Neonatal therapists, providers, and nurses share the same goal at the bedside: safe, developmentally supportive feeding outcomes for some of the most vulnerable infants in the hospital. Yet even the most committed and skilled teams can find themselves working from different frameworks, using different language, and arriving at different decisions about feeding readiness and progression – not because of a lack of expertise, but because a consistent, shared foundation is often missing across disciplines.
In July 2026, the National Association of Neonatal Nurses (NANN) released the Infant-Directed Oral Feeding for Premature and Critically Ill Hospitalized Infants: Guidelines for Practice, 2nd Edition.1 For neonatal therapists, the guidelines offer a valuable opportunity to bridge disciplinary perspectives by establishing a common language, shared principles, and greater alignment around oral feeding assessment, decision making and progression.
Why This Matters
Variability in neonatal oral feeding practice is not a new challenge. Across NICUs worldwide, between healthcare systems, and even within the same NICU, feeding decisions are often shaped by individual training, unit culture, staffing patterns, and personal experience. Two providers at the same bedside may assess readiness differently and document it differently. Multiplied across shifts and months, that variability affects both the infant’s developing feeding system and the family’s experience.
The updated NANN guidelines offer a framework for addressing this challenge, with consistency emerging as a central theme. Grounded in current evidence, they offer shared recommendations for assessing readiness, supporting the development of feeding skills, and engaging parents and caregivers as essential partners in the feeding process. A consistent framework can reduce clinician variability, strengthen communication across disciplines, and support a more predictable experience for infants and families, regardless of who is at the bedside.
The Bridge for Neonatal Therapists…
Although developed by a neonatal nursing organization, the NANN guidelines are intended to support interprofessional practice. For therapists that’s an opportunity. Rather than approaching practice from a single discipline’s perspective, therapists can use the guidelines as an evidence-based platform for multidisciplinary discussion.
Consider using the guidelines to open conversations in these areas:
Explore opportunities to standardize your assessment and documentation of feeding readiness and skills.
If your unit relies primarily on informal cue observation rather than a formal tool, use the guidelines to raise whether a more standardized approach would benefit the team. Framing this as a shared goal, rather than a therapy-specific recommendation, can support conversations with leadership about education needed to support practice change. One option your hospital may consider is formal education and assessment with the Infant-Driven Feeding® Program. (Learn more: https://bit.ly/3UBsDbV)
Review bottle and nipple selection practices. Does your unit have an evidence-based approach to selection of bottle/nipple type and flow rate? Consider how those decisions are made and how changes are documented and communicated across disciplines and shifts. Identifying where variation occurs is a first step toward consistency.
Evaluate caregiver education and engagement. Are parents primarily observers during feeding sessions, or supported as active participants? Consider whether feeding plans clearly address caregiver education and preparation and whether that responsibility is consistently understood across the team.
Revisit your unit’s process for oral feeding progression. Does progression vary depending on who’s on service, individual preference, or the “way we’ve always done it?” The guidelines provide an opportunity to examine whether feeding progression is approached systematically and communicated consistently.
This concept extends beyond neonatal feeding. The Institute for Healthcare Improvement (IHI) identifies standardization and the reduction of non-patient-specific variation as important components of reliable healthcare, recommending evidence-based best practices unless contraindicated for specific patients.2
A Call to Action
The second edition of NANN’s guidelines offers more than an evidence update. It’s an opportunity to build a more consistent, shared framework for oral feeding care. Purchase the guidelines here.
Bring the guidelines to your interdisciplinary team. Compare the recommendations with current practice. Identify where variability exists and where greater consistency could strengthen assessment, communication, feeding progression, and caregiver engagement.
For neonatal therapists, this is an opportunity not simply to follow guidelines, but to help translate evidence into collaborative bedside practice. A shared framework doesn’t replace individualized care or clinical expertise – it gives the team a common foundation to apply both. For infants and families who experience feeding care across disciplines, providers and shifts, this is a bridge worth building!
References:
1. National Association of Neonatal Nurses. Infant Directed Oral Feeding for Premature and Critically Ill Hospitalized Infants. Guidelines for Practice, 2nd Edition. 2026. https://ilearn.nann.org/
2. Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017.
