Originally published on July 16, 2018.

Feeding is a very complex skill that is made up of several components:

  • Suck
  • Swallow
  • Breathe

Healthy term babies do a pretty good job of co-ordinating these skills, but it can take a while for them to hit their stride. So it is not wonder that pre-term babies, who may have various medical conditions in addition to their early birth, can find it difficult.

Each of these is a skill in itself! But for feeding, the really difficult part is coordinating the three skills. This would typically start to develop around 34 weeks, but each baby is very different.

As well as reaching a certain gestational age, babies need a basis of physiological and autonomic stability in order to feed. Which is a long-winded way of saying that skills such as regulating temperature and breathing need to be in place before we can expect them to feed successfully. It makes sense really- if a baby cannot yet co-ordinate all the things happening within their bodies, then it is not very reasonable to expect them to take in stimuli from outside their body (like milk), and co-ordinate that as well.

Most babies below around 34 weeks will be Naso-gastrically fed to make sure that they have enough calories to grow. We use gestational age as a 'rough guide' to when a baby might feed orally, but the baby is our best guide to readiness.

Signs a baby might be ready to try early oral feeding experiences:

  • Tolerating all their tube feeds
  • Stable respiratory system
  • Tolerates being handled without desaturating
  • Showing wakeful periods
  • Showing some feeding behaviours: rooting, licking/nuzzling at breast, non-nutritive sucking (sucking on a finger or dummy).

We should not be working on oral feeding based just on gestational age, but looking for these signs too. If we work on oral feeding before the baby is ready, we are likely to increase their risk of aspiration (milk going into the lungs), and of them making negative associations with feeding. Replacing negative associations with feeding can be a much longer and more difficult process than waiting for the right time to introduce oral feeds. The good news is, that if your baby is not showing these signs yet, then we have things to work on and practise to help them get there.

We'll be talking more about these readiness cues and things you can practise with your baby in our next post.

Posts from Find the Key Speech Therapy are intended for information. They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language therapist who knows your child. Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance.