Key issues in supporting transition from tube to
bottle feeding
Gillian Kennedy
Consultant Speech and Language
Therapist
N...
.......por lo tanto
-Baby
-Maternal
-System
(hospital /
social)
Key issues in supporting transition from tube to
bottle feeding
Early input to redress negative peri-oral stimuli
Negative
• Intubation
• Suction
• CPAP
• Feeding tubes
Positive
– Skin t...
Influence of tube feeding
OGT
NGT
•Rate of flow
•Contact with baby
•Position of baby
Strategies to promote oral feeding have included:
Early introduction of oral feeds Oral stimulation programmes
Boiron et a...
Quantative outcome measures related to..
• Volume
• length of feed
• Speed of transfer from
tube oral feeding
– e.g.
Entir...
Influence of individualised care
..based in NIDCAP approach Als 1982
Shift in feeding
outcome focus from..
Quantative
Qual...
Als Synactive Theory of Development
• Physiological
• Motor
• State
• Attention / interaction
• Self regulatory
Focussing on the feeding experience for
the baby
• Baby viewed as an
active participant
• Co-regulation from the
parent / ...
Feeding readiness behaviours
White-Traut et al 2005
Thoyre et al 2005
• Alert – baby demonstrates the
ability to focus att...
34-36 week infants
• Feeding issues for late
preterm infants:
Bottle and Breast fed
Dodrill et al 2005
Meier et al 2007
Babies with Chronic Lung Disease
• Anticipated maturational patterns of
suckle and swallow rhythms do not
occur.
• ?does t...
Modifications to introduction of oral intake for
bottle fed babies weaned from long term CPAP
• EBM used for initial trial...
Positioning is important because:
• Cranio-cervical posture and
pharyngeal airway stability
are interconnected
• Premature...
Positioning
Elevated side lying
• Conserves energy
• Affords baby more control
over feed
• Facilitates infant using
self-regulatory st...
Pilot study investigating the elevated side-
lying position Clark et al 2007
• Improved oxygen saturation levels
……..when ...
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
Madrid nov 2010 final gillian kennedy
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Madrid nov 2010 final gillian kennedy

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Madrid nov 2010 final gillian kennedy

  1. 1. Key issues in supporting transition from tube to bottle feeding Gillian Kennedy Consultant Speech and Language Therapist NIDCAP Trainer in training Neonatal Unit University College London Hospital London. gillian.kennedy@uclh.nhs.uk
  2. 2. .......por lo tanto
  3. 3. -Baby -Maternal -System (hospital / social)
  4. 4. Key issues in supporting transition from tube to bottle feeding
  5. 5. Early input to redress negative peri-oral stimuli Negative • Intubation • Suction • CPAP • Feeding tubes Positive – Skin to skin / kangaroo – mother care – PositiveTouch Bond 1997
  6. 6. Influence of tube feeding OGT NGT •Rate of flow •Contact with baby •Position of baby
  7. 7. Strategies to promote oral feeding have included: Early introduction of oral feeds Oral stimulation programmes Boiron et al 2007 Fucile et al 2002 Barlow 2009 31 weeks vs. 33-34 weeks ga Simpson et al 2002 Specific feeding techniques e.g. cheek and jaw support Eishema 1991
  8. 8. Quantative outcome measures related to.. • Volume • length of feed • Speed of transfer from tube oral feeding – e.g. Entire prescribed volume taken within 20 mins without adverse effects...... Usually defined as apnoeic +/- bradycardic episodes
  9. 9. Influence of individualised care ..based in NIDCAP approach Als 1982 Shift in feeding outcome focus from.. Quantative Qualitative
  10. 10. Als Synactive Theory of Development • Physiological • Motor • State • Attention / interaction • Self regulatory
  11. 11. Focussing on the feeding experience for the baby • Baby viewed as an active participant • Co-regulation from the parent / carer to: – Facilitate and support the baby’s own efforts – identify and respond to the baby’s signals of sensitivity
  12. 12. Feeding readiness behaviours White-Traut et al 2005 Thoyre et al 2005 • Alert – baby demonstrates the ability to focus attention on feeding • Rooting – Neurodevelopmental readiness Shaker 1996 • Tongue organised to receive nipple • Body posture orientates to midline – arms forward to assist • > 90 % baseline oxygen saturation level in quiet state and in preparation period.
  13. 13. 34-36 week infants • Feeding issues for late preterm infants: Bottle and Breast fed Dodrill et al 2005 Meier et al 2007
  14. 14. Babies with Chronic Lung Disease • Anticipated maturational patterns of suckle and swallow rhythms do not occur. • ?does the absence of stable rhythms at 35 weeks predict subsequent feeding and neurological problems Gewolb et al 2001 • > incidence in gastro-intestinal issues Jadcherla et al 2010 • > incidence of feeding difficulties Hawdon et al 2000
  15. 15. Modifications to introduction of oral intake for bottle fed babies weaned from long term CPAP • EBM used for initial trial Mizuno & Ueda 2002 • Elevated side-lying position used
  16. 16. Positioning is important because: • Cranio-cervical posture and pharyngeal airway stability are interconnected • Premature infant lacks the éxoskeleton’ and strong physiological flexor of the term infant. Bosma 1972 • Feeding success strongly influenced by the feeders body mechanics Jones et al 2002
  17. 17. Positioning
  18. 18. Elevated side lying • Conserves energy • Affords baby more control over feed • Facilitates infant using self-regulatory strategies • Enables safer clearance of oral residue • Allows feeder to feel respiration
  19. 19. Pilot study investigating the elevated side- lying position Clark et al 2007 • Improved oxygen saturation levels ……..when infants fed in elevated side-lying versus semi-upright p < 0.001 Trend • Quicker return to baseline of heart- rate Further research presently underway

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