Karen F. Pridham

The early feeding skills assessment for preterm infants.

Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oral-motor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers—notably nurses and parents—need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant’s developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.

Feeding behavior of 6- to 12-month-old infants: Assessment and sources of parental information

Both the infants development of feeding skill and self-regulatory competence during the second 6 months of life have implications for weaning and for a weaning diet. This article examines four categories of feeding skills: taking food from a spoon; handling thicker, lumpy foods and foods that require chewing; self-feeding with fingers or a spoon; and drinking from a cup and managing the bottle. These skills are fundamental for the development of self-regulatory competence through the phases of sensorimotor modulation (from 3 months of age to approximately 9 to 12 months) and control (9 to 12 months of age). Available instruments to assess feeding skill and self-regulatory competence are described. Questions concerning feeding practices in relation to the infants development of feeding skill and self-regulatory competence are raised. Potential conflicts between professional and lay sources, informational methods used and preferred, and the types of problems for which help is sought are discussed.

The adaptiveness of mothers' working models of caregiving through the first year: Infant and mother contributions

How a mothers working model of caregiving develops through an infants first post-term year has implications for the infants health. Change in the adaptiveness of the working model of caregiving through the first year and influencing conditions (mother and infant) were examined for 33 premature infants and 44 full-term infants. Adaptiveness was coded from the transcription of a video-assisted interview at 1, 4, 8 and 12 months postterm age. Mother conditions included years of education, symptoms of depression, and evaluation of caregiving. Infant conditions included status at birth, birth weight, weight-for-age, and amenability of temperament. Hierarchical fixed occasions repeated measures analysis showed significant change in working-model adaptiveness with time. The highest adaptiveness scores were at 4 months and the lowest scores were at 8 months. At 8 months, mothers education had a significant positive effect on adaptiveness, mothers symptoms of depression had a negative effect, and infant weight-for-age had a positive effect. Further research is needed to learn what features of a mothers education enhance working model adaptiveness and to identify mechanisms that explain the effects of the infants weight-for-age on adaptiveness.

Postpartum Mothers’ Perceptions of Competence for Infant Care

A descriptive study was undertaken to examine the relationship between mothers’ early postpartum experiences and their perceptions of competence for infant feeding and care. A sample of 140 primiparous and multiparous mothers completed a 68-item, self-administered questionnaire before discharge from a midwestern hospitals family-centered unit. The mothers’ perceptions of competence for infant feeding and care were associated with in-hospital preparation for bottle-feeding mothers and amount of perceived rest for breastfeeding mothers. The findings suggest the need for early assessment of bottle-feeding mothers’ perceived competence for infant feeding and care, and adequate provision of rest during the postpartum period for breastfeeding mothers.

Feeding issues for mothers of very low-birth-weight, premature infants through the first year.

Adequate feeding is an area of concern for both clinicians and parents of very low-birth-weight, premature infants while in the special-care nursery and through at least the first postterm year. How feeding issues are labeled or described may make a difference in the effectiveness with which they are addressed by families and professionals. Internal working models of parenting offer a framework to explore meaning (goals, expectations, and intentions) and to evaluate progress in addressing feeding issues, viewed from the perspective of both the nurse and the family. Three case studies are presented to illustrate the framework, as used by nurses, to assess the adequacy of the infants nutrient intake in the first year post birth. Questions are raised for further study.

The effects of prescribed versus ad libitum feedings and formula caloric density on premature infant dietary intake and weight gain.

BACKGROUND Although feedings that are organized on an ad lib basis (i.e., in response to infant cues of hunger and of satiation) could enhance an infants self-regulatory capacities for feeding, ad lib feeding of fully nipple-fed premature infants in a special care nursery has not been examined. OBJECTIVE To study whether the caloric and protein intake and weight change of fully nipple-fed preterm infants differed by the feeding regimen (prescribed or ad lib) and by the caloric density of the formula (20- or 24-kcalories per ounce). METHOD The 78 infants who participated in the study were randomized to prescribed or ad lib feeding regimens and, within each regimen, were further randomized to receive either 20-calorie or 24-kcalorie per ounce formula. Dietary intake (volume/kg, caloric intake/kg) and weight change (grams/kg gained or lost) were assessed for each of the 5 study days. Multivariate data analysis was used to examine the effects of feeding regimen and caloric density on dietary intake and weight change, controlling biologic variables (infant gender, race, lung disease diagnosis, treatment with supplemental oxygen, gestational age and weight at birth, and weight on the day prior to full nipple-feeding). RESULTS Overall, the ad lib feeding regimen had a negative effect on volume intake and caloric intake. Weight gain was influenced by caloric intake, but not by feeding regimen or the caloric density of the diet. With increased full nipple-feeding experience, caloric intake of ad lib feeders approached that of the infants fed on the prescribed regimen. CONCLUSIONS Development of self-regulatory capacities through ad lib feeding experience was indicated by infant regulation of the volume of intake by the caloric density of the formula, an unexpected finding. Furthermore, the approach of the caloric intake of infants on the ad lib regimen to that of infants on the prescribed regimen suggests they had gained skill in regulating intake with experience. Whether or not the trend for similar intakes would continue beyond 5 days is a question for further study.

Preparing Heart and Mind Following Prenatal Diagnosis of Complex Congenital Heart Defect

Drawing on attachment and caregiving theory and the concept of motivation, the purpose of this descriptive study was to examine parents’ retrospective accounts of their prenatal experiences after receiving the diagnosis of a fetal heart defect. These parents constituted a subgroup of participants in a larger longitudinal study of parenting an infant with a complex congenital heart defect. Data were derived from 14 semistructured interviews with 13 mothers and 3 fathers in the home or hospital setting. A directed content analysis yielded a central category of preparing heart and mind for infant caregiving. Preparing heart and mind is a preliminary caregiving goal within the caregiving system that generates intentions and expectations indicative of specific caregiving motivations to relate to the baby, handle circumstances practically, and manage infant medical care. A theoretical model illustrates the prenatal process these parents engaged in to provide care to their infants with life-threatening medical conditions.

The Mother-Infant Feeding Tool

OBJECTIVE To describe the development and evaluation of an observation system to assess the process of mother-infant feeding interaction relevant to infant neuro-behavioral regulation: the Mother-Infant Feeding Tool. DESIGN Secondary analysis. SETTING Special care nursery just before discharge and in the home at 1 and 4 months postterm age. PARTICIPANTS Forty-three mother-infant dyads. METHODS Videotaped feeding interactions were examined to assess regulatory processes of mother-infant interaction. Data were collected at three times over the infants first 4 postterm months: before the infants discharge from the special care nursery and at 1 and 4 months postterm age in the home. RESULTS Across all three data points mothers rarely talked to their infants. CONCLUSION Further testing is needed, but the Mother-Infant Feeding Tool shows promise in assessing very early mother-infant feeding interactions.

Internal working models of parenting: Motivations of parents of infants with a congenital heart defect

Drawing on attachment-caregiving theory, we interviewed parents of 24 infants with a complex congenital heart defect (CCHD) about parenting motivations through the first year. Using directed content analysis, 8 categories of motivations, focused either on the baby, the parent-infant relationship, family, self, or tasks were identified at 1, 4 or 6, and 12 months. A matrix of motivations by parent showed family and infant age variations. Motivations illustrated for 5 parents at 1 month suggest that specification of expectations and intentions and clustering of motivations mentioned by a parent would advance study of linkages of parenting internal working models with parenting action.

An Observation Methodology for the Study of Interactive Clinical Problem-Solving Behavior in Primary Care Settings

A methodology that is adequate for a generalized description of the interactive problem-solving behavior of client and clinician must accommodate all potential types of clinical issues and client-clinician relationships. It must also be applicable to the behavior of the client as well as that of the clinician. Furthermore, behavior must be analyzable in terms of the phase of problemsolving logic that applies at the time the behavior is observed. The development, specifications, structural factors and procedures of administration of an observational methodology that is based on a 7-phase paradigm of verbal problem-solving behavior are described. Acceptable levels of consistency of coding are achievable using the methodology. Coder agreement over all phase categories was 84.8 per cent. Results of 2-way ANOVA procedures showed that the type of clinical encounter observed affected the proportion of data coded in each of the problem-solving phase categories whereas, on the whole, the identity of the coder did not. The methodology may be articulated with other methods for the study of primary care and has both research and instructional applications.