Feeding Problems and Dysphagia in Six-Month-Old Extremely Low Birth Weight Infants

It is commonly assumed that feeding problems in extremely low birth weight (ELBW) infants, experienced during the neonatal period, dissipate with time and increasing maturity and experience of both the infant and the caregiver. This study compared objective feeding and oral-motor assessments at home of 20 ELBW infants aged 6 months corrected for gestation and 20 healthy infants matched for corrected chronological age, race, gender and socio-economic circumstances using a Maternal Interview, the videotaped Feeding Assessment Schedule (FAS), the Feeding Environment Checklist, Tester's Ratings of Infant Behaviour (TRIB), the Infant Feeding Questionnaire, and a Dietary Analysis. Compared with controls, ELBW infants had sigruficant ongoing feeding difficulties, char-acterised by inconsistencies in oral-motor skill development, fewer readiness behaviours for solids, fewer self-feeding and biting skills, fewer smooth sequences in their mealtimes, and frequent environmental features such as poor positioning and inappropriate feeding equipment and mealtime settings. Behaviourally, they were more aversive, had poor attention, little vocalisation, and were less socially interactive. ELBW infants were receiving diets with lower energy and iron intake. Surprisingly, mothers of ELBW infants reported no signhcant feeding aversion or negative feelings about feeding. ELBW infants had significant feeding problems, behavioural disruption, and limited interpersonal skills. Links between early feeding dysfimction, nutritional status, and later communication and eating problems require further investigation. Working with parents to optimise early feeding and communication development in ELBW infants, both in neonatal intensive care wards and later at home, would appear important.