Date of Paper/Work


Type of Paper/Work

Doctoral Project

Degree Name

Doctor of Occupational Therapy


Occupational Science/Occupational Therapy

First Advisor

Stephanie de Sam Lazaro


Doctor of Occupational Therapy


Intro: Oral feeding is often the last discharge criterion for preterm infants in the NICU and a leading cause of extended hospital stay. Preterm infants lack motor practice they would receive in utero when swallowing amniotic fluid and have underdeveloped physiological systems and oral structures, delaying feeding skills. Standardized pre-feeding oral motor protocols that include stimulation of oral structures and sucking on pacifiers have been shown to improve feeding efficiency, decrease transition time to full oral feeding, and decrease length of stay.

Purpose: The purpose of this doctoral capstone project was to update the clinical guidelines on oral motor interventions in the University of Minnesota Masonic Children’s Hospital (UMMCH) NICU to improve the neurodevelopmental outcomes of premature infants by targeting oral motor skills through a new protocol to enhance breastfeeding and bottle feeding.

Approach: Following an extensive literature review on best oral motor practices, the occupational therapists participated in a survey and focus group, were trained to implement the new protocol, and completed a follow-up survey to assess the utility of the protocol and updated clinical guidelines. Infant oral motor outcomes were also analyzed.

Outcomes: All therapists reported feeling satisfied with the guidelines and confident in implementing the protocol and modifying it with intubated infants. Therapists also reported improved patient outcomes, including secretion management and swallowing, arousal levels, tolerance to stimulation and oral interest, and bottling skills. Short-term infant outcomes during the protocol include high percentages of good secretion management, activated swallowing, and latching to a pacifier.

Recommendations: UMMCH NICU should continue to implement the protocol with infants of appropriate gestational age, utilize the clinical guidelines to train new therapists, provide additional training on the protocol as needed, continue quality improve cycle and adjust guidelines appropriately based on new evidence, provide parent education on protocol, and distribute modified nursing guidelines to further promote positive oral input for premature infants in the NICU.