Checklist helps assess early feeding skills in premature infants

The EFS provides a user-friendly tool for assessing and monitoring feeding skills in premature infants and other infants at risk of feeding problems -- and for guiding interventions to promote the skills needed to feed successfully, according to the new research, led by Suzanne Thoyre, PhD, RN, FAAN, of the University of North Carolina at Chapel Hill School of Nursing.

Study Formally Evaluates Checklist for Assessing Feeding in Preterm Infants

Learning how to feed safely and effectively is particularly challenging for premature infants and those with medical problems requiring care during the newborn (neonatal) period. Establishment of oral feeding is often a key factor in determining when premature infants can go home from the hospital.

The EFS is a 22-item checklist developed to assess oral feeding skills in infants feeding by breast or bottle. In the study, registered nurses, speech-language pathologists, and occupational therapists used the EFS to evaluate the feeding skills of 142 infants at children's hospitals in three states. Three-fourths of the infants were born prematurely; some were full-term infants who had undergone heart surgery.

Using a method called factor analysis, the researchers identified a set of five subscales measured by the EFS: respiratory regulation, or the ability to coordinate breathing and sucking; the ability to organize oral-motor function; swallowing coordination; staying engaged with feeding; and remaining physiologically stable during feeding. Together, these factors explained about 58 percent of the variation in the EFS score; the single strongest factor was respiratory regulation.

Comparison with other assessments established that the EFS is valid and reliable -- "meaning that we can count on the tool to consistently measure what it purports to measure," according to the authors. Premature infants with later gestational ages had higher total EFS scores and higher scores on the respiratory regulation and physiologic stability subscales.

"For preterm infants and those with medical complexities, early feeding skills are in a state of emergence while receiving neonatal care," Dr. Thoyre and coauthors write. "Selecting appropriate and supportive interventions begins with thorough assessment of the infant's skills."

Previous assessments have focused on the volume of feeding or individual skills, but this overlooks the complex interplay of skills needed for effective feeding. Although the EFS has been in use for more than a decade, the new study is the first formal evaluation of its psychometric properties.

"The EFS provides a reliable and valid way to systematically observe and record the maturation of [infants'] feeding skills and guides the selection of interventions to optimally support their skill trajectory," Dr. Thoyre and colleagues conclude. They suggest that further studies using the EFS could add to understanding of neonatal feeding skill development.