Tools to Assess Infant Feeding Patterns

Introduction

Many young infants experience difficulties with feeding during the first six months of life. Thanks to improvements in healthcare, there has been an increase in the survival of sick newborns, which has led to more infants experiencing difficulties with oral feeding. Babies born before the due date and with congenital heart ailments are especially prone to facing difficulties during feeding. Nonetheless, some babies who seem to be in good health may also have issues with nursing or bottle-feeding.

It is crucial to detect feeding difficulties in infants early to provide correct treatments and enhance the development of their oral feeding abilities and nutrition. Since infants do not have effective means of expressing their discomfort during feeding, abnormal feeding habits may manifest in various forms that may not be easily distinguishable from normal feeding behaviors.

As a result, differentiating between problematic feeding and typical feeding can be quite challenging. Clinicians must have reliable assessment tools to ensure proper and consistent evaluation of oral feeding in infants, irrespective of who is using those assessment tools.

What Are the Properties of Infant Feeding Assessment Tools?

When assessing infant feeding patterns, there are several tools that healthcare professionals and researchers commonly use. These tools help gather information about the frequency, duration, and type of feeding, as well as the growth and development of infants.

Infant feeding assessment tools typically possess the following characteristics:

• Validity: The tool must assess infant feeding habits, including breastfeeding, solid food introduction, and feeding behaviors. It must be dependable and consistent.

• Reliability: The tool should yield consistent results when used by individuals or at different times, ensuring that the measurements are dependable and reproducible.

• Standardization: The tool should have clear guidelines and instructions for its administration, ensuring consistency across different users and settings. This helps to minimize variations and biases in the assessment process.

• Sensitivity: The tool should be sensitive enough to capture subtle variations in feeding patterns and behaviors. It should be able to identify deviations from normal or optimal feeding practices and alert healthcare professionals to potential issues.

• Practicality: The tool should be easy to administer and use in various settings, such as hospitals, clinics, or home environments.

• Cultural Appropriateness: The tool should consider cultural and contextual factors influencing infant feeding practices. It should be adaptable to different cultural norms and practices to ensure accurate assessment across diverse populations.

• Age-Appropriate: The tool should be suitable for infants of different ages as feeding patterns evolve and change over time.

• Comprehensive: The tool should cover various feeding-related factors, including breastfeeding, bottle-feeding, introduction of solid foods, feeding difficulties, and maternal-infant interaction during feeding.

What Are the Uses of Infant Feeding Assessment Tools?

• Evaluating feeding practices.

• Identifying feeding difficulties.

• Monitoring growth and development.

• Guiding interventions and support.

• Promoting optimal nutrition.

• Research purposes.

• Enhancing parent education.

What Are the Tools Available for Bottle Feeding Assessment?

• Early Feeding Skills Assessment - EFS assesses oral feeding skills and the development of premature and full-term infants, focusing on readiness and ability to consume oral feeds. EFSA evaluates feeding skills, including oral, coordination, swallowing, and respiratory patterns. A professional healthcare provider observes the infant during feeding and scores their performance. EFSA assists in identifying feeding difficulties, intervening, and monitoring progress in oral feeding skills development.
• Neonatal Oral Motor Assessment Scale - NOMAS assesses newborns' oral motor skills and feeding. Evaluate oral structures in feeding. NOMAS assesses sucking, swallowing, reflexes, and oral motor function. It is usually given by a healthcare professional who observes the baby's feeding behavior & ranks performance against set standards. NOMAS identifies oral motor issues, guides interventions, and tracks progress in feeding development in newborns. Both of these tools are used by specially trained clinicians and for infants below six months of age, both are breastfeeding or bottle feeding.

What Are the Tools Available for Breastfeeding Assessment?

The widely used tools for assessing various aspects of breastfeeding are listed below.

• Bristol Breastfeeding Assessment Tool (BBAT): A tool that assesses breastfeeding effectiveness, latch quality, and maternal comfort during breastfeeding.

• Infant Breastfeeding Assessment Tool (IBFAT): A tool that evaluates infant feeding behaviors, latch, milk transfer, and signs of effective breastfeeding.

• LATCH: A tool that assesses breastfeeding latch, audible swallowing, nipple type, comfort, and hold techniques.

• Mother-Baby Assessment (MBA): A tool that assesses the mother and baby's behaviors during breastfeeding, including latch, positioning, milk transfer, and maternal comfort.

• Mother-Infant Breastfeeding Progress Tool (MIBPT): A tool that evaluates the progress and challenges of breastfeeding, including infant feeding behaviors, maternal experiences, and support needs.

• Potential Early Breastfeeding Problem Tool (PEBT): A tool that identifies potential breastfeeding problems, such as latch difficulties, low milk supply, or maternal discomfort.

• Premature Infant Breastfeeding Behavior Scale (PIBBS): A tool specifically designed for premature infants, assessing their breastfeeding readiness, latch, sucking patterns, and coordination during breastfeeding.

What Is the Neonatal Eating Assessment Tool (NeoEAT)?

NeoEAT assesses the feeding skills of premature and term infants in NICUs or special care nurseries. NeoEAT evaluates feeding skills such as oral motor abilities, coordination, and swallowing for babies during bottle or breastfeeding. Healthcare professionals use the tool to score an infant's feeding performance. The NeoEAT identifies feeding issues, advises feeding methods, and tracks feeding skill growth. NeoEAT evaluates an infant's oral feeding readiness, sucking and swallowing strength, and feeding issues. It helps improve the nutrition and growth of neonatal infants through customized feeding plans and interventions. The various versions of this tool include NeoEAT-Breastfeeding, NeoEAT-Bottle-feeding, and NeoEAT-breast and bottle-feeding (mixed feeding).

What Are the Infant and Young Child Feeding Indicators of WHO?

The World Health Organization (WHO) has developed a set of indicators to assess and monitor infant and young child feeding practices. These indicators provide valuable information on the status and impact of feeding practices on child health and nutrition.

Here are some key indicators included in the WHO Infant and Young Child Feeding Indicators:

• Early initiation of breastfeeding.

• Exclusive breastfeeding.

• Continued breastfeeding for one year.

• Introduction of solid, semi-solid, or soft foods.

• Minimum dietary diversity.

• Minimum meal frequency.

• Minimum acceptable diet.

These indicators help monitor the progress of breastfeeding and complementary feeding practices, identify areas for improvement, and inform policy and program interventions to promote optimal infant and young child feeding. They are widely used in surveys, research studies, and monitoring and evaluation efforts related to child nutrition and health.

What Are the Shortcomings of the Infant Feeding Assessment Tools?

While infant feeding assessment tools can be valuable for evaluating and supporting feeding practices, they have limitations.

• Assessment tools can be subject to bias and variability due to subjective observations and interpretations by caregivers.

• Assessment tools may only capture some of the factors affecting infant feeding practices. Factors can affect feeding behaviors, but tools do not fully measure them.

• Observation tools may need to include the full infant feeding picture. Observation may be needed to fully capture maternal perceptions, infant cues, and caregiver interactions.

• Limited assessment tools may only focus on some aspects of feeding, neglecting maternal comfort, infant satisfaction, and long-term feeding outcomes.

• Assessment tools may only consider cultural practices in infant feeding across some communities. This limits tool applicability in diverse populations.

• The reliability and validity of assessment tools vary, with some having undergone inadequate testing, thus affecting their accuracy and consistency.

• Infant feeding is dynamic and can vary between feedings and overtime. Assessment tools may not fully capture variations in infant feeding abilities.

• Lack of standardization in assessment tools with criteria, scoring, and interpretation variations makes it hard to compare results in different studies/settings.

Conclusion

Despite their shortcomings, these tools provide valuable insights and are important resources for healthcare professionals and caregivers. Using them alongside clinical judgment is important, considering individual circumstances and a holistic approach to support optimal infant feeding practices. Using the right tools helps doctors and nurses find feeding problems quickly and helps parents and caregivers with the right support. Further study and use of good assessment tools will help provide better support for the healthy feeding of babies and make things better for babies worldwide.