Infant-Directed Oral Feeding for Premature and Critically Ill Hospitalized Infants: Guidelines for Practice, 2nd Edition

Nurses play a key role in educating caregivers to recognize and co-regulate with the infant’s behavioral and physiological cues surrounding feeding and in implementing interventions to support the infant’s self-regulation and coordination of suck-swallow-breathe throughout feeding. Evidence-based feeding protocols that can be consistently implemented and individualized to an infant’s cues and skills (infant-directed) and acknowledge caregivers as the primary feeders (family-centered) are imperative. 

This updated, evidence-based clinical practice guideline* equips NICU clinicians with practical strategies to support safe, developmentally appropriate oral feeding for premature and critically ill infants. Grounded in the latest research, it provides a consistent framework for assessing readiness, advancing feeding skills, and engaging caregivers as essential partners. Ideal for interprofessional teams, this resource promotes infant-directed, family-centered care to improve feeding outcomes across the continuum.

*Clinical practice guidelines are expert-developed resources that evaluate the most current evidence and translate it into recommendations, with each recommendation graded based on the strength of the supporting evidence.

This publication was developed with the support of a generous grant from Dr. Brown’s Medical.

Contributor Information
Lead Editor: Thao Griffith, PhD, RN
Editor: Debra Armbruster, PhD, APRN-CNP, NNP-BC, CPNP-PC, C-ELBW, C-NNIC
Authors: Jennifer Fewsmith, DNP, APRN, CNS, RNC-NIC; Maria Cristina Gallup, DNP, APRN, CCNS-N, NNP-BC, RNC-NIC, C-ELBW, DCSD, FCNSS; Cynthia Lira-Crame, MSN, RNC-NIC, NPD-BC; Laura L. McKenna, DNP, NNP-BC; Holly O’Quinn, DNP, APRN, ACCNS-N, CCRN, RNC-NIC, C-NNIC, C-ELBW, LSSBB; 
Reviewers: Jennifer Crouse Hood, EdD, CCC-SLP, CNT, DCSD, SBCS, NTMTC, C-ELBW; Angela Lindbloom, MSN, RNC-NIC

DIGITAL PRODUCT

Release Date: 5/21/2026

Planned Review Date: 5/21/2029

NANN products are intended for individual use for one user to view and use a single copy of the materials for personal, informational, and non-commercial use only. Licensing of this title is available for hospital or institutional libraries. Inquire at education@nann.org for pricing, terms and multi-title packages.

Licensing is only available for closed intranets or password-protected systems accessed by a limited and agreed upon range of users. Terms and conditions apply.