Partner Spotlight: Infant Feeding is Not a Game of Spin the Nipple

Do you ever feel like you’re spinning a wheel to choose a nipple or bottle system for infant feedings? Have you experienced frustration and inconsistency in the success of infant feedings? Are nipples and bottle systems chosen for each feeding based on the personal preference of who happens to be caring for an infant in your unit that shift? Then keep reading for solutions so you can help your unit stop playing the game of spin the nipple.

What is a successful infant feeding experience?
Infants’ feeding experiences are individualized and should always be safe and positive. However, individualized does not mean inconsistent. Infant feeding experiences are most often successful when they include consistency in caregivers and feeding practices.(1)

There are many factors that contribute to successful infant feedings. The Infant-Driven Feeding™ Program identifies 10 goals of successful oral feeding, which include the following:

  • Safe
  • Functional
  • Nurturing human interaction
  • Developmentally and individually appropriate
  • Focused on parent being first to feed with staff support
  • Inclusive and supportive of breastfeeding
  • Driven by the infant’s stability behavior, and feeding quality rather than staff and/or volume Implemented by a collaborative team from admission forward
  • Evidence-based
  • and Objectively and succinctly documented.

What factors contribute to an ineffective infant feeding experience?
Just like successful feeding experiences, ineffective feeding experiences are influenced by a multitude of factors. These factors include but are not limited to variations in care, independent changing of feeding plans without consultation of the healthcare team, and use of different nipples or bottle systems based on personal preference and/or availability of too many product options.(3) In addition, feedings can also be compromised by inefficient bottle systems and nipples.(4)

How can successful infant feeding experiences be consistently achieved by the team?
The Institute for Health’s A Framework for Safe, Reliable, and Effective Care, submits that reliability is achieved with four principles: standardize, simplify, reduce autonomy, and highlight deviation from practice.(5) Let’s discuss how these apply to infant feeding.

Standardize – Developing infant feeding policies, protocols and/or order sets, and documentation that follow evidence-based practice and provide clear, concise guidelines are the first step to creating a safe, positive feeding experience for all infants. These tools help define processes for all team members to ensure that infant feedings are performed the same way every time. An important aspect of standardization is tying quality, education, and training to implementation and outcomes for continuous improvement. Unit-wide education of the Infant-Driven Feeding™ Program is one way to standardize feeding practice.

Simplify – Complex tasks are hard to perform perfectly. If infant feeding protocols are too complex, the infant feeding experience will be negatively impacted. Product management is an important and complicated component of healthcare. When selecting infant feeding products, it is important to stock options that demonstrate consistency and allow for individualized care while minimizing variation in selection and utilization. Providing easy access and clear guidelines for use of all feeding products by all team members keeps practice standards consistent for all shifts including nights and weekends.

Reduce Autonomy – Spin the nipple often starts when infant feeding decisions are based on personal preference and individualized belief instead of evidence. Reducing autonomy does not reduce any team member’s scope of practice. Rather it invites the entire interdisciplinary team for shared decision making. This ensures that everyone caring for the infant can bring their expertise to the table. What this looks like in practice is creating a culture where interdisciplinary team discussions or consultations occur before changing the nipples or bottle systems.

Highlight Deviation from Practice – Simplifying and reducing autonomy doesn’t mean that the healthcare team will never deviate from protocol. Everyone on the healthcare team brings experience and expertise to the table, and sometimes the team may decide that deviation from protocol is necessary for infant safety. Deviations from the protocol should be documented and studied by the interdisciplinary healthcare team.

Successful and consistent infant feedings make every aspect of care easier. If your unit is not achieving the best results with regards to infant feedings, then advocate for evidence-based practice that will achieve consistency and improve patient outcomes. Remember, infant feeding is not a game of spin the nipple. Every feeding experience matters because every baby matters.

For more information on how your unit can apply the IHI 4 Principles to your feeding practices, contact Dr. Brown’s Medical at

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