Feeding therapy: The transition from NICU to inpatient pediatric rehabilitation to outpatient and what to expect

Feeding therapy helps infants who are struggling with eating or drinking. The goal is to create positive feeding experiences so that newborns meet their nutritional needs.

At Good Shepherd Rehabilitation, for example, a physician-led feeding team uses an infant-led, “cue-based” approach to develop a plan that leads to successful feeding for years to come. Because parents and caregivers are the most important part of the feeding team, Good Shepherd works with parents to tailor plans made for children’s specific needs. This custom approach supports transitioning from an inpatient pediatric rehabilitation setting to back home and outpatient feeding, as appropriate.

Here are some frequently asked questions (FAQ) on the transition from NICU to inpatient pediatric rehabilitation to outpatient and how pediatric feeding therapy can benefit your child:

What is the difference between the NICU and inpatient pediatric rehabilitation?

A NICU prioritizes ensuring babies have survived the most challenging time of their lives over a period of days, weeks or months. When babies are at the NICU, expert medical professionals focus on making sure babies stay healthy and grow stronger each day.

While some babies in the NICU learn how to eat quickly without intensive feeding therapy, some need more focused time to progress in this area. During inpatient pediatric rehabilitation, a baby’s family receives intensive, one-on-one therapy sessions multiple times each day to help the child improve feeding skills to meet nutritional needs.

At Good Shepherd, pediatric feeding therapists prioritize an infant-led, “cue-based” approach to feeding therapy, working alongside parents and caregivers. Certified lactation counselors on the unit help with nursing, pumping and nutrition for milk production as desired as well.

What is infant-led, cue-based feeding?

Feeding is the first communication between parents and their baby. Under the guidance of our Pediatric Medical Director, Good Shepherd pediatric feeding therapists help parents understand how babies signal if they are enjoying the feeding or if it is causing them stress. Those cues help decide when to continue the feed or when to give your baby a break. Parents also learn the difference between reflexive, or involuntary, sucking and volitional, or on purpose, sucking and how this can impact a baby’s feeding skills for years to come.

Will you attempt to wake my baby at every feeding time?

Sleep is vital to a baby’s development and progress, which may allow the baby to sleep through a scheduled feeding time. The NG/G-tube (Nasogastric/Gastrostomy tube) enables babies to receive their nutrition and hydration needs without the added stress of trying to eat. This allows babies to continue growing while also saving energy for the next feeding time. If safe, our team will always offer a bottle during feeding time if babies are awake and showing hunger cues on their own.

Could the amount my baby drinks look different than when in the NICU?

Yes, this may be possible in the beginning, but it is not definite. Good Shepherd’s feeding program focuses on the quality of babies’ feeds. As we learn a baby’s cues and create a custom eating plan, it is possible to see a temporary decrease in volume while the quality of skill gets better.

The plan will likely look different based on what your child is telling us. Your child may be more successful in the quality of feeding by reducing the amount taken at a time, changing the style of bottle or how the bottle is presented or changing the thickness of formula/milk.

Research and our past experiences have shown babies will start to eat more from their bottle as the quality of their feeding skill improves. Remember: You can’t have quantity without quality.

Which staff members will be a part of my baby’s feeding team?

At inpatient, a multi-disciplinary team of physicians, nurses and therapists will create a therapy plan designed specifically for each child’s needs. The team can utilize or add specific strategies to create positive feeding experiences. Depending on needs, your child may require only skilled speech therapists to reduce the chance of aspiration, which is fluid going into the lungs. To keep babies as comfortable as possible while receiving feeding therapy, our team will make sure staff know the children well and understand their cues before adding them to a baby’s customized feeding plan.

How long will we be admitted?

Every child is different, which means admission timeframes vary. Rest assured, the team at Good Shepherd meets weekly to discuss your baby’s progress, what your baby needs and the steps being taken to get your baby home. Feeding is a process. Our goal at Good Shepherd is to send you and your baby home feeling confident to use the strategies developed in therapy, making babies’ feeding experiences enjoyable and positive.

How do we transition to outpatient feeding therapy?

You will meet regularly with a care manager at Good Shepherd, who will update you on your baby’s progress. Your care manager will also support your transition by scheduling follow-up appointments and setting up outpatient therapy. Our team will also make sure you are comfortable with the recommended feeding strategies and mode of feeding when your baby is home to ensure a successful return home.

To learn more about how Good Shepherd can support a family’s feeding needs, call 1-888-447-3422 (44-REHAB) or contact us online.