The transition to oral feeding in low-risk premature infants: Relation to infant neurobehavioral functioning and mother-infant feeding interaction

Dalia Silberstein, Ronny Geva, Ruth Feldman, Judith M. Gardner, Bernard Z. Karmel, Hava Rozen, Jacob Kuint

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: The achievement of oral feeding is a critical task for the premature infant-mother dyad, yet neurobehavioral and relational factors associated with feeding difficulties of low-risk premature infants during hospitalization are not well understood. Aim: To examine the relations between infant neurobehavioral functioning, the transition to oral feeding, and the emerging mother-infant feeding relationship in premature infants. Study design and subjects: Ninety-seven low-risk premature infants (birth weight > 1000 g; gestational age > 30 weeks) and their mothers were followed at the NICU. Neurobehavioral functioning was assessed with the Rapid Neonatal Neurobehavioral Assessment Procedure. Outcome measures: The duration of the transition to oral feeding and specific feeding difficulties during the transition were assessed. Infant feeding robustness, suck and milk transfer rates, and maternal adaptability, affect, intrusiveness and distractibility were coded from videotaped mother-infant feeding interactions prior to discharge from the NICU. Results: Thirty percent of the infants presented feeding difficulties during the transition to oral feedings. Infants with abnormal neurobehavioral functioning (37% of the cohort) showed more feeding difficulties, slower suck rates, and lower feeding robustness, and their mothers displayed less adaptive and more intrusive behavior. Maternal intrusiveness was related to lower feeding robustness and to lower suck and milk transfer rates. Neurobehavioral functioning and maternal feeding behavior predicted feeding robustness. Conclusions: Less intact neurobehavioral functioning in the neonatal period is related to difficulties during the transition to oral feeding and to less optimal early mother-infant feeding interactions. Low-risk premature infants with poor neurobehavioral functioning should receive special attention and care.

Original languageEnglish
Pages (from-to)157-162
Number of pages6
JournalEarly Human Development
Issue number3
StatePublished - Mar 2009

Bibliographical note

Funding Information:
This study was supported by the US-Israel Bi-National Science Foundation (# 2001-241). We thank the participating families for their cooperation; Prof. Aron Weller for his mentorship; Dr. Ita Litmanovitz from the Meir Medical Center for participating in the reliability study; the medical team at the Sheba Medical Center: Department of Neonatology; and the research teams at the Developmental Neuropsychology Lab and the Early Development Lab at the Gonda Brain research Center.


  • Feeding
  • Mother-infant interaction
  • Neonatal care
  • Neurobehavioral development
  • Preterm infants


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