Helping babies feed stress-free

That career started more than two decades ago, when Park, then a master’s student in nursing, was working in one of the largest newborn intensive care units (NICU) in Seoul, South Korea. From there she moved to the University of North Carolina at Chapel Hill for her doctoral work and, in 2015, to Boston College to join the faculty at the Connell School. This summer, her years of effort paid off in a satisfying way: she received an R21 Exploratory/Developmental Research Grant Award from the National Institutes of Health (NIH) and National Institute of Nursing Research (NINR).

This prestigious R21 grant, which supports exploratory research, will allow Park and her collaborators at the University of North Carolina and Boston’s Beth Israel Deaconess Medical Center to investigate the “Biobehavioral Efficacy of the Semi-Elevated Side-Lying Position for Feeding Preterm Infants.” In other words: will a preterm infant’s health improve if she feeds while lying on her side instead of in another position?

The stakes are high. The problems infants experience while feeding often persist into childhood, with consequences for the child’s long-term growth and neurodevelopment. Park, however, is optimistic that this simple feeding intervention may not only improve children’s health but also reduce the strain on caregiving families and the health care systems supporting them.

“To feed safely and efficiently,” Park says, “infants must develop certain anatomical structures and neurological capacities.” The physical challenge of feeding demands complex musculature: forming a seal around the nipple takes healthy lips, while drawing out milk requires strong cheeks. The neurological challenge of feeding involves intense self-control: to swallow, infants must stop breathing, so they must learn to alternate the two in a steady “suck-swallow sequence.”

Such a complex process can go wrong in many ways. The child born with a cleft lip will be unable to form a seal around the nipple. Preterm infants, who must breathe 60 to 70 times a minute to maintain their oxygen levels, have a particularly hard time regulating breathing while feeding. Some infants are so overwhelmed with milk they turn blue from oxygen deprivation. Other infants, however, are too weak to draw enough milk from the nipple; these children go hungry if forced to rely on oral feeding.

Even when preterm infants manage to feed successfully, Park observes, it is such an intense process that an infant’s delicate balance is easily upset. She recalled one father who paid a visit to his preterm daughter while she was feeding in a NICU. “He gently reached out to his daughter’s hand while she ate,” Park says, “but that extra touch proved too much: the infant became too exhausted to continue feeding. She was already using all her energy for feeding, so extra stimulation overwhelmed her.” Her research indicates that it is essential to support infants during feeding by minimizing unnecessary stimulation as much as possible.

These feeding struggles can result in a host of consequences beyond the stunted neurological development ongoing hunger causes. If a child repeatedly experiences stress while feeding, she may form an enduring association of stress with feeding, and she may later refuse to swallow, insist on a bribe each time she feeds, or refuse to feed at all. These behaviors can put caregivers under tremendous strain and harm the child. This is why, Park says, it is critical to intervene before a child’s feeding problems become chronic.