Join us for The Early Feeding Skills Assessment Tool: A Guide to Cue-based Feeding

Please plan to join Dr. Suzanne Thoyre and I on August 29-30, 2023, in Baltimore at Greater Baltimore Medical Center for a Train-the-Trainer session on The Early Feeding Skills (EFS) Assessment Tool: A Guide to Cue-Based feeding in the NICU.

Bring your colleagues, or your whole feeding team! We are aiming for an interdisciplinary-professional group, putting our heads together to improve feeding experiences for our most vulnerable infants. We hope to see you in Baltimore! 

Learn to use the EFS to effectively plan and provide an infant-guided approach to feeding.

Simultaneously learn to train others back home to use the EFS to strengthen your unit’s feeding care. Review current research, the role of experience, dynamic systems theory, and feeding outcomes after NICU. Videotapes with enhanced audio of swallowing and breathing to learn key skill areas of the EFS: respiratory regulation, oral motor and swallowing function, physiologic stability, engagement, and change in coordination patterns of s-s-b as infants develop. Gain confidence scoring early feeding skills as not yet evident, emerging or established. Learn components of an infant-guided, co-regulated approach to feeding and contingent adaptations that make this approach so effective, using the EFS to plan individualized interventions. Receive teaching resources to take back to your unit to train others to use the EFS. As a group, we will network and navigate challenging issues and role-model a collaborative feeding practice.

The EFS provides a means of identifying, for individual preterm infants, areas of strength and areas in which support is required to accomplish safe and effective feeding. All too often during oral feeding, infants experience multiple episodes of oxygen desaturation, increased energy expended in response to stress, and fatigue. Possible negative sequelae of recurring stress are often unnoticed, disregarded, or minimized. Through developmental conceptualization of specific infant feeding skills, the EFS provides an infant-focused framework for planning individualized interventions.In addition, the EFS provides a means for assessing infant readiness to engage in oral feeding and for evaluating infant response to a feeding, including any interventions employed.

Assessment and intervention are integrated functions. As infants are fed and their capacities assessed, caregiver behaviors and assessment foci must be adjusted for the individual infant. If he stops sucking spontaneously only on occasion, for example, the infant probably needs a brief imposed break from sucking to support regulation of breathing and to prevent fatigue and/or physiologic dysregulation. If the infant does not root when his lips are stroked, indicating lack of readiness to feed, the feeder explores reasons for this. If the infant has difficulty coordinating swallowing and breathing, the feeder is more alert to his capacity to manage the bolus of fluid given the frequency of sucks and the duration of sucking bursts. The feeder will want to help prevent abbreviated or missed breaths for the infant, to listen more closely for complete and safe swallowing, and to explore the need for a sidelying feeding position, low-flow nipples, pacing strategies, or more extensive swallowing evaluation by a pediatric therapist. Thorough and ongoing assessment is an essential component of feeding practice, particularly for infants early in their skill development. 

Not only does the EFS provide a pathway for your NICU team to infant-guide feeding , but it also has been shown to have strong psychometric properties for use in research. See:  Thoyre, S. M., Pados, B. F., Shaker, C. S., Fuller, K., & Park, J. (2018). Psychometric Properties of the Early Feeding Skills Assessment Tool. Advances in Neonatal Care, 18(5), E13-E23.




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