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Factors Contributing to Preterm Infant Engagement During Bottle-Feeding

Thoyre, Suzanne M.; Brown, Roger L.


Background: Preterm infants have difficulty maintaining engagement throughout early oral feedings, which can lead to less efficient feeding and prolonged feeding skill development.

Objective: To examine contributions of the infant, mother, and feeding context to infant engagement during bottle-feeding.

Methods: Bottle-feedings of very-low-birthweight infants (n = 22) by their mothers were observed. Infant and maternal behaviors were coded and synchronized with physiologic measures. At completion of the feeding, the mothers were interviewed, and their working model of feeding coregulation was scored. Feedings were subdivided into feeding episodes (n = 114). Using multilevel linear regression analyses, four dyadic characteristics (working model of the caregiver’s role as coregulator, birthweight, postconceptional age, baseline oxygen saturation) and five episode characteristics (readiness at episode onset, episode baseline oxygen saturation, mean oxygen saturation during the episode, maternal feeding behavior, and phase of feeding) were examined as potential predictors of feeding episode engagement.

Results: Conditions observed during the feeding observation explained most of the variation in engagement. Engagement was more likely to occur during the early phase of feeding (p < .05), during feeding episodes that began with infant readiness (p < .05), and during feeding episodes with higher mean oxygen saturation during the episode (p < .05). Feeding episodes with less jiggling of the nipple had a significantly greater amount of engagement (p < .05).

Conclusions: The ability of the preterm infant to maintain engagement during bottle-feeding cannot be explained by characteristics of the infant or by the prefeeding condition of the infant alone. Rather, engagement is coregulated by the caregiver and the infant throughout the feeding. Strategies to assist infants in maintaining physiologic stability during bottle-feeding and further study of effective and contingent caregiver feeding behaviors are needed.

Suzanne M. Thoyre, PhD, RN, is Assistant Professor, University of North Carolina at Chapel Hill.

Roger L. Brown, PhD, is Professor, University of Wisconsin-Madison.

Editor’s Note

Materials supplementing the content of this article are posted at

Accepted for publication May 15, 2004.

This study was supported by NINR fellowship grant NR07052-02 and NINR grant K01NR07668.

The authors thank Karen F. Pridham, PhD, RN, FAAN, Professor Emeritus at the University of Wisconsin-Madison, School of Nursing, for her mentoring throughout the study, and Lorna Cisler-Cahill, MS, RN, Advanced Practice Nurse, Patient Care Services, Children’s Hospital of Wisconsin, Milwaukee, for support in concept development.

Corresponding author: Suzanne M. Thoyre, PhD, RN, School of Nursing, CB 7460 Carrington Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.