Celia Harding

An evaluation of the benefits of non-nutritive sucking for premature infants as described in the literature.

Babies have specific needs that assist them in their development and enable them to thrive. Feeding is an important aspect of development. When feeding, there are opportunities for babies to develop a positive interactive bond with parents. This has a long-term impact on the well-being of infants in terms of emotional development, social learning, and health. Infants born prematurely and those born with specific needs making them vulnerable are likely to develop the necessary skills to allow them to mature, interact and thrive. Many premature infants may need alternative feeding methods until they are ready to develop the skills necessary for oral feeding. A beneficial approach for infants who are showing oral readiness is the use of a non-nutritive sucking programme. This paper explores the research that supports non-nutritive sucking, and considers other variables that need to be included in further research, including those infants who have neurodisability.

How does non-nutritive sucking support infant feeding?

Fifty nine premature infants participated in a randomized controlled study to determine the effectiveness of non-nutritive sucking (NNS). It was predicted that NNS would not accelerate the development of full oral feeding or early language skills as sometimes perceived in practice. However, it was predicted that using NNS as a strategy to support parents to identify and respond to early communication and oral readiness signs would increase confidence in infant management and enable quicker discharge home. Infants were aged 26-35 weeks gestation. Infants with no significant difficulties were randomly assigned to one of three groups; Group 1, NNS pre-tube feeding (n=19); Group 2, NNS on onset of tube feeding (n=20) and Group 3, Control (n=20). Follow-up occurred at 6 months. There were no significant differences with number of days to full oral feeding between the groups receiving NNS and the Control group, χ2(2, n=59)=4.33, p=.115. A significant difference in number of days in hospital between the Control group and the other two groups was found χ2 (2, n=59)=7.678, p=.022. Significant changes were noted with the development of more normal sucking patterns in Groups 1-3. At 6 months there were no significant differences in receptive or expressive language skills between all groups. NNS had no significant impact on the transition to full oral feeding or later language development. There was a significant difference in the number of days in hospital between the Control group and the other two groups which involved parents in identification of early communication signs. Possible reasons for this change and future directions are discussed.

The Use of Nonnutritive Sucking to Facilitate Oral Feeding in a Term Infant: A Single Case Study

This individual case study presents an evaluation of and reflection on the use of nonnutritive sucking as a technique to facilitate nutritive sucking with an infant with feeding difficulties. Nonnutritive sucking is used in a variable way with mainly premature or sick infants. However, the rationale underpinning use of such an approach is not clear. The infant participant in this study, Baby H, was born at 37 weeks. This case illustrates the use of nonnutritive sucking as an approach with supported rationales for promoting transition toward oral feeding with infants who have complex needs and who are term infants. The literature focuses on using nonnutritive sucking with premature infants who have no additional difficulties such as hypoxic neonatal encephalopathy, meconium aspiration, sepsis, or severe perinatal asphyxia. The intervention carried out with Baby H demonstrates that nonnutritive sucking can contribute toward the management of an infants feeding development. Baby H took 23 days to develop a sequential nonnutritive sucking pattern, but her ability to transfer this to nutritive sucking and safe feeding took the first 17 months of this infants life. This study is unique in that it explored the issues involved with a term infant who had complex needs that impacted on feeding development. It is important because many practitioners use nonnutritive sucking with infants who have complex needs.

Evaluation of an intensive desensitisation, oral tolerance therapy and hunger provocation program for children who have had prolonged periods of tube feeds

BACKGROUND Some children with feeding difficulties may require nasogastric tube feeding or insertion of a percutaneous endoscopic gastrostomy (PEG) from a young age. A small cohort of these children can develop severe oral aversions that can delay the re-introduction of oral feeding. Multidisciplinary approaches that provide an intensive approach are deemed the most effective method of intervention to reduce nasogastric and PEG dependency. METHODS Two children and their parents received an intensive approach to reduce PEG feeds (Child A and Child B), while one child and her parents elected to receive a traditional feeding clinic approach (Child C). The mean age of the participants was 4 years 4 months. RESULTS Child A initially took 2090 kJ (44% daily nutritional requirement) via her PEG before the intensive program, and Child B took 100% daily nutritional requirement via his PEG. Three months post the intervention, Child A took 100% of her nutritional requirements orally and Child B had reduced PEG requirement significantly to 38% of daily nutritional requirement. Child C showed no changes in PEG versus oral intake. Children who received the intervention were able to remain focused on mealtimes for longer, with fewer instances of leaving the table. Parents altered their language styles post coaching on the intensive intervention using fewer reprimands. No changes with these behaviours were noted with Child C. CONCLUSIONS Although this was a small pilot study, there are some strategies used within an intensive multidisciplinary context that can enable children to reduce their reliance on PEG feeds significantly.

Managing eating and drinking difficulties (dysphagia) with children who have learning disabilities: What is effective?

People who work with children who have neurological and learning disabilities frequently need to manage the health and emotional risks associated with eating, drinking and swallowing (dysphagia). Some approaches can support children to develop oral feeding competence or to maximise their ability to maintain some oral intake supplemented with tube feeding. However, some clinicians feel that oral-motor exercises can support eating and drinking skills as well as speech and language development, whereas there is little evidence to support this. The implied “beneficial” association between oral-motor exercises, speech and swallowing skills gives a false impression in terms of future outcomes for parents and carers of children with learning disabilities. This paper considers oral-motor approaches in the remediation of dysphagia and the need for a cultural shift away from this view. Realistic and useful outcomes for people with learning disabilities need to be an essential part of therapeutic intervention.

Communication is the key: improving outcomes for people with learning disabilities

Purpose – This paper aims to introduce the open communication tool (OCT) as described in “From ‘What do you do?’ to ‘a leap of faith’: developing more efficient indirect intervention for adults with learning disabilities”.Design/methodology/approach – Qualitative data from a study identifying barriers to effective intervention was used to create a model of working practice.Findings – This paper introduces a model of addressing intervention which could be used by the broader multidisciplinary team to increase successful intervention outcomes and pinpoint concerns about care providers who do not enhance communication effectively.Originality/value – The authors suggest that a more consistent and robust approach to delivering indirect intervention could be used to bridge communication gaps between healthcare providers and commissioners/monitoring bodies of services for people with learning disabilities.

Pediatric feeding and swallowing rehabilitation: An overview

Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on supporting growth, nutrition and hydration, the development of feeding activities, and ensuring safe swallowing with the aim of preventing choking and aspiration pneumonia. Pediatric feeding and swallowing disorders can be divided into four groups: transient, developmental, chronic or progressive.This article provides an overview of the available literature about the rehabilitation of feeding and swallowing disorders in infants and children. Principles of motor control, motor learning and neuroplasticity are discussed for the four groups of children with feeding and swallowing disorders.

New developments in the management of speech and language disorders

Speech and language disorders, which include swallowing difficulties, are usually managed by speech and language therapists. Such a diverse, complex and challenging clinical group of symptoms requires practitioners with detailed knowledge and understanding of research within those areas, as well as the ability to implement appropriate therapy strategies within many environments. These environments range from neonatal units, acute paediatric wards and health centres through to nurseries, schools and children’s homes. This paper summarises the key issues that are fundamental to our understanding of this client group.

A survey of augmentative and alternative communication used in an inner city special school

This study surveyed staff use of augmentative and alternative communication (AAC) within a large inner city special school for children with complex needs and learning disabilities. A questionnaire asked 72 staff members about the range of AAC strategies they typically used during the working day and how often they used it; training they had received about AAC; and which AAC approaches they found easy to use and those they found difficult. A range of AAC approaches were identified by staff. Participant confidence and understanding of the reasons for using identified AAC strategies was reported to be one of the key barriers to implementing AAC effectively. The implications in relation to how children with complex needs receive support for their receptive and expressive communication within an education environment are discussed.

Assessing children’s swallowing: parent and professional perceptions

Purpose – For infants and children who have difficulties with eating, drinking and swallowing (dysphagia), there are significant health risks that include aspiration (food and fluid entering the lungs) and poor growth. Videofluoroscopy is often the instrumental method of assessment used to exclude or confirm aspiration. The purpose of this paper is to investigate parental and referrer perceptions of the reasons for and the outcomes of videofluoroscopy. Design/methodology/approach – Data were gathered through the use of structured telephone interviews before and after videofluoroscopy. Findings – Four key themes emerged: first, the importance of identifying specifically the problems with swallowing; second, understanding the rationale for videofluoroscopy; third, preparing a child for videofluoroscopy; and fourth, using videofluoroscopy to inform management. Referrers used videofluoroscopy to confirm their concerns about a child’s ability to swallow safely. Practical implications – Parents understood that ...