INEFFECTIVE INFANT FEEDING PATTERN
Impaired ability of an infant to suck or coordinate the suck/swallow
response resulting in inadequate oral nutrition for metabolic needs
• Inability to coordinate sucking, swallowing, and breathing
• Inability to initiate or sustain effective suck
• Anatomic abnormality
• Oral hypersensitivity
• Neurological delay or impair-
• Prolonged NPO status
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Fluid and electrolytes
• Growth and development
The neonate will
• Not lose more than 10% of birth weight within ﬁrst week of life.
• Gain 4–7 oz (113.5–198.5 g) after ﬁrst week of life.
• Remain hydrated.
• Receive adequate supplemental nutrition until able to suckle sufﬁ-
• Establish effective suck-and-swallow reﬂexes that allow for
adequate intake of nutrients.
The parents will
• Identify factors that interfere with neonate establishing effective
• Express increased conﬁdence in their ability to perform appropri-
ate feeding techniques.
SUGGESTED NOC OUTCOMES
Breast-Feeding Establishment: Infant; Breast-Feeding Maintenance;
Muscle Function; Nutritional Status: Food & Fluid Intake;
INTERVENTIONS AND RATIONALES
Determine: Weigh neonate at the same time each day on the same
scale to detect excessive weight loss early.
Continuously assess neonate’s sucking pattern to monitor for inef-
Assess parents’ knowledge of feeding techniques to help identify
and clear up misconceptions.
Assess parents’ level of anxiety about the neonate’s feeding difﬁ-
culty. Anxiety may interfere with the parents’ ability to learn new
Monitor neonate for poor skin turgor, dry mucous membranes,
decreased or concentrated urine, and sunken fontanels and eyeballs
to detect possible dehydration and allow for immediate intervention.
Record the number of stools and amount of urine voided each
shift. An altered bowel elimination pattern may indicate decreased
food intake; decreased amounts of concentrated urine may indicate
Assess the need for gavage feeding. The neonate may temporarily
require alternative means of obtaining adequate ﬂuids and calories.
If neonate requires intravenous nourishment, assess the insertion
site, amount infused, and infusion rate every hour to monitor ﬂuid
intake and identify possible complications, such as inﬁltration and
Perform: Remain with the parents and neonate during the feeding to
identify problem areas and direct interventions.
For bottle-feeding, record the amount ingested at each feeding; for
breast-feeding, record the number of minutes the neonate nurses at
each breast and the amount of any supplement ingested to monitor
for inadequate caloric and ﬂuid intake.
Provide an alternative nipple, such as a preemie nipple. A preemie
nipple has a larger hole and softer texture, which makes it easier for
the neonate to obtain formula.
For breast-feeding, ensure that the neonate’s tongue is properly
positioned under the mother’s nipple to promote adequate sucking.
Alternate oral and gavage feeding to conserve the neonate’s
Inform: Teach parents to place the neonate in the upright position
during feeding to prevent aspiration.
Teach parents to unwrap and position a sleepy neonate before
feeding to ensure that the neonate is awake and alert enough to
Attend: Provide positive reinforcement for the parents’ efforts to
improve their feeding technique to decrease anxiety and enhance
feelings of success.
Manage: Assess neonate for neurologic deﬁcits or other pathophysio-
logic causes of ineffective sucking to identify the need for referral
for more extensive evaluation.
SUGGESTED NIC INTERVENTIONS
Attachment Promotion; Breast-Feeding Assistance; Lactation Coun-
seling; Nonnutritive Sucking
Kelly, M. M. (2006, September–October). Primary care issues for the healthy
premature infant. Journal of Pediatric Health Care, 20(5), 293–299.