Neonatal Feeding Behavior as a Complex Dynamical System.
The requirements of evidence-based practice in 2017 are motivating new theoretical foundations and methodological tools for characterizing neonatal feeding behavior. Toward that end, this article offers a complex dynamical systems perspective. A set of critical concepts from this perspective frames challenges faced by speech-language pathologists and allied professionals: when to initiate oral feeds, how to determine the robustness of neonatal breathing during feeding and appropriate levels of respiratory support, what instrumental assessments of swallow function to use with preterm neonates, and whether or not to introduce thickened liquids. In the near future, we can expect vast amounts of new data to guide evidence-based practice. But unless practitioners are able to frame these issues in a systems context larger than the individual child, the availability of "big data" will not be effectively translated to clinical practice.
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
Eugene C
EC
Goldfield
Feeding and Swallowing Program, Boston Children's Hospital, Boston, Massachusetts.
Jennifer
J
Perez
Feeding and Swallowing Program, Boston Children's Hospital, Boston, Massachusetts.
Katherine
K
Engstler
D003679:Deglutition / Q000502:physiology; D055317:Evidence-Based Practice; D005247:Feeding Behavior / Q000502:physiology*; D019959:Feeding and Eating Disorders of Childhood / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007225:Infant Food; D041943:Infant Formula; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D012138:Respiratory Therapy; D013066:Speech-Language Pathology; D013391:Sucking Behavior / Q000502:physiology; D014783:Viscosity; D014939:Work of Breathing / Q000502:physiology