Premature Babies Inspire –
First Annual NANT Conference
Why Quality Matters Most
If you’ve never taken golf lessons, bear with me. (I am NOT a good golfer – yet. It frustrates me to no end. So much so that I’ve taken the last 8 years off.)
When I took my first golf lesson about 15 years ago, the pro didn’t start off by telling me to just swing 200 times every time I picked up a club. Instead he showed me the correct grip and broke the activity of the swing down into segments. (Sounds like therapy 101 class – right?)
First I was only allowed to practice my backswing. I had to do this until I could perform a QUALITY movement – with my body and the club in correct alignment. Only when I could do that consistently, was I permitted to move onto the next movement. And so on. You get this.
The pro also knew that after 25-30 minutes of this, my muscles began to fatigue and my motions became sloppier and less effective. Time to stop. Mercifully.
So why am I talking about golf?
As therapists we’re educated and trained to put ‘quality’ at the top of our list. Whether it’s voice quality, quality of movement, level of independence with any activity, we concentrate on quality versus quantity. And why is that?
I believe it’s because we see things through a therapeutic lens. From a different angle. Quality now facilitates quality later.
We understand muscle memory and sensory integration. We know that neurons that fire together, wire together. (Just like the golf pro, except he’d use different language.) So quality matters, especially in the long run.
During one of our latest feeding seminars, someone asked if an oral feeding could be documented as ‘PO fed well’ if the infant took 40/55mls ‘well’ but couldn’t finish the ordered volume. What does ‘well’ really mean? Finishing the whole bottle?
And the answer is twofold.
- We absolutely need to document feeding quality in terms other than ‘well, fair and poor’ because those words are subjective and inconsistently applied.
- That being said, “YES” an infant can eat very effectively and safely AND be unable to finish the required volume. (That’s what NGTs are for!) Taking the entire volume tells us something about endurance and maturity, but not nearly the most important things. Quality – stability, safety, coordination, efficiency, independence – matters most.
If an infant demonstrates (what is objectively defined as) good quality with feeding, I’m not very concerned with the volume. Barring any neurological issues, volume will come with maturity and time. If we don’t get in the way.
The infant is laying down important neural pathways about feeding with every experience. The quality of those experiences sets the stage for future experiences. (Bad golf swing now, bad golf swing later. Negative feelings associated with golf now….)
The sensory system is taking in information whether we’re supporting the infant appropriately while he’s eating, or ‘getting the volume in’ – two very different approaches to feeding. One fosters quality, safety and normal development, one focuses on volume AS quality.
The bottom line is this: for decades the culture of oral feeding (breast or bottle) in the NICU has been focused on volume. And volume does matter, because infants need to take in adequate calories and nutrition to grow and thrive.
But I believe we’ve been going about it backwards.
Quality first. Volume later.
A simple but powerful change.
It almost makes me want to play golf again.
