, holistic feedings. Throughout the course of feeding in the NICU, the nurse conveys to parents the integrated details (observations, decisions, and actions) particular to their infant, thus passing on the means for parents to become competent in quality feeding, to enjoy feeding time into the future, and to gain in confidence as they watch their infants grow.     

Behavioral responses of preterm infants to a standard-care and semi-demand feeding protocol

It was hypothesized that healthy preterm infants 32 to 33 weeks postconceptional age randomized to a semi-demand feeding protocol would have more optimal behavioral responses in the transition from gavage to oral feeding compared to control infants receiving the standard care. The protocols were performed in 2 tertiary nurseries, with 38 experimental and 41 control infants. The control protocol followed the standard practice of slowly increasing scheduled oral feedings. The semi-demand protocol combined use of nonnutritive sucking to promote awake behavior for feeding, behavioral assessment to identify feeding readiness, and systematic use of infant behavior to regulate feedings. Behavioral responses were analyzed with a random effects analysis of variance model. Experimental infants began their oral feedings more often in alert, quiet behavior and were more often in sleep states after feeding than control infants. Alert, quiet behavior is optimal for successful oral feeding, and the sleep state after feeding is beneficial in promoting digestion and growth. Copyright 2002, Elsevier Science (USA). All rights reserved.     

Systematic Review of Quality Improvement Initiatives Related to Cue-Based Feeding in Preterm Infants

Objective

To examine and synthesize the outcomes of quality improvement (QI) initiatives related to cue-based feeding of preterm infants to facilitate implementation of findings to improve nursing practice.

Breastfeeding preterm infants as the initial oral feeding: An integrative review

BackgroundAlthough breastfeeding up to six months of age is strongly encouraged, the preterm infant is challenged to orally feed. Breastfeeding should be encouraged as the initial oral feeding, then offered as the preferred method as tolerated by the infant.MethodsThe study used an integrative review method that included articles between 2017 and 2022 related to direct breastfeeding preterm infants and methods to support initiation of oral feedings.ResultsEleven articles met the criteria for review. Six themes emerged: medically stable infant to start and/or continue oral feedings, skin-to-skin/kangaroo mother care, breastfeeding benefits, cue-based feedings, increased weight gain, and non-nutritive sucking.ConclusionsCaregivers support preterm infants with transitioning from gavage to breast by implementing skin-to-skin, non-nutritive sucking, and cue-based feeding. Direct breastfeeding increased exclusive breastfeeding rates at discharge. The interventions should start on medically stable infants and continue as long as there is demonstrated physiologic stability.     

Feeding readiness behaviors and feeding efficiency in response to ATVV intervention

A prospective clinical random design was used to assess the effects of prefeeding auditory, tactile, visual and vestibular (ATVV) intervention on the behavioral state, frequency of feeding readiness behaviors, and oral feeding efficiency in 22 stable, premature infants. Experimental infants (group E) received 15 minutes of ATVV intervention immediately prior to their first 3 oral feedings, while the controls received normal nursery care. FRBs and behavioral states were recorded and later scored via videotape. Feeding efficiency was determined by feeding volume and feeding duration. Group E infants were more alert after the intervention (P < .0001) and showed more FRBS during the intervention for 5 of the 8 behaviors (P < .05). A trend toward decreased feeding time was noted for group E infants. The present findings support the use of ATVV intervention prior to feeding as a means of modulating behavioral states and increasing the frequency of FRBs. Copyright 2002, Elsevier Science (USA). All rights reserved.     

Development and validation of an instrument to measure nurse-patient bonding

Background

Most instruments on nurse-patient relationship determine the caring behavior of the nurse, but have minimal consideration of the patient's role in the interaction. Moreover, it is the patients that complete many of those instruments, thus leaving out the perspective of the nurse. There is then a need to account for the contributions that both the nurse and the patient bring into their encounter where bonding is formed.

Objective

This study aimed to develop and validate an instrument that determines the degree of bonding between nurse and patient based on their openness to each other and their engagement in patient care.

Settings

Data were collected from nurses and patients in the wards of four public and private tertiary hospitals in Manila, Philippines, where most Filipino nurses render care to patients before getting employed in other countries.

Participants

A total of 420 nurses and patients (i.e., 210 dyads) participated in this research conducted in 2008. Most of the nurses were young females with beginning clinical experience, while the patients had a wider age range with the majority having no college education and no employment.

Methods

The Nurse-Patient Bonding Instrument (NPBI), which dimensions were generated from qualitative observations and interviews, and corroborated by literature, was validated at the bedside setting. To determine interrater reliability, two trained raters unobtrusively observed actual nurse-patient interactions and ticked on the NPBI behavioral indicators of openness and engagement. Construct validity was established using known-groups technique. Moreover, bonding score was correlated with patient satisfaction for predictive validity.

Results

Reliability ranged from r = .80 to .95 (p < .01). Factor analysis demonstrated that the subscale scores of patient openness, nurse openness, patient engagement, and nurse engagement all loaded on one factor, the bonding factor, demonstrating a unified structure of the NPBI. Nurses and patients had higher bonding scores in interactions of longer duration than shorter duration, controlling for number of previous encounters. This provided evidence for construct validity using known-groups technique. The NPBI was likewise shown to distinguish groups based on age, education, and civil status. Patient satisfaction correlated positively with bonding score, providing evidence suggestive of the predictive validity of the NPBI.

Conclusion

The NPBI was shown to be a reliable and valid tool for assessing nurse-patient bonding, and can possibly predict patient satisfaction. The openness and engagement of nurse and patient were demonstrated to result in a structure, a nurse-patient dyad. This finding invites further investigations on the characteristics and development of this dyad.