Best Practices for Oral Motor Stimulation to Improve Oral Feeding in Preterm Infants: A Systematic Review

Objective: Interventions within the scope of occupational therapy were examined to identify the effectiveness of pre- feeding interventions to improve feeding outcomes of premature infants. Evidence-based methods of peri-oral and intra-oral stimulation and oral support were explored and will be discussed in this review. Method: Literature published from 1995 to 2015 using eight electronic databases and Cochrane Database of Systematic Reviews was searched. Fifteen studies met the inclusion criteria and were critically appraised and synthesized. Results: Analysis revealed best practices utilizing four areas of intervention: oral motor stimulation, non- nutritive sucking, oral support, and co-interventions. Conclusion: For infants, feeding is a vital occupation that supports growth and development. However, premature infants often have difficulties with the feeding process. Occupational therapists working with pre- term infants must have a sufficient understanding of the evidence to be able to employ best practices to improve pre-feeding readiness and oral feedings. Immature suck-swallow-breath coordination; absent, delayed, or impaired oral reflexes; abnormal muscle tone; and impaired motor control impact the infant's safe and successful oral intake of adequate nutrition. Strong evidence supports the use of peri-oral and intra-oral stimulation for pre-feeding readiness and preparation to promote successful oral feeding in preterm infants. There is also strong evidence to substantiate the use of oral support during feeding of preterm infants to increase suction and decrease liquid loss to promote efficient intake of nutrition.