Finding Power In Your Practice

Tired of trying to change NICU culture… I’ve been there too. Let’s focus on you.

Let’s be honest for a minute… it’s easy to talk about changing NICU culture—to say the expected things about educating staff and the importance of multidisciplinary collaboration. I’ve done it. I’ve said it. I’ve meant it. And yes, my last post was all about it.

And when you have the energy and support, absolutely take on those challenges. But many of us hit periods where it feels like we’re spinning our wheels—trying to change things that may never shift, or at least not anytime soon. So where does that leave you?

You still have the ability to create change—but maybe it starts with you.

Maybe it starts with demonstrating your value, your skill, and changing the experiences of your patients one family at a time.

This brings me to the work of the Guided Progressions pathway. The Guided Progressions pathway is centered on the unique skill set of neonatal therapists. It relies on thoughtful activity grading and the ability to slowly, intentionally increase the complexity of an experience. For that reason, this work is best carried by the neonatal therapy disciplines.

Using simulated feedings in your practice can meaningfully change the experiences of your infants and the relationships you build with families. It may not transform NICU culture overnight—but it can shift how others see you, your role, and how you see your own value in an infant’s care.

Through simulated feeding as a prefeeding intervention, you allow an infant’s capacities to unfold gradually. You are building competence without the pressure of performance. That alone is a gift—for both the infant and their family.

In my experience, when you engage families in simulated-feedings, you start to see a shift. Parents begin to feel that their infant is capable—not just of eating, but of engaging in something deeply human. Feeding is social. Food is connection. So much of our lives are built around these shared experiences.

And yet, feeding in the NICU is often loaded with pressure and performance. Before that pressure takes over (and yes, we can debate whether it should), we have the opportunity to create meaningful moments—experiences that build confidence in both the infant and the parent as they prepare for what’s ahead.

When you’re feeling powerless in the NICU, sometimes the most impactful thing you can do is turn inward—focus on your process and your skill. Learning how to create effective simulated-feeding experiences can be your superpower.

I encourage you to read more, explore what you can from the Prefeeding Pathways framework, and reach out with questions. In the coming months, we’ll be offering deeper training, and I hope you’ll join us in continuing to grow this part of your practice.

When I feel overwhelmed by all the things I can’t change, I come back to this work. I lean into the families in front of me and focus on creating moments.

These moments are for them—but they’re also for me. They remind me of my value.

It’s in the smile of a 28-weeker tasting their first drop of milk.

In the 32-weeker who can now coordinate small, purposeful sucks and swallows.

In the mother who lights up and says, “Oh my gosh, she’s doing it!”

I hold onto the hope that these are the moments that lead to something bigger—that maybe these small moments are leading to the day this infant will sit and enjoy their first ice cream cone.

Some days, these moments are all we get. But most days, they’re enough.