Clinical Bedside Feeding Assessments in the Neonatal Intensive Care Unit (NICU)

Course Description 
This 14.5 hour course will provide all neonatal therapists with foundational knowledge to complete a comprehensive, clinical bedside feeding and swallowing evaluation in a systematic and evidence-based way. Building on these competencies, this course will emphasize the importance of the whole-child and how to capture the complexities of the infant/family’s needs while in the neonatal ICU. This course will highlight all the interactions and synergies that greatly contribute to the overall growth and success of the infant and family. Finally, this course will provide neonatal therapists a way to not only evaluate the infant, but to empower caregivers to effectively and safely feed their infants.  

Target Audience   
OT, SLP, PT, RN, MD, and neonatal professionals 

Level 
Intermediate 

Overall Course Objectives 

1. Demonstrate knowledge and discerns appropriate use of age-appropriate formal and informal assessment options for bottle feeding and breastfeeding.  
2. Summarize the ways we use a Whole-Infant Approach to feeding assessments. 
3. Identify how an infant’s anatomy, physiology and neurology may affect their assessment during a bottle or breastfeeding.  
4. Demonstrate strategies to interact with, empower and support caregivers in the NICU. 

Instructional Method  
Recorded webinar, lecture, videos, case studies, and handouts. A learning assessment follows each module and course evaluation follows the course.   

Course Completion Requirements  
The learner must view the entire webinar, complete the course evaluation, and complete each post-module learning assessment with at least an 80% to receive education credit. Login and logout times are recorded and documented. Following completion of this course physical therapists, nurses and other disciplines will receive a certificate of completion and a zip file containing information necessary to submit to their individual state for education credit. Zip file will include course bibliography. Physical therapists are responsible for knowing and adhering to their state’s deadlines, rules, and regulations. 

Module Objectives

Module 1: Feeding in the NICU Begins at Day of Life # 1 
Module 1 Objectives 

1. List 3 benefits infants receive when Family-Centered Care is practiced.
2. Summarize the principles of Trauma-Informed Care.
3. Recognize the value of shared roles of each member of the NICU team. 
4. Identify the process used by a feeding team for appropriate care.
5. Differentiate between the various types of Neonatal Touch.
6. Compare the pros and cons of various Feeding Cultures.

Module 2: Anatomy, Physiology, Neurology and Development of the Aerodigestive Mechanism 
Module 2 Objectives 

1. Identify the anatomic, physiologic, and neurologic components of an infant’s breathing, sucking and swallowing mechanisms.
2. Recognize how the sucking, swallowing, and breathing mechanisms develop in utero and in prematurely born infants.
3. Summarize typical non-nutritive sucking patterns, as well as typical nutritive sucking patterns.

Module 3: Assessing the “Whole Infant” and Non-Nutritive Sucking 
Module 3 Objectives 

1. List the 5 subsystems of Als’ Synactive
2. List 3 assessments to evaluate an infant’s neuromotor, oral motor or non-nutritive sucking skills.
3. Identify a normal from abnormal non-nutritive sucking pattern.
4. List the GA in which the main oral reflexes emerge. 
5. Define the importance of why assessing an infant’s whole body is important for feeding evaluation.

Module 4: Assessing the Bottle Feeding  
Module 4 Objectives 

1. Identify infant readiness cues and disengagement cues
2. Identify the difference between the mature and immature nutritive sucking patterns
3. List 3 Nutritive Sucking Assessments used in the NICU
4. Recognize 3 interventions utilized during bottle feeding evaluation

Module 5: Assessing the Breastfeeding 
Module 5 Objectives 

1. Compare key roles a lactation consultant and a neonatal specialist share in the NICU.
2. Identify the anatomy of a mother’s breast.
3. List the oral movements necessary during breastfeeding.
4. List 3 breastfeeding assessments used in the NICU.
5. Recognize 3 interventions utilized during breastfeeding

Speaker Bios 
Louisa Ferrara-Gonzalez, PhD, CCC-SLP, BCS-S, CNT, NTMCT, is a pediatric speech-language pathologist with 15 years of clinical experience working with neonates, medically fragile infants, and children with a myriad of complex medical/developmental needs. She is a Board Certified Specialist in Pediatric Feeding and Swallowing Disorders, a Certified Neonatal Therapist, a Neonatal Touch and Massage Certified therapist and a Trauma-Informed Professional. Dr. Louisa has worked in numerous pediatric settings. For 10 years, she served as an advanced clinical specialist and manager of a Level 3 NICU feeding program. Since stepping down from that role, she now provides parent education and neonatal care through her Private Practice, manages the NICU Dysphagia research team at NYU Langone Hospital on Long Island and serves as Chief Clinical Officer at Innara Health, developer of the NTrainer.  Dr. Louisa’s research in the field of neonatal swallowing disorders has been published in high-standing peer-reviewed journals and is recognized worldwide. In 2020 she received the peer-nominated award for Excellence in Research through NANT.  Furthermore, she is an internationally sought out speaker on the topic of neonatal feeding and swallowing development and disorders. She is a proud mom to her son Mario, dog Sadie, and is happily married to her husband, Joe. 

Jenny Reynolds, MS, CCC-SLP, CNT, BCS-S, CLC, is a speech-language pathologist (SLP) with over 20 years of clinical experience. She is an advanced clinical specialist at Baylor University Medical Center in Dallas, Texas, where she has a clinical and research role in the Neonatal ICU. Ms. Reynolds is a Certified Neonatal Therapist, a Certified Lactation Counselor, and a Board-Certified Swallowing Specialist with a focus on pediatric dysphagia. Ms. Reynolds developed a clinical Neonatal and Infant FEES (Fiberoptic Endoscopic Evaluation of Swallowing) Program in the NICU and has partnered with Texas Woman’s University to complete clinical research on Neonatal FEES. She is a co-investigator with multiple research projects in the NICU focusing on infant feeding. Currently, Ms. Reynolds is pursuing her PhD at Texas Woman’s University in Health Studies.  Ms. Reynolds shares her expertise and research contributions in peer-reviewed journal publications, as a highly sought-after speaker at conferences, and as a clinical educator. She is an Adjunct lecturer at UT Dallas, Texas Women’s University, and the University of North Texas for graduate speech pathology programs and acts as a neonatal therapy Mentor for the National Association of Neonatal Therapists’ (NANT) Ignite Training Program. Ms. Reynolds serves on the American Speech Hearing Association Convention Programming Committee, the Texas Speech Hearing Association Convention Committee, and the NANT Professional Collaborative (NPC), where she contributed to developing the Practice Competencies for the Neonatal Therapist. Ms. Reynolds is also devoted to her volunteer work as a Court Appointed Special Advocate (CASA) for Dallas County, where she advocates for children in foster care.

Disclosures 
Louisa Ferrara-Gonzalez, PhD, CCC-SLP, BCS-S, CNT, NTMCT  
Financial Disclosures: Speaker received an honorarium from NANT for this course. Speaker receives a salary from Innara Health and NYU Langone Hospital-Long Island.  
Nonfinancial Disclosures: Speaker is a Member of the Neonatal Therapy Certification Board.  

Jenny Reynolds, MS, CCC-SLP, CNT, BCS-S, CLC  
Financial Disclosures: Speaker received an honorarium from NANT for this course. Speaker receives a salary from Baylor Institute for Rehabilitation.  
Nonfinancial Disclosures: Speaker is a Member of the NANT Professional Collaborative.  

Conflict of Interest
There is no conflict of interest for anyone with the ability to control content for this activity. 

Agenda 
Module 1 Agenda 
0:00-10:00 min:             Introduction and Goals for this course 
10:00-45:00 min:          Care in the NICU 
45:00-65:00 min:          Family in the NICU 
65:00-90:00 min:          Teams in the NICU 
90:00-115:00 min:         Feeding Teams in the NICU 
115:00-141:00 min:       Feeding in the NICU 
141:00-147:00 min:       Module 1 learning assessment

Module 2 Agenda 
0:00-35:00 min:             Sucking and Swallowing Anatomy, Physiology & Neurology 
35:00-70:00 min:          Pulmonary System Anatomy, Physiology & Development  
70:00-110:00 min:         Development of Suck-Swallow-Breathe Coordination 
110:00-141:00 min:       Anatomic Anomalies and Conditions which affect the Aerodigestive Mechanism 
141:00-147:00 min:       Module 2 learning assessment

Module 3 Agenda 
0:00-40:00 min:             Als’ Synactive Theory for Physiologic Stability 
40:00-80:00 min:          Preparing an Infant for Assessment 
80:00-120:00 min:         Neurobehavioral & Neuromotor Assessments 
120:00-171:00 min:       Oral Motor Assessments 
171:00-178:00 min:       Module 3 learning assessment

Module 4 Agenda 
0:00-10:00 min:             Introduction and review from Module 3  
10:00-50:00 min:          Nutritive Sucking Measures  
50:00-110:00 min:         Cue Based Feedings  
110:00-150:00 min:       Feeding Interventions  
150:00-195:00 min:       Dysphagia and Instrumental Swallowing Assessments  
195:00-205:00 min:       Module 4 learning assessment

Module 5 Agenda 
0:00-25:00 min:             Introduction to Human Milk and the Dream Team 
25:00-45:00 min:          Breast Anatomy and Physiology 
45:00-65:00 min:          Partnering with the Mother 
65:00-85:00 min:           Appropriate Infant Latch  
85:00-105:00 min:         Sucking Mechanics on Breast 
105:00-125:00 min:       Positioning 
125:00-145:00 min:       Breastfeeding Assessment 
145:00-165:00 min:       Assessing Needs for Interventions  
165:00-184:00 min:       Breastfeeding Assessment Tools  
184:00-193:00 min:       Module 5 learning assessment 

Registration information 
Members: Click the “Login” button at the top of the screen to verify your Membership and purchase this course at the discounted Member rate. After logging into your account, click “Buy Now”. 
Non-Members: You may purchase this course as a non-member by clicking the “Buy Now” button above. Join NANT to receive this course at the discounted Member rate.  

For ADA accommodations, please call NANT Customer Service for more information at (866) 999-5524. 

Cancellation Policy 
Click HERE to review NANT’s Course Cancellation Policy. 

Continuing Education Information 

AOTA CEUs

National Association of Neonatal Therapists® (NANT) is an AOTA Approved Provider of professional development. Course approval ID# 06437. This Distance Learning-Independent Course is offered at 1.4 CEUs (Intermediate level, Occupational Therapy Service Delivery & Professional Issues). AOTA does not endorse specific course content, products, or clinical procedures.  

ASHA CEUs

Learners must complete the entire course in order to receive ASHA CEUs. No partial credit awarded. ASHA CE Provider approval and use of the Brand Block does not imply endorsement of course content, specific products or clinical procedures.
ASHA CE Registry users: NANT will submit your ASHA CEU credit to ASHA on your behalf. ASHA CEUs may take up to 100 days to appear on your ASHA Transcript. 

Non-ASHA CE Registry users: Maintain your course records and please keep your registry status current in your NANT account. Update your NANT account with your ASHA number if your registry status changes. NANT is not responsible for tracking your registry usage. 

PT CE Credit

This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider 2501058TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas.

The assignment of Texas PT CCUs does not imply endorsement of specific course content, products, or clinical procedures by TPTA or TBPTE.

NANT is recognized by the New York State Education Department’s State Board for Physical Therapy as an approved provider of physical therapy and physical therapist assistant continuing education.