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Survey Says (Part 2)…

Last month, we asked you to complete a survey concerning the use of pacing as a supportive strategy in infant feeding. Thank you to all who responded!

Who completed the survey?
169 respondents including:

-48% SLP; 31% OT; 8% PT, 12% Nursing -88% work in a NICU, with 52% greater than 15 years’ experience.

What did we learn? And the “Survey Says”:

Pacing is only ONE (1) effective strategy
Most respondents believe that pacing is an effective strategy, but NOT that it should be used as the first strategy. It is difficult to be consistent with pacing and at times, pacing can interfere with an infants’ overall organization. The number one first response was using a low flow nipple, which can provide a more consistent strategy, provided the nipple being used offers a low coefficient of variability with a consistent flow rate (Pados 2019). In addition, the use of a Zero-Resistance™ bottle system can improve consistency.

Variety of pacing methods – inconsistency at its best.
There is no one method of pacing as reported that most respondents use to pace. The two more commonly used methods were to tilt or remove the bottle (39 and 30% respectively). About 17% tilt the baby as their primary method of pacing. There seems to be no consensus as to what method of pacing that truly provides the most beneficial results for an infant who requires support. While many professionals practice what they learned from others, there are a few articles that describe a process related to a research study (Thoyre, et al., 2012). This lack of consistency is one reason respondents do not advocate pacing as a first-choice strategy.

Proactive vs. Reactive Pacing
Sixty-six (66) percent of respondents use both types of pacing, while the rest use one or the other. Profound, since infant feeding is not a one- option technique for all infants. Observing stress cues and offering neuroprotection proactively are synonymous. By only providing reactive pacing, the infants feeding could result in ‘rescue feeding”. If this practice is consistently repeated, negative feeding experiences could result with long term consequences. In addition, if we pace according to an arbitrary number, it seems counterproductive to an infant-driven process. Proactive pacing has a benefit of protecting the infant, while watching the infants’ communication could be called reactive. A combination of the two is comparable to what in the literature refers as “Co-Regulated Feeding” (Shaker 2017; Thoyre 2016). Feeding should be dynamic – partnering with the infant during feeding, observing what the infant is communicating, and then interpreting the infant’s communication to providing support when needed.

Confidence level on parent instruction
The most telling piece of information from the survey is when asked “how confident are you that staff are providing consistent instruction to parents regarding pacing?”

70% responded either “Not confident” or “Less than confident”.

How revealing that we need to find a more accurate and consistent method for not only the NICU staff, but most importantly to the parents. In 2013, the NANN Paper on Infant-Directed Oral Feeding stated, “There is evidence that a relationship exists between the consistency and continuity of feeding-management practices and improved feeding performance.” In addition, this lack of consistency can affect the parent-infant interaction, which can then interfere with the development of parental competence and confidence (Shaker 2018). We must find a way to provide a more consistent message to parents regarding feeding. How can we do this? Below are some suggested behaviors:

-Allow staff to receive the same education on feeding infants.

  • See below to learn more about a consistent, dependable, successful feeding program.
  • Implement more opportunities with parents to teach infant-guided feeding.
    -Catherine Shaker describes a wonderful way to guide parents in her article “Mom, you got this.” (2018)
  • Read more articles about pacing and the history of pacing.
  • Dr. Brown’s Medical provides free educational webinars addressing pacing, as well as other topics on infant feeding from a developmental, neuroprotective model. View at

To see specific data from the survey, you can view the results here.

Click here for more information about Dr. Brown’s Medical Nipple flow rates.

Click here for more information about Dr. Brown’s Zero Resistance bottle systems.

Click here for more information about a consistent, reliable feeding program.

Thank you for your cooperation and Dr. Brown’s Medical hopes you find this information interesting.

Click here for References