To consent, or not to consent, that is the question: Ethical issues of informed consent for the use of donor human milk in the NICU setting

Except in rare instances, mother’s own milk (MOM) is the best source of nutrition for her infant and there is evidence that it reduces comorbidities common to prematurity and very low birth weight. When there is not sufficient MOM for an infant’s nutritional needs or when there are contraindications to the use of MOM, pasteurized donor human milk (DHM) is a viable substitution. In this paper, we discuss the history of DHM use and the ethics surrounding the consent process for the use of DHM. There is a need for standardization and consistent use of informed consent for DHM in the NICU.

Authors: Kelly McGlothen-Bell, Lisa Cleveland, & Britt Pados

Publication information: Advances in Neonatal Care. 2019; 19(5): 371-375. doi: 10.1097/ANC.0000000000000651

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Parents’ descriptions of feeding their young infants

In this study, 29 parents of infants less than 6 months were asked to describe their infants’ feeding and their parental concerns about feeding. Parents frequently described concerns about feeding and many made changes to improve feeding. Characteristics of the infant (e.g., temperament), the task of feeding (e.g., milk flow), and factors external to the infant (e.g., breast anatomy) were described as affecting feeding. Some parents described feeling happy, calm, and bonded during feeding, while others described feeling terrified, anxious, and worried. Health care providers played an important role in supporting parents when feeding concerns existed, but sometimes provided conflicting and even unsafe feeding advice.

Authors: Britt Pados & Rebecca Hill

Publication information: Nursing for Women’s Health. 2019; 23(5): 404-413. doi: 10.1016/j.nwh.2019.08.001

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Symptoms of feeding problems in preterm-born children at 6 months to 7 years old

This study included 57 very preterm (< 32 weeks gestation), 199 moderate to late preterm (32 – 37 weeks gestation), and 979 full-term born children who were between 6 months and 7 years old at the time of the study. Compared to children born full-term, both very preterm and moderate to late preterm born children had significantly more symptoms of problematic feeding, as measured by the Pediatric Eating Assessment Tool. Children born preterm may require careful assessment of feeding throughout childhood.

Authors: Jinhee Park, Suzanne Thoyre, Britt Pados, & Matt Gregas

Publication information: Journal of Pediatric Gastroenterology. 2019; 68(3): 416-421. doi: 10.1097/MPG.0000000000002229

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Symptoms of problematic feeding in children with Congenital Heart Disease (CHD) compared to healthy peers

In this study, I compared symptoms of problematic feeding in children with congenital heart disease (CHD; n = 94) compared to healthy children without medical conditions (n=999) who were between 6 months and 7 years of age and eating solid foods by mouth. Children with CHD had significantly more symptoms of problematic feeding than healthy children on the Pediatric Eating Assessment Tool total score, more physiologic symptoms, problematic mealtime behaviors, selective/restrictive eating, and oral processing dysfunction. Children with CHD are at risk for problematic feeding and should be monitored for feeding difficulties throughout childhood.

Authors: Britt Pados

Publication information: Cardiology in the Young. 2019; 29(2): 152-161. doi: 10.1017/S1047951118001981

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Changes in symptoms of problematic eating over six months in infants and young children

In this study, we followed 58 children who were between the ages of 6 months and 7 years old and who were being seen in an outpatient feeding clinic. We found that the scores on the Pediatric Eating Assessment Tool (PediEAT) decreased over the 6 months that these children were followed, with the greatest change being in the Physiologic Symptoms subscale. Child characteristics that were associated with more symptoms of problematic feeding included older child age, constipation, and speech–language delay, developmental delay, food allergy, and/or genetic disorder.

Authors: Jinhee Park, Cara McComish, Britt Pados, Hayley Estrem, & Suzanne Thoyre

Publication information: Infants and Young Children. 2018; 31(4): 297-309. doi: 10.1097/IYC.0000000000000128

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Systematic review: What is the evidence for the side-lying position for feeding preterm infants?

In this review of the literature, we examined the available evidence on the effect of side-lying position on oral feeding in preterm infants. Only 4 studies were identified that used a quasi-experimental or experimental design to examine the effect of side-lying compared to either semi-upright, cradle-hold, or semi-reclined position on feeding. Findings were inconsistent. Two studies found side-lying to positively impact physiologic stability during feeding while two studies did not find any significant differences in outcomes. There were limitations of the included studies that limit the generalizability of the findings. Additional research is needed to determine the effects of the side-lying position on preterm infant feeding.

Authors: Jinhee Park, Britt Pados, & Suzanne Thoyre

Publication information: Advances in Neonatal Care. 2018; 18(4): 285-294. doi: 10.1097/ANC.0000000000000529

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“It’s a long term process”: Description of family life when a child has a feeding disorder

In this study involving interviews with twelve parents of children with feeding disorders, we describe family management of feeding in the context of everyday life when a child had a significant feeding problem. The Family Management Style Framework was used as a guide. The description of family management of feeding can provide a foundation for further investigation and development of family-focused feeding interventions.

Authors: Hayley Estrem, Kathy Knafl, Marcia Van Riper, Suzanne Thoyre, & Britt Pados

Publication information: Journal of Pediatric Health Care. 2018; 32(4): 340-347. doi: 10.1016/j.pedhc.2017.12.002

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Feeding problems in infancy and early childhood: Evolutionary concept analysis

In this evolutionary concept analysis, we explored the current literature on pediatric feeding disorder. Among literature published before the year 2000, there is a history of mother or parent blame in pediatric feeding problems, both direct and indirect. In literature published since 2000, there are many different definitions of pediatric feeding disorder, but none have sound validity or generalizability. Common attributes of pediatric feeding disorder across disciplines involved in the care of children with feeding problems are problematic feeding behaviors and selective or restrictive dietary intake.

Authors: Hayley Estrem, Britt Pados, Jinhee Park, & Suzanne Thoyre

Publication information: Journal of Advanced Nursing. 2016; 73(1): 56-70. doi: 10.1111/jan.13140

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FIRST, DO NO HARM: A response to “Oral alimentation in neonatal and adult populations requiring high-flow oxygen via nasal cannula“

This article is a response to the paper “Oral alimentation in neonatal and adult populations requiring high-flow oxygen via nasal cannula.” In this paper, we outline the reasons why the published study does not provide adequate information to support the claim that feeding neonates on high-flow oxygen is safe.

Authors: Pamela Dodrill, Memorie Gosa, Suzanne Thoyre, Catherine Shaker, Britt Pados, Jinhee Park, Nicole DePalma, Keith Hirst, Kara Larson, Jennifer Perez, & Kayla Hernandez

Publication information: Dysphagia. 2016; 31(6): 781-782. doi: 10.1007/s00455-016-9722-x

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Mothers’ psychological distress and feeding of their preterm infants

In this descriptive study of 34 mothers and their infants hospitalized in the neonatal intensive care unit (NICU), we found that increased maternal psychological distress, particularly depressive symptoms and role stress, were associated with less use of developmentally supportive feeding behaviors. Supporting maternal well-being is a critical aspect of supporting positive early infant feeding interactions.

Authors: Jinhee Park, Suzanne Thoyre, Hayley Estrem, Britt Pados, George Knafl, & Debra Brandon

Publication information: MCN, The American Journal of Maternal/Child Nursing. 2016; 41(4): 221-229. doi: 10.1097/NMC.0000000000000248

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Concept of pediatric feeding problems from the parent perspective

In this study, 12 parents of children with feeding problems were interviewed. Parents described pediatric feeding problems to be a process or journey on which they found themselves for an unknown duration. Common themes were problematic feeding behaviors of the child, restrictive or selective intake, and child weight or growth concerns. While healthcare providers often view feeding problems as a problem of the child, parents describe pediatric feeding problems within the context of the family and their collective lives. Interdisciplinary, family-centered care of children with pediatric feeding disorder is needed.

Authors: Hayley Estrem, Britt Pados, Suzanne Thoyre, Kathy Knafl, & Cara McComish

Publication information: MCN, The American Journal of Maternal/Child Nursing. 2016; 41(4): 212-220. doi: 10.1097/NMC.0000000000000249

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Effects of milk flow on the physiologic and behavioral responses to feeding in an infant with hypoplastic left heart syndrome

In this case study of an infant with hypoplastic left heart syndrome, we explore the impact of flow rate on the physiological and behavioural responses to feeding. In this infant, oral feeding, whether with a slow-flow or a standard-flow nipple, was distressing. During slow-flow feeding, she experienced more coughing events, whereas during standard-flow she experienced more gagging. Clinically significant changes in heart rate, oxygen saturation, and respiratory rate were seen during all feedings. Heart rate was higher during standard-flow and respiratory rate was higher during slow-flow. Further research is needed to examine the responses of infants with hypoplastic left heart syndrome to oral feeding and to identify additional supportive feeding strategies.

Authors: Britt Pados, Suzanne Thoyre, Hayley Estrem, Jinhee Park, George Knafl, & Brant Nix

Publication information: Cardiology in the Young. 2017; 27(1): 139-153. doi: 10.1017/S1047951116000251

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Developing a co-regulated, cue-based feeding practice: The critical role of assessment and reflection

Using a case of a very preterm infant, we illustrate the assessment of early feeding skills and how reflection on the infant’s capacities and methods of adapting to feeding can be used to identify potential targets for co-regulating the feeding experience. Taking a descriptive approach to feeding assessment, we provide an example of how to account for the dynamic nature of feeding and the changes that come with infant maturation and experience.

Authors: Suzanne Thoyre, Jinhee Park, Britt Pados, & Carol Hubbard

Publication information: Journal of Neonatal Nursing. 2013; 19(4): 139-148. doi: 10.1016/j.jnn.2013.01.002

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The blue baby blues: A rare case of cyanosis in the newborn

In this paper, we describe the case of a full-term infant who presented at birth with cardiorespiratory failure of unknown origin. At approximately 10 hours of life, the infant was transported to our children’s hospital given failure to respond to respiratory support. A full history and clinical presentation are provided along with case study questions and answers to guide clinical learning.

Authors: Britt Pados & Ann Philip

Publication information: Journal of Pediatric Healthcare. 2008; 22(3): 190-195. doi: 10.1016/j.pedhc.2008.01.003

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Safe transition to home: Preparing the near-term infant for discharge

In this review, I outline the physiologic mechanisms of increased risk for the late preterm infant born at 34 to 37 weeks gestation. A discharge education and checklist is provided as well as a handout for when to call your pediatric healthcare provider.

Authors: Britt Pados

Publication information: Newborn and Infant Nursing Review. 2007; 7(2): 106-113. doi: 10.1053/j.nainr.2007.03.002

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