Trajectory of Infant Problematic Feeding Symptoms: Study Protocol.

Background: Infants with developmental risk factors are more likely to have feeding problems and develop chronic feeding disorders. Early detection and understanding of the progression of problematic feeding and its relationship with a child's biological functioning and the family feeding environment will enhance effective symptom management and development of interventions to prevent pediatric feeding disorders.

Objectives: The New Through Two (NewThru2) feeding study protocol is described. Study aims are to (a) characterize symptoms of problematic feeding and trajectories of symptoms from pre-discharge from neonatal intensive care through age 24 months; (b) determine the relationship of child biological function at discharge with symptom characteristics and trajectories; (c) describe the child's feeding environment and its relationship to symptoms from discharge through 24 months; and (d) determine the relationship between problematic feeding symptoms and growth and developmental outcomes.

Methods: NewThru2 is a prospective, longitudinal, mixed method study following over 200 infants who received care in a neonatal intensive care unit and were identified as at risk for compromised development. The study follows enrolled infants through 24 months of age. Symptoms of problematic feeding are measured pre-discharge by clinical observation and medical record review and post-discharge by parent report. Biological function is measured by medical history and cardiorespiratory and autonomic nervous system function during feeding prior to discharge. Child feeding environment is measured by strategies parents use to manage feeding, the effect of feeding on the parent and family, and the use of feeding services. A subset of parents is interviewed to achieve a contextual understanding of the family feeding environment. Child outcome measures include parent-reported feeding skills and clinician-reported growth and neurodevelopment.

Discussion: The results of this study will improve understanding of pediatric feeding disorders during a time of development sensitive to adequate nutrition and with infants at risk for developmental delays or impairments.