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Does the Infant-Driven Feeding Method Positively Impact Preterm Infant Feeding Outcomes?

Settle, Margaret, PhD, RN, NE-BC; Francis, Kim, PhD, RN, PHCNS-BC

Section Editor(s): Gephart, Sheila

doi: 10.1097/ANC.0000000000000577
Oral Feeding Strategies: Special Series

Background: Achievement of independent oral feeding is a major determinant of discharge and contributes to long lengths of stay. Accumulating evidence suggests that there is great variation between and within newborn intensive care units in the initiation and advancement of oral feeding. The Infant-Driven Feeding (IDF) method is composed of 3 behavioral assessments including feeding readiness, quality of feeding, and caregiver support. Each assessment includes 5 categories and is intended as a method of communication among caregivers regarding the infant's readiness and progression toward independent oral feeding.

Purpose: To identify and summarize the available evidence on the use of the IDF method at initiation of oral feeds, time to independent oral feedings, and length of stay in the newborn intensive care unit or level II nursery for preterm infants.

Methods/Search Strategy: Four databases including CINAHL, Medline/PubMed, Ovid Nursing, and Embase were searched for “infant guided feedings,” “infant driven feeding,” “cue-based feeding,” and “co regulated feeding.” The full text of 32 articles was reviewed to identify experimental, quasiexperimental, or retrospective design to assess the evidence related to cue-based feeding.

Findings: There were no randomized control, quasi-experimental, or retrospective studies utilizing the IDF method. There were 3 quality improvement projects utilizing the IDF method. The findings were conflicting: 1 project found the IDF method favorable in the achievement of full oral feedings, 2 projects found the IDF method favorable for reducing length of stay, and 1 project did not find differences in initiation, achievement of oral feedings, or length of stay.

Implications for Practice: There is scant evidence limited to quality improvement projects to support the use of the IDF method.

Implications for Research: Research is needed to empirically validate the IDF method and to inform practice related to the initiation and advancement of oral feeding for preterm infants.

Massachusetts General Hospital, Wrentham.

Correspondence: Margaret Settle, PhD, RN, NE-BC, Newborn Intensive Care unit, Massachusetts General Hospital, 165 Elysium St, Wrentham MA 02093 (

Acronyms: IDF; Infant Driven Feeding, DOL; Day of Life, NF; Nipple Feedings, LOS; Length of Stay, PMA; Post Menstrual Age.

The authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses