1. Section Editor(s): Thoyre, Suzanne M. PhD, RN, FAAN

Article Content

From the advent of pediatric and maternity nursing, nurses have provided anticipatory guidance for well-child feeding and supported sick children in meeting their nutritional needs. Nurses have had a strong presence in postpartum, neonatal, and pediatric inpatient units in supporting newborn infants as they establish breastfeeding, preterm infants as they develop early feeding skills, and in selecting and implementing feeding plans for infants and young children with complex medical conditions. In community health and primary care settings, nurses monitor feeding and growth of infants and children, address families' feeding concerns, and guide interventions when difficulties in eating and obesogenic behavioral patterns are observed. In feeding specialty clinics, nurse practitioners partner with families, lactation consultants, physicians, speech-language pathologists, occupational therapists, physical therapists, nutritionists, psychologists, and others to coordinate the team's care and provide direct management of biological antecedents to feeding problems, such as constipation and gastroesophageal reflux.


Providing adequate nourishment is an essential role of the parent and it is not unusual for parents to seek affirmation that their child's feeding behaviors are within the norm. Parents are the first to observe when feeding is not going as it should; they need those of us providing healthcare to listen to their expertise and partner with them as the complexity of the problem is explored. Although feeding problems occur in typically developing children, they are often the initial indicator of a yet-to-be-diagnosed condition. Therefore, it is critical that nurses have skill in (1) identifying infants and children who need support with eating early and (2) partnering with families as the problem unfolds and interventions individualized to the child's symptoms and the family's style of management are trialed.


Feeding requires dynamic interactions within the child and between the child, the environment, and the task. When exploring feeding concerns we look to constraints within these systems as a way to understand possible causes and select appropriate feeding interventions. The observable behaviors of the child are representative of the dynamic adaptations the child has made to these constraints and the interactions between these systems.


The articles in this special issue are examples of the dynamics of feeding for infants, young children, their families, and healthcare providers. Hodges et al. explore the changes in typically developing children's hunger and satiety cues across the first year. Pados et al. provide concrete information on differences in the milk flow of bottle nipples commonly used by families during infancy. The flow of milk from the nipple is an excellent example of a task constraint that has an impact on strength and frequency of infants' sucking behavior; consequently, nurses can use this information to guide selection of a nipple that best matches the infant's capacities. Thoyre et al. describe an intervention to guide mothers in developing their feeding practice by enhancing their understanding of unique characteristics of feeding for their very preterm infants. Park et al. explore maternal psychological well-being during the time mothers are learning to feed their very preterm infants. Estrem et al. examine the meaning of a feeding problem for parents, highlighting the lengthy journey families experience as the feeding problem evolves and they search for effective care. McComish et al. describe the dynamics of a specialized interdisciplinary feeding team using a medical motor behavioral approach to treatment.


Effective care for feeding concerns considers all parts of the system that are interdependently contributing, acknowledges the family as the central provider of feeding care for their child, and determines what is best for the child and family's well-being. Nurses, who are astute observers and educated to holistically integrate all aspects of a health concern, and who are committed to providing family-centered care, are uniquely positioned to assist in improving family-focused feeding care.