dr erin wearing ppe in a nicu setting while interacting with a small baby

Feeding Fundamentals, LLC provides a variety of continuing education resources for the professional (nurses, speech/language pathologists, physical and occupational therapists, lactation consultants, physicians, and other professionals supporting infants and families who are working on establishing and maintaining enjoyable mealtimes.) SOFFI®: Supporting Oral Feeding in Fragile Infants training is currently offered across the virtual environment via ZOOM, as well as via a series of recorded videos. The SOFFI® Hybrid Expanded Course offers the training by blending a series of prerecorded videos followed by a live two-day session. Professionals who complete the SOFFI® training and pass a series of tests on the material will be a SOFFI® Certified Professional. To date, the training has been conducted in many countries, including Canada, Australia, New Zealand, Indonesia, Greece, Great Britain, Scotland, Poland, France, Portugal, Brazil, Mexico, the Republic of Ireland, Israel, Singapore, Chile and India. In 2014, the first international SOFFI® Training Center was opened in Brest, France.  Additional video trainings are available, including ones focused on supporting normal development of feeding skills in infants and in children, as well as specialized topics focused on a variety of medical conditions.  RINGGCAST focuses on the process of critical thinking and infant feeding.  Additional video trainings focus on topics related to teamwork within the NICU setting.  Dr. Ross is a Certified Lactation Counselor (CLC) and is creating content to improve the breastfeeding outcomes for infants with medical conditions, and infants who are born prematurely.

What is SOFFI®?

SOFFI® is an integrated approach to supporting oral feeding in preterm infants and in infants struggling to eat for any reason, both in the NICU and in the Early Intervention setting. The training is offered in a variety of ways. SOFFI® provides the practitioner with evidence-based information regarding feeding development as well as assessment and intervention strategies. SOFFI® is guided by SOFFI® Algorithms which are clinical decision-making pathways designed to ensure all feeders use the same critical thinking during feedings. In 2013, the National Association of Neonatal Nurses highly recommended the use of the SOFFI® Algorithm in conjunction with their “Infant-Directed Oral Feeding for Premature and Critically Ill Hospitalized Infants: Guideline for Practice” (Sables-Baus, S., et al., 2013.) “The SOFFI® algorithm is grounded in similar principles as described in this guideline.” National Association of Neonatal Nurses. SOFFI® is the ONLY intervention to date that has longitudinal evidence with infants both within the NICU setting AND after their discharge where parents are the primary feeders. Additionally, it is the ONLY intervention to date that has been implemented and studied with both premature infants, and infants with medical comorbidities – both preterm and term. These data were part of a research study on the effectiveness of SOFFI®, conducted at a large tertiary children’s hospital (Horner, et al., 2014).

SOFFI® provides a framework, that is constructed using the following assumptions:

Feeding is an interactive process that requires an ongoing assessment of an infant’s physiology and behavior throughout the feeding

Feeders (professionals and parents) need to know how to observe the infant’s physiology and behaviors throughout a feeding, so that they can understand the communication of the infant during feeding. Since every experience (both pleasant and unpleasant) is influencing the brain development (and therefore learning) of the infant, feeders must have a shared “vocabulary” to understand how the infant is experiencing the feeding. Feeders must respond to the sometimes subtle indications related to how the feeding is going. Research shows us that parents need professional guidance to know what to look for, and how to respond to help their infant in times of distress. (Thoyre, et al, 2016)  SOFFI® teaches professionals how to recognize, and how to teach parents to look for, infant behaviors that indicate a readiness to engage, or a need to provide a break. These same behaviors prompt the feeder to then provide additional supports during a feeding. The SOFFI® Algorithms provide a structured pathway to follow, to encourage the ongoing assessment of the infant.

Conscious, knowledgeable decisions on the part of the feeder support immediate and long-term enjoyment of food

SOFFI® uses the SOFFI® Algorithms to raise awareness of the critical decision-points during a feeding experience that every feeder needs to consider. These Algorithms connect the understanding of how to interpret infant physiology and behaviors to a consistent response from the caregivers. This consistency allows flexibility because infants are changing rapidly, while limiting the variability amongst feeders that is not based on the behaviors of the infant. This consistency is related to the final assumption.

Biologically expected experiences are the best way to support appropriate learning about eating

Infants who are hospitalized after birth, rather than going home with their parents, have a high risk of developing feeding challenges while in the hospital, or after discharge.  Several articles suggest, on average, 40% of infants who were in the Neonatal Intensive Care Unit (NICU) develop feeding problems that continue at least through the first four years of life.  This risk is likely related to the drastically different experiences these infants have while hospitalized.  SOFFI® focuses caregivers on the need to protect against aversive experiences and promote biologically expected inputs.  The biologically expected input that is most critical is the presence of the parent – who provides the best sensory environment for the infant.

Identification and implementation of evidence-based interventions to support skill development provides a consistent environment within which infant learning occurs

There are several interventions that are correlated with improved quality of feedings for infants in the hospital setting – both premature infants and infants with medical comorbidities. These interventions are also used with infants in the home and clinic settings.  The Algorithms identify these interventions.  The original SOFFI® Algorithm is designed for the infant in the hospital setting who is just beginning to eat. SOFFI® EI is an Algorithm that was designed for the professionals working with infants in home and early intervention settings who may or may not have supplemental tubes to use when the infant has not taken full volume. The shared goal of the SOFFI® training as well as the Algorithms is to decrease the variability in both recognizing and responding appropriately to infant behaviors.