Implementing Co-Regulated Feeding with Mothers of Preterm Infants.
OBJECTIVE
The purpose of this study is to describe implementation of the Co-Regulated Feeding Intervention (CoReg), when provided by mothers and guided by intervention nurses trained in methods of guided participation (GP). Co-regulated feeding intervention aims to prevent stress during feeding and ease the challenge very preterm (VP) infants experience coordinating breathing and swallowing during the early months. Guided participation is a participatory learning method to guide the complex learning required for mothers.


METHODS
Sixteen mothers of 17 VP infants participated. Each mother received a median of five intervention sessions during the infant's transition to oral feeding. Intervention field notes, audio recordings of the sessions, and video recordings of the nurse-guided feedings were reviewed, organized, and content analyzed to evaluate implementation.


RESULTS
The co-regulated feeding intervention was well received by mothers; enrollment, participation, and retention rates were high. Most mothers chose to spread out the intervention sessions across the transition period. Scheduling sessions was the greatest barrier. Mothers had competing demands and infant readiness to eat could not be predicted. The top five issues identified as needing attention by the mother or nurse included reading cues, coregulating breathing, providing motoric stability, regulating milk flow, and providing rest periods. Main GP strategies included joint attention with the mother to the dyad's feeding challenges, auditory assessment of breathing and swallowing, and reflection with planning for future feedings using video playback.


CONCLUSIONS
Nurse presence while mothers feed affords rich opportunities to guide coregulated, cue-based feeding. Co-regulated feeding intervention would be enhanced if mothers are guided by the bedside nurse.
Suzanne M. Thoyre is a Frances Hill Fox Term Distinguished Professor, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC. She can be reached by email at thoyre@email.unc.edu.Carol Hubbard is a Coordinator, Special Infant Care Clinic, Division of Neonatal-Perinatal Medicine, University of North Carolina Healthcare, Chapel Hill, NC.Jinhee Park is an Assistant Professor, Connell School of Nursing, Boston College, Chestnut Hill, MA.Karen Pridham is a Professor Emerita, School of Nursing, University of Wisconsin-Madison, Madison, WI.Anne McKechnie is an Assistant Professor, School of Nursing, University of Minnesota, Minneapolis,.
Suzanne M
SM
Thoyre
Carol
C
Hubbard
Jinhee
J
Park
Karen
K
Pridham
Anne
A
McKechnie
D000328:Adult; D003299:Cooperative Behavior; D005248:Feeding Methods / Q000592:standards*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D015144:Southeastern United States