The National Center for Evidence-Based Practice
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Pediatric Dysphagia

Feeding Protocols



External Scientific Evidence

Evidence-Based Practice Guidelines
No evidence-based practice guidelines were found.

Evidence-Based Systematic Reviews
Feeding Protocols to Improve the Transition from Gavage Feeding to Oral Feeding in Healthy Premature Infants: A Systematic Review
Medhurst, A. (2005).
Evidence in Health Care Reports, 3(1), 1-25.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: April 2013

This is a systematic review of randomized or quasi-randomized controlled trials investigating the use of feeding protocols compared to traditional feeding methods in the transition from gavage to oral feeding in healthy premature infants.


  • "The results of this review suggest feeding protocols may improve the transition from gavage feeding to oral feeding in the healthy premature infant when compared to traditional feeding methods. When utilising feeding protocols the number of days to transit from gavage feeding to oral feeding may be reduced, growth may be maintained and the length of hospitalisation may be reduced. These results must be interpreted with caution due to the possibility of systematic errors in the design, conduct, analysis and reporting of the two RCTs included in the review" (p. 11).

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Timing Introduction and Transition to Oral Feeding in Preterm Infants: Current Trends and Practice
Breton, S., & Steinwender, S. (2008).
Newborn & Infant Nursing Reviews, 8(3), 153-159.
Added: April 2013

This is a review of the published literature investigating the best practices related to the timing of introduction to oral feeds and transition to full oral feeds with preterm infants. Findings from the review were classified as weak, fair, or good based on the following criteria:

  • "Good - Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes

  • Fair - Evidence is sufficient to determine effects on health outcomes, but the strength of evidence is limited by quality or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes

  • Weak - Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes" (p. 157).

There is fair evidence that full oral feeding can be attained earlier by using a semi demand/cue-based feeding protocol based on the state and behavior of the preterm infant.

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Clinical Expertise/Expert Opinion

Consensus Guidelines
No consensus guidelines were found.

Client/Patient/Caregiver Perspectives

No information was found pertaining to client/patient/caregiver perspectives.

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