Using non-nutritive sucking to support feeding development for premature infants: A commentary on approaches and current practice

Non-nutritive sucking is often used with premature infants by either using a pacifier or an expressed breast nipple to support the introduction and development of early oral feeding. The pattern of non-nutritive sucking is distinct in that it involves two sucks per second in contrast to nutritive sucking which is one suck per second. Although some literature has identified that non-nutritive sucking has some benefit for the premature infant’s feeding development, it is not entirely clear why such an approach is helpful as neurologically, activation of non-nutritive and nutritive skills are different. A summary is presented of the main approaches that use non-nutritive sucking with reference to the literature. This paper also considers other factors and beneficial approaches to managing the introduction of infant feeding. These are: the infant’s toleration of enteral feeds pre oral trials, overall development and gestational age when introducing oral experiences, developing swallowing skills before sucking, physiological stability, health status, as well as the development and interpretation of infant oral readiness signs and early communication

Law Professors’ Conceptualization and Use of Students’ Prior Knowledge and Experience in Developing Subject-Matter Understanding

This study was an attempt to better understand how law faculty search for and create linkages between subject matter being taught and law students’ existing (that is, prior) knowledge and experience. For faculty who do search for and create these linkages, the study can help them understand, and potentially give them access to, specific practices and resources that can support their teaching in this manner, while also helping them understand this approach to teaching. The study was informed and guided by three conceptual frames: pedagogical content knowledge, culturally framed theories of teaching and learning, and convergent teaching. The study included 14 faculty teaching first-year required classes at one of four law schools: two elite and two broad-access (two to four faculty members per campus). I collected data via a combination of interview, observation, and document analysis methods. The study’s findings are summarized as follows: First, a significant amount of participating faculty members’ first-year doctrinal teaching drew on students’ prior knowledge to support students in making connections to course material. It is possible, then, that teaching from students’ prior knowledge is common, at least in certain law schools, yet it is not acknowledged as such. Second, study participants described significant barriers to or stated concerns about the possibility of teaching in this way, including: hesitation to engage in sensitive or controversial discussions, limited instructional time, large class sizes, and a large amount of material to cover in a course. Third, teaching with attention to students’ prior knowledge is likely to be particularly challenging in subject matter areas that are distant from students’ everyday lives (though law school faculty can develop strategies for overcoming this challenge). Fourth, in study participants’ views, their institutions offered virtually no formal support for this kind of teaching to faculty wishing to engage in it. Fifth, virtually all participating faculty members identified as deeply committed to teaching in a way that draws on students’ prior knowledge worked at broad-access (non-elite) law schools, suggesting that these sites may be particularly amenable to such teaching. These faculty members also had certain characteristics in common—for example, possessing significant prior experience in full-time legal practice, being inclined to care for students and being attentive to their well-being, and having been educated themselves in non-elite law schools. The study concluded with discussion of the implications of these findings for law school institutional policy and leadership, faculty practice and professional development, future research, and theory. There was a particular focus on: (a) factors that encourage this type of teaching at broad access law schools and position such institutions as important leaders in this regard; and (b) the possibility that such teaching may help to democratize legal education in broad-access and elite institutions

Older workers’ talk: discursive representations of age, work and retirement identities

There is a growing trend for older people in the UK to keep working for longer. The percentage of 50-64 year-olds rose from 62% in 2001 to 69.4% in 2015; and for people over 65, from 5% to 10.5% in the same period (Office for National Statistics (ONS), 2015). There are now over 8.5 million people aged over 50 in paid employment (The Experts in Age and Employment (TAEN), 2012). In the context of this changing workforce demographic, it is important to examine how older people negotiate their age-related identities as older workers and represent their views on retirement. This study takes a Discourse Analytic (DA) approach to examining how older age-identity is negotiated in talk, gathered from seven focus groups conducted in workplaces and twelve semi-structured interviews with older workers and retirees. Discourse Analytic research on identity has often neglected to address age-identity construction. The use of DA methodologies in this investigation has enabled discursive strategies, such as distancing strategy, to be identified during participants’ older age-identity constructions; and Social Identity Theory (SIT) (Tajfel and Turner, 1979; Benwell and Stokoe, 2006), positioning theory (Harré and van Langenhove, 1999; Jones, 2006), and Membership Categorisation Analysis (Sacks, 1995; Housley and Fitzgerald, 2002) have provided frameworks for a discourse analytic approach. Older age-identities were negotiated whilst participants were orienting to being older in the workplace and retirement. Previous qualitative studies [into this topic] have focused on a content analysis of what was said, not how. There is a discursive element to age-identity construction that requires a social constructionist, context dependent approach to how age is negotiated through language. In this study, a DA approach has allowed for a micro-level examination which extends previous research by demonstrating how participants use language to negotiate their age-identities as older workers and retirees by drawing on different aspects of ageing, such as chronological, physical and social dimensions [of age] in a specific social context relating to being older at work. Findings indicate that many participants resisted negative perceptions of decrement and decline that may be associated with ageing and retirement when constructing their age-identities. This was achieved in several ways, for example, by discursively claiming membership of a younger age cohort, resisting the changes that accompany ageing, or by ‘out-grouping’ people who were perceived to display certain archetypal behaviours associated with older people. Findings also demonstrate that older people who were still at work articulated negative views about retirement; however, people who had already retired demonstrated a positive orientation towards this life stage. Keeping busy and active after leaving work was said by both older workers and retirees to play a vital part in defraying the possible decline that accompanies old age and may help to achieve successful retirement and ageing. This study has demonstrated how an ideology of positive ageing has been discursively constructed during older age-identity negotiations

The Effect of Severe Intraventricular Hemorrhage on the Biorhythms of Feeding in Premature Infants

Background: Suck-swallow rhythmicity and the integration of breathing into infant feeding are developmentally regulated. Neurological injury and breathing abnormalities can both impact feeding in preterm infants. Objective: To determine the effects of neurologic injury independent of effects of disordered breathing on feeding biorhythms in premature infants. Methods: Low-risk preterm infants (LRP), infants with Grade 3–4 Intraventricular Hemorrhage (IVH), those with bronchopulmonary dysplasia (BPD), and those with both BPD and IVH (BPD+IVH) were identified. Forty-seven infants, 32–42 weeks Postmenstrual Age (PMA) were evaluated on one or more occasions (131 studies). Of these, 39 infants (81 studies) were performed at \u3e35 weeks PMA. Coefficient of variation (COV) (=standard deviation of the inter-event (e.g., suck-suck, swallow-breath, etc.) interval divided by the mean of the interval) was used to quantify rhythmic stability. Results: To adjust for PMA, only those infants \u3e35–42 weeks were compared. Suck-suck COV was significantly lower (more rhythmically stable) in the LRP group [COV = 0.274 ± 0.051 (S.D.)] compared to all other groups (BPD = 0.325 ± 0.066; IVH = 0.342 ± 0.072; BPD + IVH = 0.314 ± 0.069; all p \u3c 0.05). Similarly, suck-swallow COV was significantly lower in LRP babies (0.360 ± 0.066) compared to the BPD group (0.475 ± 0.113) and the IVH cohort (0.428 ± 0.075) (p \u3c 0.05). The BPD+IVH group (0.424 ± 0.109), while higher, was not quite statistically significant. Conclusions: Severe IVH negatively impacts suck-suck and suck-swallow rhythms. The independent effect of neurological injury in the form of IVH on feeding rhythms suggests that quantitative analysis of feeding may reflect and predict neurological sequelae

Eating problems at age 6 years in a whole population sample of extremely preterm children

Aim: The aim of this study was to investigate the prevalence of eating problems and their association with neurological and behavioural disabilities and growth among children born extremely preterm (EPC) at age 6 years. Method: A standard questionnaire about eating was completed by parents of 223 children (125 males [56.1%], 98 females [43.9%]) aged 6 years who were born at 25 weeks' gestation or earlier (mean 24.5wks, SD 0.7wks; mean birthweight 749.1g, SD 116.8g), and parents of 148 classmates born at term (66 males [44.6%], 82 females [55.4%]). All children underwent neurological, cognitive, and anthropometric assessment, and parents and teachers completed a behaviour scale. Results: Eating problems were more common among the EPC than the comparison group (odds ratio [OR] 3.6, 95% confidence interval [CI] 2.1–6.3), including oral motor (OR 5.2, 95% CI 2.8–9.9), hypersensitivity (OR 3.0, 95% CI 1.6–5.6), and behavioural (OR 3.8, 95% CI 1.9–7.6) problems. Group differences were reduced after adjustment for cognitive impairment, neuromotor disability, and other behaviour problems. EPC with eating problems were shorter, lighter, and had lower mid-arm circumference and lower body mass index (BMI) even after adjusting for disabilities, gestational age, birthweight, and feeding problems at 30 months. Interpretation: Eating problems are still frequent in EPC at school age. They are only partly related to other disabilities but make an additional contribution to continued growth failure and may require early recognition and intervention

Maturation of oral feeding skills in preterm infants.

AIM: Safe and successful oral feeding requires proper maturation of sucking, swallowing and respiration. We hypothesized that oral feeding difficulties result from different temporal development of the musculatures implicated in these functions. METHODS: Sixteen medically stable preterm infants (26 to 29 weeks gestation, GA) were recruited. Specific feeding skills were monitored as indirect markers for the maturational process of oral feeding musculatures: rate of milk intake (mL/min); percent milk leakage (lip seal); sucking stage, rate (#/s) and suction/expression ratio; suction amplitude (mmHg), rate and slope (mmHg/s); sucking/swallowing ratio; percent occurrence of swallows at specific phases of respiration. Coefficients of variation (COV) were used as indices of functional stability. Infants, born at 26/27- and 28/29-week GA, were at similar postmenstrual ages (PMA) when taking 1-2 and 6-8 oral feedings per day. RESULTS: Over time, feeding efficiency and several skills improved, some decreased and others remained unchanged. Differences in COVs between the two GA groups demonstrated that, despite similar oral feeding outcomes, maturation levels of certain skills differed. CONCLUSIONS: Components of sucking, swallowing, respiration and their coordinated activity matured at different times and rates. Differences in functional stability of particular outcomes confirm that maturation levels depend on infants\u27 gestational rather than PMA