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Nonnutritive Sucking at the Mother's Breast Facilitates Oral Feeding Skills in Premature Infants

A Pilot Study

John, Hima B., BOT, MSc; Suraj, Charis, BOT; Padankatti, Sanjeev M., BSc, BOT, MOT; Sebastian, Tunny, MSc; Rajapandian, Earnest, BOT, MA

doi: 10.1097/ANC.0000000000000545
Oral Feeding Strategies: Special Series

Background Premature infants have difficulties in transitioning from gavage to breastfeeding. Targeted interventions to support breastfeeding in premature infants in the neonatal intensive care unit are scarce.

Purpose: This pilot study evaluates the effectiveness of nonnutritive sucking at the mother's breast in premature infants to facilitate breastfeeding performance and exclusive breastfeeding.

Methods: The study design constituted a single-blinded randomized control trial, with 9 participants randomly allocated into experimental (n = 4) and control (n = 5) groups. The intervention, nonnutritive sucking at the mother's breast thrice a day for 5 minutes, till nutritive breastfeeding was started, was done in addition to standard care, which was nonnutritive sucking on a finger during gavage feeds. The control group received only standard care. Nonnutritive sucking was assessed using “Stages of Nonnutritive Sucking Scale,” and breastfeeding performance was assessed using the “Preterm Infant Breastfeeding Behavior Scale” by a blinded assessor unaware of the infants' allocation.

Results: Five infants in the control arm and 4 in the intervention arm completed the study. The infants in the intervention group showed faster transition to mature stages of nonnutritive sucking (P = .05) and had longer sucking bursts during breastfeeding (P = .06) than those in the control group. There was no difference in the rates of exclusive breastfeeding at 6 months in the intervention and control groups.

Implications for Practice: Early initiation of nonnutritive sucking at the mother's breast in very preterm infants is a safe and effective intervention to facilitate maturation of oral feeding and breastfeeding behavior.

Implications for Research: Nonnutritive sucking at the mother's breast can be explored as an intervention, with a larger sample, to facilitate exclusive breastfeeding and to establish intervention fidelity.

Departments of Neonatology (Ms John), Physical Medicine and Rehabilitation (Ms Suraj), Occupational Therapy (Messrs Padankatti and Rajapandian), and Biostatistics (Ms Sebastian), Christian Medical College, Vellore, Tamil Nadu, India.

Correspondence: Hima B. John, BOT, MSc, Department of Neonatology, Christian Medical College, Vellore 632004, Tamil Nadu, India (

This study was conducted at Christian Medical College, Vellore, Tamil Nadu, India.

None of the authors declare any conflicts of interest related to the results in the text of the article.

© 2019 by The National Association of Neonatal Nurses