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IDF 2013

© Infant-Driven Feeding, LLC. All Rights Reserved. www.infantdrivenfeeding.com

Infant-Driven Feeding®:A Neurodevelopmental Approach to

Oral Feeding in the NICUPresented by:

Sue Ludwig, OTR/L, NTMTCKara Ann Waitzman, OTR/L, NTMTC

November 4, 2013

© Infant-Driven Feeding, LLC

Why are we here?


Objectives

1. Discuss at least two benefits (to staff or infant) of having a neurodevelopmental approach to oral feeding.

2. List the 7 components of the Infant-Driven Feeding® Model of practice.

3. Describe how and when to use the different parts of the Infant-Driven Feeding Scales©.


7 Components of the Infant-Driven Feeding® Model of Practice

S upport DevelopmentU nify Team

C hange Culture

C reate ExperiencesE stablish Systems

S trategize InterventionsS ustain Progress


Families First:the first and best way to support development

Shattered expectations


Breastfeeding Bottles and Nipples Breast Pump

Feeding Redefined


IDF 2013


Supporting Development from admission forward is a foundational component of Infant-Driven Feeding.

Neuroprotection Neurodevelopmental Care

Why? Because the path to feeding success begins long before the introduction of oral feeding.


Support Development by supporting the sensory system(Just one example – the Tactile System)


In addition to the importance of touch, it’s equally vital to consider how you enter the infant’s space.


Create Early Experiences

Foster Long Term Success


AutonomicAutonomic

MotoricMotoric

StateState Attention-InteractionAttention-Interaction

Self Regulation

Self Regulation

Synactive Theory

Als, 1982


AutonomicAutonomic

MotoricMotoric


Self Regulation

Self Regulation


IDF 2013


AutonomicAutonomic

MotoricMotoric


Self Regulation

Self Regulation


It’s a Team Sport!


Mutual Trust: Team member earns each others’ trust, creating strong norms of reciprocity and greater opportunities for shared achievement.

Effective Communication: Consistent channels for communication which are accessed and used by all team members.

Measurable Processes and Outcomes: Team reliably implements processes so that performance can be tracked over time.

Shared Goals: The team works toward shared goals that reflect patient and family priorities and are understood by all.

Clear Roles: Clear expectations for team member’s functions, responsibilities, and accountabilities to accomplish something more than the sum of its parts.

Principles of Team-Based Health Care

Provided by the Best Practices Innovation Collaborative of the Institute of Medicine 2012

Mitchell, PM, Wynia R, et al 2012© Infant-Driven Feeding, LLC

Family Inclusion in the Team

• Provide and celebrate firsts• Support the parents in

decision to breast or bottle feed

• Encourage and teach parent participation

• Describe transition to oral feeding

• Education about infant communication and care

• Discuss importance of quality and quantity of feeding


Create Oral Experiences

Foster Long Term Oral Success


Infant-Driven Feeding


IDF 2013



Safe

Tongue Elevation

Palatal Elevation and Retraction

Pharyngeal Wall Peristalsis

Epiglottis Folds Down

Vocal Folds Adduct

Upper Sphincter Relaxes

Safe, Functional, Nurturing, Developmentally & Individually Appropriate

Functional


Adequate Nutrition forProper Growth & Development


Functional


WITHOUTUndue Stress!

AutonomicAutonomic

MotoricMotoric


Self Regulation

Self Regulation


Functional


Nutrition is Primary.The means by which an infant eats is secondary.


Nurturing


Feeding is Fun!


Nurturing


Eating Experience Amygdala Response HippocampusMemory Storage


IDF 2013


Developmentally and Individually Appropriate

Safe, Functional, Nurturing, Developmentally & Individually Appropriate © Infant-Driven Feeding, LLC


Change Culture Is oral feeding a competitive sport in the NICU?

Change Culture

Traditional Model

– Staff, time, volume driven

– The good feeder/ feeding a

rock

– Inconsistent techniques

– Random, subjective

documentation

Infant-Driven Model

– Infant drives feeding

initiation & progression

– Staff are supportive rather

than directive

– Consistent techniques

– Consistent objective

documentationI’m always the last to know. No one told me I should be hungry at 9:00.


Infant-Driven Feeding® A systematic model for oral feeding in the NICU

Establish Systems


Establish Systems

①②

③

The same is true for parent education. Establishing consistent education about reading cues from the beginning is vital to parents’ confidence and competence surrounding feeding. This education is part of the IDF model of practice.


Infant-Driven Feeding Scales© (IDFS) - ReadinessIndicators of feeding readiness have been organized into the readiness portion of the IDFS. They

are numbered 1-5; 1 indicating ‘most ready’ to feed and 5 indicating ‘least ready’. Ludwig & Waitzman 2007

Score Description

1 Alert or fussy prior to care. Rooting and/or hands to mouth

behavior. Good tone.

2 Alert once handled. Some rooting or takes pacifier. Adequate tone.

3 Briefly alert with care. No hunger behaviors. No change in tone.

4 Sleeping throughout care. No hunger cues. No change in tone.

5Significant change in HR, RR, 02, or work of breathing outside safe

parameters.


IDF 2013



Feeding Readiness

Score Description

1 Nipples with a strong coordinated SSB throughout feed.

2 Nipples with a strong coordinated SSB but fatigues with

progression.

3 Difficulty coordinating SSB despite consistent suck.

4 Nipples with a weak/inconsistent SSB. Little to no rhythm.

5 Unable to coordinate SSB pattern. Significant change in HR,

RR, 02, work of breathing outside safe parameters or

clinically unsafe swallow during feeding.

Infant-Driven Feeding Scales© - QualityLudwig & Waitzman 2007


What about Breastfeeding?

Yes, the Infant-Driven Feeding Scales© are used for breast and bottle feeding.


Score Description

AModified Sidelying: Position infant in inclined sidelying position with head in

midline to assist with bolus management.

BExternal Pacing: Tip bottle downward/break seal at breast to remove or

decrease the flow of liquid to to facilitate SSB pattern

CSpecialty Nipple: Use nipple other than standard for specific purpose ie. nipple

shield., slow-flow, Haberman

DCheek Support: Provide gentle unilateral support to improve intra oral

pressure.

EFrequent Burping: Burp infant based on behavioral cues not on time or

volume completed

FChin Support: Provide gentle forward pressure on mandible to ensure

effective latch/tongue stripping if small chin or wide jaw excursion

Infant-Driven Feeding Scales© – Caregiver TechniquesLudwig and Waitzman 2007


Score Description








pressure.


volume completed






IDF 2013


Score Description








pressure.


volume completed







Score Description








pressure.


volume completed






Please tell me we’re

NOT changing nipples AGAIN!


IDF 2013


Score Description







D Cheek Support: Provide gentle unilateral support to improve intra oral pressure.

EFrequent Burping: Burp infant based on behavioral cues not on time or volume

completed

FChin Support: Provide gentle forward pressure on mandible to ensure effective

latch/tongue stripping if small chin or wide jaw excursion



© Infant-Driven Feeding, LLC© Infant-Driven Feeding, LLC

Score Description








pressure.


volume completed






Score Description







D Cheek Support: Provide gentle unilateral support to improve intra oral pressure.

EFrequent Burping: Burp infant based on behavioral cues not on time or volume

completed

FChin Support: Provide gentle forward pressure on mandible to ensure effective

latch/tongue stripping if small chin or wide jaw excursion




IDF 2013


Infant-Driven Feeding®


Benefits of Infant-Driven Feeding


Resources References will be posted with webinar recording.

Visit www.infantdrivenfeeding.com to:

• Download our FREE e-book titled: 7 Risky Mistakes NICUs

Make with Oral Feeding Practice Every Day

• Learn more about the new online Infant-Driven Feeding® education course created for hospitals, hospital systems and individuals.

• Contact the speakers regarding this talk


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