Establishing Characteristics of Feeding Physiology and Milk Ingestion Rates of Healthy Term Infants

Abstract

Background: The Early Feeding Skills and Oral Feeding Scale are commonly used clinical feeding assessments. 15, 23 These scales evaluate various signs of dysphagia during an infant’s feed.3 Although these clinical evaluations are useful for diagnosis of dysphagia, neither is normed to typical, non-dysphagic infants.1 Unfortunately, there remains a paucity of knowledge regarding feeding performance of healthy non-dysphagic term infants.21 To fill this void, we completed an investigation to elucidate healthy term infant feeding performance characteristics using the Early Feeding Skills Assessment and the Oral Feeding Scale. Methods: Healthy, full-term infants without known feeding impairments underwent monitoring while drinking from their typical Dr. Brown’s bottle and nipple system. Monitoring included video recording of the infant’s face and upper torso and the use of the Oral Feeding Scale milk ingestion outcomes including amount of milk provided and consumed, and feeding duration. Video recordings were analyzed post hoc by licensed Speech Language Pathologists for feeding quality using the Early Feeding Scale. Differences in continuous outcomes were compared using unpaired t-tests and reported as mean 土 standard deviation. Results: 30 infants (50% male) were included in the investigation. Average age at the time of data collection was 3 土 1.88 months. 67% of infants used a Dr. Brown’s Level 1 bottle nipple, 30% used a Dr. Brown’s Level 2 bottle nipple, and 3% used a Newborn/Transitional level nipple. Examination of OFS feeding parameters revealed infants consumed milk at an average rate of 6.79 土 2.7 mL/minute. Rate of transfer was greatest during the first 5 minutes of feeding, consuming 50% of their total milk ingestion during this time. Results of EFS Feeding Parameters indicate the majority of participants scored the best EFS score relating to integrating breathing within the suck burst (100%, N=17), displaying no work of breathing (90%, N=27), opening mouth when presented nipple (90%, N=27), maintaining motor tone and energy throughout the feed (97%, N=29) and the absence of gurgling sounds (94%, N=16) or color changes (97%, N=29) during the feed. Study participants commonly score the worst EFS score relating to demonstrating greater than one occurrence of losing milk out of the lips (67%, N=20), producing gulping or hard swallows (24%, N=4), exhibiting coughing or choking sounds (24%, N=4), and displaying one or more compelling stress cues (63%, N=19). Conclusions: Examining feeding characteristics of healthy, term infants, our study found that infants consume milk at a rate faster than 1.5 mL/minute and drank more than 30% of their milk in the first five minutes. Additionally, study findings reveal that although it is common for infants to score the best EFS score on certain domains, it is also common for infants to score the worst EFS score in other domains. Future investigations regarding feeding parameters of healthy, non-dysphagic infants is warranted.