Protecting our smallest, most vulnerable patients: Home Infant Feeding Program increases access to care 

April 14, 2022  //  FOUND IN: Strategy & Leadership,
Back row, L-R: Christine Ndagije, M.A., CCC-SLP, CLC (speech-language pathologist, certified lactation counselor), Melissa Andersen, Ph.D. (pediatric psychologist, principal investigator of cue-based feeding grant, and Home NG Program director), Natalie Morris, Ph.D., BCBA (pediatric feeding psychologist); front row, L-R: Tracey Furtak (inpatient cue-based feeding technician), Catherine Joppich, R.D.N., C.L.C. (registered dietitian, certified lactation counselor), Megan Schmuckel, M.A., CCC-SLP, C.L.C. (speech-language pathologist, certified lactation counselor). Not pictured: Ciara Sego (inpatient feeding technician) and Kimberly Monroe, M.D., M.S. (pediatric hospitalist).

Often one of the first joys of parenthood is the moment a baby is brought home from the hospital. Unfortunately, some infants, who are born prematurely or with medical conditions, have trouble feeding naturally and must stay in the hospital to receive the nutrition necessary for their development. This extends the newborn’s hospital stay and increases the parents’ frustration and stress as they visit each day, hoping their discharge will come soon. 

Thanks to Mott’s new interdisciplinary outpatient Home Nasogastric Tube (NG) Follow-Up Clinic, many of these infants are discharged earlier, allowing parents to help develop their baby’s feeding skills in the comfort of their own home. Parents are trained in understanding their baby’s feeding “cues” and how to use feeding tubes and receive support from a care team that includes infant feeding psychologists, speech language pathologists and registered dietitians, as well as lactation consultants, as needed.

“It was great to be home with our baby,” said Ellen Budaj, whose daughter, Ruthie, was born premature at 34 weeks. “We felt confident that we could care for her with her tube at home because of the great care and support we had.”  

Preemies, like Ruthie, often stay several weeks in the hospital on feeding tubes, but this program is already showing a consistent reduction in stay by seven days or more. In addition, all infants who completed care through the home-based clinic have been safely weaned from feeding tubes, with parents reporting 100% satisfaction with the clinic.

Budaj can attest to that: “Ruthie has developed a lot and is now able to eat by herself. She will finish a whole bottle in 10 minutes. She also can burp herself!” 

Long-lasting benefits

But the program’s goals reach far beyond reduced hospital stays and successfully weaned babies. Both the home program and its related inpatient Interdisciplinary Pediatric Feeding Program (IPFP) focus on prevention of longer-lasting feeding disorders from developing in our smallest, most vulnerable patients. 

The Budaj family.

According to the program’s director, Melissa Andersen, Ph.D., pediatric psychologist, and assistant professor of pediatrics, the way we feed infants just after birth has a big impact on whether they establish a positive relationship with the feeding experience.

“A large percentage of infants born prematurely or with significant medical conditions associate feeding with stress and discomfort,” she said. “These negative associations can persist. Research is increasingly demonstrating that early experiences with food are important in establishing life-long eating habits. For example, studies have shown that 70% of children who refused to eat during infancy will continue to experience feeding problems at four years old.

“We were noticing that a good proportion of children referred to our feeding program had a history of being admitted to the hospital after birth, which started them on the trajectory of feeding problems. So, we turned our attention toward preventing feeding disorders from developing in this vulnerable population.”

To head off this common trajectory, the team secured funding to establish an infant Cue-Based Feeding Program in 2019. The cue-based approach prioritizes the quality of the feeding experience by only feeding babies when they are showing signs, or “cues,” that they are ready to eat by mouth. When babies show cues that eating will be an uncomfortable experience, parents are instructed to use the feeding tube to give them needed nutrition.

In addition to Melissa Andersen, Christine Ndagije, and Kimberly Monroe, members of the multi-disciplinary Cue-Based Feeding Program Task Force include: Michelle Nemshak, D.N.P., M.S.N., RNC-NIC, ACCNS-N (clinical nurse specialist), Meera Meerkov, M.D. (neonatologist), Becky Pehovic, M.S., R.N., C.P.N., CNS-BC (clinical nurse specialist), Heather Bowen, M.O.T., OTRL, C.N.T. (occupational therapist), Carrie Pawlowski, R.N., B.S.N., IBCLC (lactation consultant) and Jessamyn Ressler-Maerlender, M.P.H., CPXP (continuous improvement specialist).

The team expanded this program to the home NG clinic in February 2021. Both programs, which are unique to Michigan Medicine, improve the patient and family experience, while providing more options and greater access to our safe, high-quality care for the communities we serve. These efforts support U-M Health’s  BASE strategic priorities.

“Without comprehensive, coordinated services from feeding specialists, families often get incomplete and conflicting advice on how to help their baby eat,” Andersen said. “Oftentimes this advice focuses on how much and how often we feed babies. This translates to feeding babies a specific amount at specific times to get the baby to eat as much as possible regardless of whether they are ready to eat safely and comfortably. Neglecting the baby’s cues often leads to worse feeding problems by creating an association between stress and feeding.”

Ruthie is doing very well today.

“Often parents consider the need for a tube or a special feeding program as a failure or a negative sign that there is something wrong,” added Andersen. “We help families understand that a cue-based approach and feeding tubes are helpful, necessary tools to keep their baby’s oral feedings safe and positive, protect their relationship with the breast and bottle, and help them build the skills they need to eat by mouth.”

To date, 39 infants have successfully completed the program, and Andersen expects it will expand as they care for infants with more medical complexities who experience longer than necessary hospital stays due to delayed feeding. 

Budaj had never heard of a program like this when Ruthie experienced feeding problems.

“I was surprised and so pleased with the support we received in the hospital, and once we got home. Everyone was so helpful and calm. They were very encouraging and responsive. We are thankful that Ruthie has grown so much. When she was first born, she was in the 1st percentile for weight. At her 4-month check-up she was in the 43rd percentile. What a great improvement,” she said. 

The new program team offered tips for parents whose babies are having difficulty feeding. Click here to check them out!