Infant Driven Feeding

[NBmomto2]

Good morning. I have a question about the practice of Infant driven feeding in the NICU. I recently watch the Webinar from Dandle Lion, called 'infant Driven Feeding: A Neurodevelopmental approach to feeding infants in the N ICU." I was very intrigued. In our unit now, 20 bed, we have such a diverse group of nurses, and many of us are not on the same page when it comes to when to initiate feeds, feeding plans, how to feed, and how to assess feeding sessions. I really think a systematic approach to infant feeding is needed in all units. What we need is just what Ludwig and Waitzmen says....an objective approach to assessing feeding readiness, and a more objective way to assess feeding sessions. Getting away from charting just fed poor, fair, and well, for ex. I approached our Nurse Manager and our Nurse Educator about the prospect of having our nurses take this online course offered by Ludwig and Waitzman, and they are both as excited about it as I am. We are going to have a meeting next week to discuss it. And the Nurse Educator has emailed to get a group rate for this online course.

Please offer any advice you may have pertaining to this Infant Driven Feeding approach. Do you use it in your unit? What are your experiences with it?

Here are a couple of links referring to the above webinar and course I referred to.

http://www.dandlelion-webinars.com/previous-teleclasses/2013-2/archive-november-2013/

http://store.healthstream.com/product.aspx?zpid=37648&sr=true

And a link to the Infant Driven Feeding site.

http://www.infantdrivenfeeding.com

[staycalm]

We have cue based feeding. It is very objective. At first it was quite an adjustment; kind of seemed like it took the nurse judgement out of the process. We all quickly realized it just adds to our judgement (no more family or doctor scrutiny). Most of the babies are still on q3hr feedings with an ordered amount. There's 5 cues to look for prior to offering a feeding, and 5 areas that are scored after a bottle feeding. It is explained to families, and if they are present in the room, I have them help determine the "score", and thus they can feel they are a part of decision (or understand) if the baby is ready to be offered a bottle for that feeding time (or if the score from a previous attempt was too low, then the baby has to be gavaged anyway). It helps them understand what we look for in a successful feeding, not just amount. We had the scoring built into the I&O section of our EPIC charting. The doctor has to write the order to begin initial bottle feedings "May offer cue based feedings". The rest is developed policy. Babies actually are discharged sooner. Rather being offered too many bottles & wearing out or too few bottle feedings for those over achiever fast track kids- it's just the right amount.

[HyperSaurus, RN, BSN]

That's interesting--We do have 'nipple as tolerated, ad lib on demand no longer than 4hrs', but there's nothing set or formalized to determine when they are ready to eat, so you find that unless the child is screaming their head off, nurses often wait until the max time to feed the infant.

[NicuGal, MSN, RN]

We also do cue based feeds and have great success! We are seeing much less feeding aversions!

[TiffyRN, BSN, PhD]

With the cue based feeding where I work, whereas there is a performance score for the infant, it does not affect their ability to nipple the next time. This would be a true improvement. As things are now, those of us with experience "fudge" the scores to give a needed break to those kids who cue wildly every time but can't ever come close to finishing. If they get a break they do much better and most nurses will give them opportunities to up their attempts particularly if family is there to practice their feeding skills.

The less experienced nurses tend to stick the bottle in the kid's mouth every three hours regardless and wonder why their kid never takes more than half the bottle then have an ugly A/B. Most of them will listen to the experienced nurses though and improve.

Wish our CBF feed protocol was more like the previous poster's.