Improvement in problematic feeding symptoms for infants with lip-tie and tongue-tie after frenotomy

In this study, we compared symptoms of problematic feeding, as measured by the Neonatal Eating Assessment Tool (NeoEAT), before and 2 weeks after frenotomy in 84 infants with tongue-tie and lip-tie. We found that NeoEAT scores were significantly lower (i.e., improved) after frenotomy.

Authors: Rebecca Hill, Karen Lyons, Susan Kelly-Weeder, & Britt Pados

Publication information: Journal of Neonatal Nursing, doi: 10.1016/j.jnn.2023.07.007

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State of the science of the benefits of human milk for hospitalized, vulnerable neonates

In this state of the science paper, I review the currently-available literature on the benefits of human milk for hospitalized, vulnerable neonates. Human milk has the potential to reduce the risk and severity of many of the morbidities associated with premature birth, including necrotizing enterocolitis, infection, retinopathy of prematurity, bronchopulmonary dysplasia, and intraventricular hemorrhage. It also has the potential to reduce the risk of death in all hospitalized neonates. Both the dose of human milk and the timing of introduction are important, which more human milk and earlier introduction being associated with improved health outcomes.

Authors: Britt Pados

Publication information: Nursing for Women’s Health, doi: 10.1016/j.nwh.2023.01.008

This paper is available open access, click here.

Feeding at 6-12 months in infants with CHD

In this study of 30 infants with CHD, delayed acquisition of feeding skills and problematic feeding behaviors were common. At 6 months, 95% of infants had delayed feeding skills and 90% of infants had problematic feeding behaviors. Feeding difficulties improved between 6 and 12 months, but at 12 months, 30% continued to have delayed feeding skills and 38% continued to meet criteria for problematic feeding behaviors. Infants with more symptoms of gastrointestinal distress and gastroesophageal reflux had more problematic feeding behaviors.

Authors: Britt Pados & Tondi Harrison

Publication information: Cardiology in the Young, doi: 10.1017/S1047951122003298

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Breastfeeding symptoms with tongue- and lip-tie

In this study of 121 mother-infant dyads, we found that more severe classifications of tongue- and lip-tie were associated with particular symptoms in mom and baby. All infant symptoms improved and feeding duration improved post-frenotomy.

Authors: Rebecca Hill, Melissa Richard & Britt Pados

Publication information: MCN, the American Journal of Maternal-Child Nursing, doi: 10.1097/NMC.0000000000000876

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Gastrointestinal symptom improvement for infants following tongue-tie correction

In this study of 84 infants with tongue-tie, we found significant improvements in symptoms of gastrointestinal distress and gastroesophageal reflux 2 weeks after correction with frenotomy.

Authors: Rebecca Hill & Britt Pados

Publication information: Clinical Pediatrics. doi: 10.1177/00099228221117459

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Your Baby, Reflux, and Gastroesophageal Reflux Disease

In this paper written to a parent audience, I outline what gastroesophageal reflux and gastroesophageal reflux disease are and ways to help reduce symptoms.

Author: Britt Pados

Publication information: Healthy Mom&Baby, Issue 32, page 42-43

This article is available through the publisher’s websites here.

Effect of frenotomy on maternal breastfeeding symptoms and the relationship between maternal symptoms and problematic infant feeding

In this study of 102 mother-infant dyads, we found that there was a decrease in maternal breastfeeding symptoms after frenotomy, including improvement in painful and difficult latch, creased/cracked nipples, bleeding or abraded nipples, chewing of the nipple, and feelings of depression. Symptoms of problematic infant feeding (as measured by the Neonatal Eating Assessment Tool) were significantly lower 2 weeks after frenotomy.

Authors: Rebecca Hill, Karen Lyons, Susan Kelly-Weeder, & Britt Pados

Publication information: Global Pediatric Health. 2022. doi: 10.1177/2333794X211072835

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A pilot study of non-nutritive suck measures immediately pre- and post-frenotomy in full term infants with problematic feeding

In this study, we explored changes in non-nutritive sucking measures before and after frenotomy procedures in infants with tongue tie who were experiencing symptoms of problematic feeding.

Authors: Rebecca Hill, Morgan Hines, Alaina Martens, Britt Pados, & Emily Zimmerman

Publication information: Journal of Neonatal Nursing. In press. doi: 10.1016/j.jnn.2021.10.009

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Preterm infants born before 32 weeks gestation experience more symptoms of gastroesophageal reflux in the first 6 months of life than infants born at later gestational ages

In this study of 582 infants less than 6 month old, we found that infants born prior to 32 weeks gestation experienced more symptoms of gastroesophageal reflux (GER) than infants born at later gestational ages. While full-term infants experience improvement in GER symptoms over the first 6 months of life, infants born at 32 – 37 weeks do not show this same improvement. Family history of allergy was related to an increase in GER symptoms. Additional research is needed to understand the mechanisms and development of GER symptoms in infants born before 37 weeks gestation.

Authors: Britt Pados, Grace Briceno, Victoria Feaster, & Katherine Gregory

Publication information: Pediatric Medicine. 2021; 4: 12. doi: 10.21037/pm-20-100

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Prevalence of problematic feeding in young children born prematurely: A meta-analysis

In a meta-analysis of 22 research studies involving 4381 children born preterm (< 37 weeks gestation), we found that 42% of these children had some degree of problematic feeding in the first 4 years of life. Problematic feeding is common in infants born preterm. Healthcare providers need to screen children born preterm for feeding difficulties throughout early childhood and consider early referral to feeding specialists when feeding challenges are present.

Authors: Britt Pados, Rebecca Hill, Joy Yamasaki, Jonathan Litt, & Chris Lee

Publication information: BMC Pediatrics. 2021; 21: 110. doi: 10.1186/s12887-021-02574-7

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Elevated intestinal inflammation in preterm infants with signs and symptoms of gastroesophageal reflux disease

In this study of 32 infants born preterm, we found that infants with signs and symptoms of gastroesophageal reflux disease (GERD) had higher levels of intestinal inflammation as measured by fecal calprotectin. Further studies are need to explore the role of intestinal inflammation in development of gastrointestinal symptoms.

Authors: Colleen Shelly, Evgenia Filatava, Julia Thai, Britt Pados, Sara Rostas, Hidemi Yamamoto, Raina Fichorova, & Katherine Gregory

Publication information: Biological Research for Nursing. 2021; 23(3): 524-532.

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The prevalence of ankyloglossia in children less than one year of age: A systematic review & meta-analysis

In this meta-analysis of research studies involving 24,536 children, we found that the overall prevalence of tongue-tie was 8%. Tongue-tie is a relatively common oral anomaly, but existing assessment tools lack adequate psychometric properties. Further research on the impact of tongue-tie on feeding and development of a psychometrically-sound assessment is needed.

Authors: Rebecca Hill, Chris Lee & Britt Pados

Publication information: Pediatric Research. 2020; 90: 259-266. doi: 10.1038/s41390-020-01239-y

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Bottle-feeding challenges in preterm-born infants in the first 7 months of life

This study involved data from 625 infants less than 7 months old. In this study, we found that infants born very preterm (< 32 weeks gestation) had more symptoms of problematic feeding as measured by the Neonatal Eating Assessment Tool – Bottle-feeding (NeoEAT – Bottle-feeding) than infants born at later gestational ages. Infants with bronchopulmonary dysplasia, gastroesophageal reflux, and anomalies of the face and mouth were associated with problematic feeding, even when degree of prematurity was taken into account. Infants born prior to 32 weeks and infants with bronchopulmonary dysplasia, gastroesophageal reflux, and anomalies of the face and mouth should be considered at risk for problematic feeding and be monitored/screened closely. Early referral to feeding specialists should be considered to support these infants as their feeding continues to develop through infancy.

Authors: Rebecca Hill, Jinhee Park, & Britt Pados

Publication information: Global Pediatric Health. 2020; 7: 1-14. doi: 10.1177/2333794X20952688

This paper is available for free and open access on the publisher’s website, click here.

Symptoms of problematic feeding in infants under 1 year of age undergoing frenotomy: A review article

In this review of the existing literature on feeding in infants with tongue-tie under 1 year old, we found that there is evidence that frenotomy results in improvement in maternal nipple pain, breastfeeding self-efficacy and LATCH scores. Little data was found on the effect of frenotomy on infant feeding and those studies that did explore infant feeding lacked comprehensive feeding assessments with adequate psychometric properties. Additional research is needed on the impact of frenotomy on infant feeding using comprehensive, psychometrically-sound feeding assessments.

Authors: Rebecca Hill & Britt Pados

Publication information: Acta Paediatrica. 2020; 109(12): 2502-2514. doi: 10.1111/apa.15473

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Establishing a foundation for optimal feeding outcomes in the Neonatal Intensive Care Unit

Feeding difficulties are common in infants hospitalized in the neonatal intensive care unit (NICU). Setting a foundation for successful oral feeding starts from the moment of birth. For infants born preterm or with medical complexity, this starts long before the first time a breast or bottle is presented for feeding. In this paper, we discuss strategies to protect infants from noxious stimuli and promote positive sensory experiences to support neurodevelopment for the complex task of feeding.

Authors: Britt Pados & Kristy Fuller

Publication information: Nursing for Women’s Health. 2020; 24(3): 202-209. doi: 10.1016/j.nwh.2020.03.007

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Gastrointestinal symptoms in healthy, full-term infants under 7 months of age

In this study of 320 infants, we found that symptoms of gastrointestinal distress as measured by the Infant Gastrointestinal Symptoms Questionnaire (IGSQ) decreased with increasing age over the first 7 months of life. Reference values for the IGSQ are provided for infants under 7 months old to guide score interpretation. In this study, the IGSQ had acceptable internal consistency reliability and concurrent validity.

Authors: Britt Pados & Abby Basler

Publication information: Journal of Pediatric Nursing. 2020; 53: 1-5. doi: 10.1016/j.pedn.2020.03.011

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Symptoms of gastroesophageal reflux in healthy, full-term infants less than 7 months old

In this study of 559 healthy, full-term infants, we found that symptoms of gastroesophageal reflux (GER) as measured by the Infant Gastroesophageal Reflux Questionnaire – Revised (I-GERQ-R) decreased over the first 7 months of life. Reference values are provided for the I-GERQ-R for infants 0-2, 2-4, 4-6, and 6-7 months old. In this study, we found the I-GERQ-R to have acceptable internal consistency reliability and concurrent validity.

Authors: Britt Pados & Joy Yamasaki

Publication information: Nursing for Women’s Health. 2020; 24(2): 84-90. doi: 10.1016/j.nwh.2020.01.006

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Pathophysiology of gastroesophageal reflux disease in infants and non-pharmacologic strategies for symptom management

Gastroesophageal reflux is a common, but complex pathophysiologic process in young infants. Recent clinical practice guidelines suggest use of non-pharmacologic management strategies given concerns about the safety and effectiveness of acid-reducing medications in this population. In this paper, we holistically review the pathophysiology of gastroesophageal reflux disease with a focus on identify symptom management targets. Symptom management strategies include targeting stress, alterations in the intestinal microbiome, food intolerances, feeding difficulties, and positioning.

Authors: Britt Pados & Emma Davitt

Publication information: Nursing for Women’s Health. 2020; 24(2): 101-114. doi: 10.1016/j.nwh.2020.01.005

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To consent, or not to consent, that is the question: Ethical issues of informed consent for the use of donor human milk in the NICU setting

Except in rare instances, mother’s own milk (MOM) is the best source of nutrition for her infant and there is evidence that it reduces comorbidities common to prematurity and very low birth weight. When there is not sufficient MOM for an infant’s nutritional needs or when there are contraindications to the use of MOM, pasteurized donor human milk (DHM) is a viable substitution. In this paper, we discuss the history of DHM use and the ethics surrounding the consent process for the use of DHM. There is a need for standardization and consistent use of informed consent for DHM in the NICU.

Authors: Kelly McGlothen-Bell, Lisa Cleveland, & Britt Pados

Publication information: Advances in Neonatal Care. 2019; 19(5): 371-375. doi: 10.1097/ANC.0000000000000651

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Parents’ descriptions of feeding their young infants

In this study, 29 parents of infants less than 6 months were asked to describe their infants’ feeding and their parental concerns about feeding. Parents frequently described concerns about feeding and many made changes to improve feeding. Characteristics of the infant (e.g., temperament), the task of feeding (e.g., milk flow), and factors external to the infant (e.g., breast anatomy) were described as affecting feeding. Some parents described feeling happy, calm, and bonded during feeding, while others described feeling terrified, anxious, and worried. Health care providers played an important role in supporting parents when feeding concerns existed, but sometimes provided conflicting and even unsafe feeding advice.

Authors: Britt Pados & Rebecca Hill

Publication information: Nursing for Women’s Health. 2019; 23(5): 404-413. doi: 10.1016/j.nwh.2019.08.001

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