Research Corner: Reflection in the NICU

Thoyre, S., Park, J., Pados, B., & Hubbard, C. (2013). Developing a co-regulated, cue-based feeding practice: The critical role of assessment and reflection. Journal of Neonatal Nursing, 19(4), 139-148.


Those of you who practice in the NICU will enjoy this article by my colleague, Suzanne Thoyre PhD RN, on the use of reflection during the assessment of feeding in the NICU. Together we developed the Early Feeding Skills Assessment Tool (EFS) which is referenced at the end of this article.  The focus herein is viewing an assessment as providing opportunities for infant communication.

I believe that when we conceptualize feeding as a relationship–based experience, we then see our role during feeding as dynamically attending to infant communication from moment to moment, responding contingently to support physiologic and behavioral stability, and therefore averting stress for the infant. This then supports neuroprotection, which is our ultimate goal with both preterm and sick newborns in intensive care. Dr. Thoyre does a wonderful job capturing this concept. Because it is written by an NICU RNs, it is information that will likely be helpful to you in your conversations about cue-based feeding with your nursing colleagues.

“The feeder maintains a goal to optimize the feeding through assessment of infant cues. Assessment skills are deepened through a process of focused observation and reflection on what is being learned (from the infant).  The feeder uses all modalities available to observe and interpret infant communication (both physiologic and behavioral), and reflects on the meaning of the infant’s cues. Cue-based feeding is therefore more than learning to respond to infant distress; it is also learning from the infant how to anticipate what they will need and providing appropriate support so they can have as successful a feeding experience as is possible. Through this process, the feeder supports and strengthens the infant’s efforts, and respects and protects their limits. Assessment of the skills an infant brings to the feeding is essential if we are to provide feeding support that meets the infant’s needs.


Leave a Reply