Oral feeding skills in premature infants: A concept analysis


concept analysis
oral feeding skills
premature infants

How to Cite

Astuti, D. D., Rustina, Y., & Wanda, D. (2022). Oral feeding skills in premature infants: A concept analysis. Belitung Nursing Journal, 8(4), 280–286. https://doi.org/10.33546/bnj.2107
Share |


Background:  The delay in developing oral feeding skills becomes a problem experienced by premature infants. One of the reasons for the delay may be related to inconsistent definitions of oral feeding skills, which can cause discrepancies in the provision of nursing care.

Objective: This study aimed to clarify the concept of oral feeding skills in premature infants.

Methods: The Walker and Avant concept analysis method was used. A literature search was also conducted from five databases: CINAHL, PubMed, ProQuest, EMBASE, and Google Scholar, to find articles between January 2020 and December 2022.

Results: The literature search obtained 20 articles on oral feeding skills from various disciplines. Five attributes were developed from the concept analysis, including (1) coordination ability to suck, swallow, and breathe, (2) the ability to regulate oral-motor functions, (3) the ability to regulate sensory functions, (4) the ability to maintain the stability of physiology function, and (5) the ability to regulate feeding behavior. Antecedents to oral feeding skills include immaturity of the nervous system, gestational age, feeding intolerance, increased length of stay and cost of care, increased rehospitalization, stress on parents, and increased morbidity and mortality. Consequences include optimization of growth and development, reduction of length of stay and cost of hospitalization, increased bonding attachment, increased self-efficacy of parents in caring for premature infants, and improvement of the quality of life of premature infants.

Conclusion: The concept analysis provides five comprehensive attributes and their antecedents and consequences. However, this concept can be used to provide nursing care to premature infants, assess the criteria for discharge, and optimize nutrition for the growth and development of premature infants.



Copyright (c) 2022 Dyah Dwi Astuti, Yeni Rustina, Dessie Wanda

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Article Metrics

Abstract views: 211 | PDF views: 214


Download data is not yet available.

PlumX Metrics

Declaration of Conflicting Interest

There are no conflicts of interest in this study.




Acknowledgment to the Faculty of Nursing, Universitas Indonesia, especially the Doctoral Study Program in Nursing that has facilitated and supported the completion of this concept analysis.

Authors’ Contributions

DDA conceptualized, designed, analyzed, and drafted the manuscript. YR and DW contributed to conceptualizing, analyzing, reviewing, and supporting concepts with intellectual content. All authors provided final approval of the version to be published.

Data Availability

Not Applicable.

Ethical Consideration

Not applicable.


Azuma, D., & Maron, J. L. (2020). Individualizing oral feeding assessment and therapies in the newborn. Research and Reports in Neonatology, 10, 23-30. https://doi.org/10.2147/RRN.S223472

Brantes, A. L. G., dos Santos Curado, M. A., & Cruz, I. R. (2021). Feeding methods in promoting the oral motor skills of the preterm newborn: A scoping review. Enfermería Global, 20(1), 521-535. https://doi.org/10.6018/eglobal.410411

Chen, D., Yang, Z., Chen, C., & Wang, P. (2021). Effect of oral motor intervention on oral feeding in preterm infants: A systematic review and meta-analysis. American Journal of Speech-Language Pathology, 30(5), 2318-2328. https://doi.org/10.1044/2021_AJSLP-20-00322

da Rosa Pereira, K., Levy, D. S., Procianoy, R. S., & Silveira, R. C. (2020). Impact of a pre-feeding oral stimulation program on first feed attempt in preterm infants: Double-blind controlled clinical trial. PloS One, 15(9), e0237915. https://doi.org/10.1371/journal.pone.0237915

Elsewadi, B. F., Samson, N., Nadeau, C., Vanhaverbeke, K., Nguyen, N., Alain, C., Fortin-Pellerin, É., & Praud, J.-P. (2022). Safety of bottle-feeding under nasal respiratory support in preterm lambs with and without tachypnoea. Frontiers in Physiology, 12, 785086. https://doi.org/10.3389/fphys.2021.785086

Fontana, C., Menis, C., Pesenti, N., Passera, S., Liotto, N., Mosca, F., Roggero, P., & Fumagalli, M. (2018). Effects of early intervention on feeding behavior in preterm infants: A randomized controlled trial. Early Human Development, 121, 15-20. https://doi.org/10.1016/j.earlhumdev.2018.04.016

Girgin, B. A., Gözen, D., Uslubaş, R., & Bilgin, L. (2021). The evaluation of oral feeding in preterm infants: Turkish validation of the Early Feeding Skills Assessment tool. Turkish Archives of Pediatrics, 56(5), 440-446. https://doi.org/10.5152%2FTurkArchPediatr.2021.21008

Gu, Z.-y., Gao, H.-t., Yang, Q.-j., Ni, M., Li, M.-j., Xing, D., Zhao, T.-y., Zhao, T., & Li, C.-x. (2022). Screening of olfactory genes related to blood-feeding behaviors in Culex pipiens quinquefasciatus and Culex pipiens molestus by transcriptome analysis. PLoS Neglected Tropical Diseases, 16(2), e0010204. https://doi.org/10.1371/journal.pntd.0010204

Kamity, R., Kapavarapu, P. K., & Chandel, A. (2021). Feeding problems and long-term outcomes in preterm infants—A systematic approach to evaluation and management. Children, 8(12), 1158. https://doi.org/10.3390/children8121158

Kamran, F., Sagheb, S., Khatoonabadi, S. A., Ebadi, A., Faryadras, Y., & Aghajanzadeh, M. (2021). The validity and reliability of early feeding skills assessment and cue-based feeding scales for preterm infants. Middle East Journal of Rehabilitation and Health Studies, 8(3), e110973. https://doi.org/10.5812/mejrh.110973

Li, L., Wang, L., Niu, C., Liu, C., Lv, T., Ji, F., Yu, L., Yan, W., Dou, Y. L., & Wang, Y. (2021). Early skin contact combined with mother’s breastfeeding to shorten the process of premature infants≤ 30 weeks of gestation to achieve full oral feeding: the study protocol of a randomized controlled trial. Trials, 22(1), 1-10. https://doi.org/10.1186/s13063-021-05605-x

Majoli, M., Artuso, I., Serveli, S., Panella, M., Calevo, M. G., & Antonio Ramenghi, L. (2021). A key developmental step for preterm babies: Achievement of full oral feeding. The Journal of Maternal-Fetal & Neonatal Medicine, 34(4), 519-525. https://doi.org/10.1080/14767058.2019.1610733

Ostadi, M., Armanian, A.-M., Namnabati, M., Kazemi, Y., & Poorjavad, M. (2021). The effects of swallowing exercise and non-nutritive sucking exercise on oral feeding readiness in preterm infants: A randomized controlled trial. International Journal of Pediatric Otorhinolaryngology, 142, 110602. https://doi.org/10.1016/j.ijporl.2020.110602

Pados, B. F., Hill, R. R., Yamasaki, J. T., Litt, J. S., & Lee, C. S. (2021). Prevalence of problematic feeding in young children born prematurely: A meta-analysis. BMC Pediatrics, 21(1), 1-15. https://doi.org/10.1186/s12887-021-02574-7

Patton, L., de la Cruz, D., & Neu, J. (2022). Gastrointestinal and feeding issues for infants< 25 weeks of gestation. Seminars in Perinatology, 46(1), 151546. https://doi.org/10.1016/j.semperi.2021.151546

Philippe, K., Chabanet, C., Issanchou, S., Grønhøj, A., Aschemann-Witzel, J., & Monnery-Patris, S. (2022). Parental feeding practices and parental involvement in child feeding in Denmark: Gender differences and predictors. Appetite, 170, 105876. https://doi.org/10.1016/j.appet.2021.105876

Pineda, R., Prince, D., Reynolds, J., Grabill, M., & Smith, J. (2020). Preterm infant feeding performance at term equivalent age differs from that of full-term infants. Journal of Perinatology, 40(4), 646-654. https://doi.org/10.1038/s41372-020-0616-2

Putnick, D. L., Bell, E. M., Ghassabian, A., Robinson, S. L., Sundaram, R., & Yeung, E. (2022). Feeding problems as an indicator of developmental delay in early childhood. The Journal of Pediatrics, 242, 184-191. https://doi.org/10.1016/j.jpeds.2021.11.010

Samane, S., Yadollah, Z. P., Marzieh, H., Karimollah, H.-T., Reza, Z. M., Afsaneh, A., & Als, H. (2022). Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: A non-randomized trial. BMC Pediatrics, 22(1), 1-8. https://doi.org/10.1186/s12887-021-03077-1

Sasmal, S., & Shetty, A. P. (2021). Systematic review protocol examining the effect of prefeeding oromotor stimulation on preterm neonate’s feeding outcomes. Manipal Journal of Nursing and Health Sciences, 7(1), 3.

Segala, F., Bolzan, G. d. P., Nascimento, M. D., Gonçalves, D. d. S., Melchior, A., Moraes, M. V. M. d., & Weinmann, A. R. M. (2022). Influence of taste stimulation on sucking pressure in newborn infants at term. CoDAS, 34(3), e20210002. https://doi.org/10.1590/2317-1782/20212021002

Soleimani, F., Azari, N., Ghiasvand, H., Shahrokhi, A., Rahmani, N., & Fatollahierad, S. (2020). Do NICU developmental care improve cognitive and motor outcomes for preterm infants? A systematic review and meta-analysis. BMC Pediatrics, 20(1), 1-16. https://doi.org/10.1186/s12887-020-1953-1

Viswanathan, S., & Jadcherla, S. (2020). Feeding and swallowing difficulties in neonates: Developmental physiology and pathophysiology. Clinics in Perinatology, 47(2), 223-241. https://doi.org/10.1016/j.clp.2020.02.005

Walker, L. O., & Avant, K. C. (2014). Strategies for theory construction in nursing (5th ed.). London: Pearson.

Widman-Valencia, M. E., Gongora-Meza, L. F., Rubio-Zapata, H., Zapata-Vázquez, R. E., Lizama, E. V., Salomón, M. R., & Estrella-Castillo, D. (2021). Oral motor treatment efficacy: Feeding and swallowing skills in children with cerebral palsy. Behavioural Neurology, 2021, 6299462 https://doi.org/10.1155/2021/6299462

Zinoni, M. M., Herrero, L. C., Lamuño, D. G., & de las Cuevas Terána, I. (2021). Translation and study of the measurement properties of the Early Feeding Skills Assessment tool in premature newborn. Anales de Pediatría (English Edition), 95(2), 72-77. https://doi.org/10.1016/j.anpede.2020.05.018