Communicating Intent

There are so many topics I could write about when it comes to prefeeding practices in the NICU, but I wanted to start here—with communicating intention. Specifically, how we communicate our intention with the medical team and with families.

When we work in the prefeeding space in the NICU, we are often working with infants at some of the youngest ages we treat. They are also at their most fragile. Nurses and physicians are understandably protective of these babies—as they should be. That doesn’t mean neonatal therapy isn’t indicated. It does mean that we have to be very clear about why we are there and what we are trying to accomplish.

There is a substantial body of evidence supporting prefeeding habilitation practices. But therapeutic care is never one-size-fits-all. Infants need different supports at different times, and what is helpful for one infant may be inappropriate—or even contraindicated—for another. This is why centering conversations around a single intervention is rarely effective. No matter how strong the evidence is, one intervention alone will never be enough to meet the complex needs of our preemies.

You know the saying, “you can’t see the forest for the trees.” When we communicate our therapeutic intention, it’s easy to get lost in the details of specific techniques. Instead, it’s often more helpful to step back and talk about the bigger picture: what we’re doing, with whom we’re doing it, and why it matters.

For example, when describing a prefeeding habilitation approach for infants between 26–31 weeks PMA, the message might be simple: we are providing experiences that support positive oral-facial, sensory, and motor development. We’re doing this because positive associations with touch, smell, and taste are foundational to all future feeding skills. The specific interventions used to support those goals are secondary to the goal itself—and they will always be individualized based on each infant’s needs, strengths, and vulnerabilities.

Once that intention is clearly communicated, it becomes much easier to build trust and buy-in. The focus shifts away from needing to justify our presence with a stack of RCTs and toward the value of thoughtful, developmentally aligned care. What we bring to the bedside is a clear therapeutic perspective—one that meets infants where they are and has a purposeful trajectory for where they’re going next.