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Development of Feeding Across the First Year
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Development of Internal Regulation and Feeding
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Development of The Oral Motor System
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EVIDENCE BASE FOR SOFFI®
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Homeostasis as the Foundation for Feeding
$25.00 for 6 months Sign Up Now
Interventions to Support Homeostasis During Oral Feedings using SOFFI®
$140.00 for 6 months Read more
Interventions to Support Internal Regulation using SOFFI®
$60.00 for 6 months Read more
Medical Issues that Impact Oral Feeding Skills
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Overview of Feeding Development and Treatment Strategies: What every professional should know
$229.00 for 6 months Sign Up Now
SOFFI® Quizzes for Certification
$69.00 for 6 months Sign Up Now
SOFFI® Training Package
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SOFFI® Virtual Full Course Event
$465.00 Add to cart
SOFFI® Virtual Full Course Event December
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Supplemental Tube Feeding Considerations
$50.00 for 6 months Read more
Supporting Parents and Infants During Early Feedings in the Intensive Care Unit and at Home
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The Bross Approach
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Speakers/Disclosures

Speakers/Disclosures
Dr. Erin Sundseth Ross is a Speech Pathologist with a Doctoral degree in Clinical Sciences – Health Services Research. She completed a two-year post-doctoral training in the Section of Nutrition and is an Assistant Clinical Professor in the School of Medicine, Department of Pediatrics, at the University of Colorado Denver. She is also on faculty at the Rocky Mountain University of Health Professions. Dr. Ross has over 30 years of experience working in the NICU within several HealthONE hospitals, and with older children when she was at the SOS Feeding Solutions clinic in Denver, Colorado. Dr. Ross is the creator of SOFFI®, a feeding program for use in the NICU. She has specialized in the development of feeding skills, and the etiology and treatment of feeding and growth problems in infants and very young children from initial hospitalization through the first 5 years of life.

Statement of Financial Disclosures for Speaker: Dr. Erin Ross is a paid consultant for Nestec Ltd and Intertek, and is a paid speaker for Toomey and Associates. She owns intellectual property as the principal owner of Feeding Fundamentals, LLC., and created and receives a salary as compensation for SOFFI®.

Statement of Non-financial Disclosure for Speaker: Dr. Ross is the Chair of the Advocacy Pillar of Feeding Matters, which is a voluntary position.

Continuing Education

Continuing Education

Online SOFFI® Package:

Starting September 5th, 2020: This course is offered for 1.3 ASHA CEUs (Intermediate Level, Professional content area). This course will focus on the SOFFI® Method and will not discuss other similar or related treatments. This course is not offered for partial credit. Each agenda item must be completed and quiz passed before you may move to the next section of the course. Completion of all 12 sections and quizzes passed is needed to award ASHA CEU’s

SOFFI® Virtual “LIVE” Course:

This course is offered for 1.55 ASHA CEUs (Intermediate Level, Professional content area). This course will focus on the SOFFI® Method and will not discuss other similar or related treatments. This course is not offered for partial credit. Full attendance and passed grade on quiz is needed to award ASHA CEU’s

While the content is the same for each of these offerings, the virtual live course offers a chance for interaction and questions/answers. It therefore is scheduled as such.

Cancellations

Cancellation of Registration by Registrant – Policy
Cancellations are accepted minus an administrative fee of $25.00 up until two weeks prior to the offering. After that time, cancellations will not be accepted but the participant may join a different virtual event offered within 6 months of the original course offering without penalty. Virtual courses are offered at least every 2 months. Participants must attend an event within the 6 months of the original course offering or forfeit their registration.

AGENDA All times listed are Mountain Time in the US (GMT-7).

(N/A for webinars) Cancellation of live and live-streamed events by Speaker

If the conference is cancelled by speaker due to, but not limited to, the following:
• Speaker cancellation
• Limited enrollment

Registrants will receive a full refund of their registration fee within 30 days of the originally scheduled conference by the method that the registrant used to pay for the registration. (If payment was received by credit/debit card, the refund will be refunded to the original credit/debit card used, if payment was received via a check, a refund will be provided by check.)

ADA

ADA
Toomey & Associates, Inc. and SOFFI®, complies with ADA provisions. If you require special accommodations or need assistance, please contact Gina Gass at least two weeks in advance of the conference at ggass@feedingfundamentals.com.

Complaint Policy & Procedures

Complaint Policy & Procedures
SOFFI® views complaints as an opportunity to learn and improve future programs and resources, as well as a chance to put things right for the person or organization that has made the complaint. Please read the full Complaint Policy and Resolution Procedures

Attendance & Policies

Attendance & Policies
In order to achieve the intended Learning Outcomes and to satisfy the completion requirements for the conference and Continuing Education Units, learners are expected to view the entire online workshop.  Not viewing the workshop in its entirety will cause the learner to miss crucial information needed to be able to correctly use the specific topic area of SOFFI®, Upon completion of the online workshop, a test will be assigned that covers the information taught within the online workshop.

Cancellations

Cancellation of Registration by Registrant – Policy
All Sales are Final

(N/A for webinars) Cancellation of live and live-streamed events by Speaker

If the conference is cancelled by speaker due to, but not limited to, the following:
• Speaker cancellation
• Limited enrollment

Registrants will receive a full refund of their registration fee within 30 days of the originally scheduled conference by the method that the registrant used to pay for the registration. (If payment was received by credit/debit card, the refund will be refunded to the original credit/debit card used, if payment was received via a check, a refund will be provided by check.)

Course Quiz

Interventions to Support Homeostasis During Oral Feedings using SOFFI® - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
Identify at least one reported outcome of implementing feeding plans:
- More volume in a shorter amount of time (efficiency)
- Parents are more satisfied
- Lower length of stay for infants
- None of the above
Which of the following are evidence-based intervention(s) for bottle feeding:
- Slowing the flow rate
- Regulated Pacing
- Talking to other people, singing and rocking while feeding
- A and B
One evidence-based intervention for supporting breast feeding is:
- Pre- and post-test weights
- Waiting until the infant is over 34 weeks to begin and oral experiences
- Avoiding pacifiers in the NICU and after discharged
- Using only expressed mother’s milk and not donor human milk
According to SOFFI®, a feeding should be stopped:
- When the infant loses homeostasis (is no longer physiologically stable), or is tired or has finished
- Based ONLY on whether the infant has taken the entire bottle
- ONLY after the baby has tried eating for a full 30 minutes
- None of the above
One factor that affects flow rate from a bottle is:
- Hydrostatic pressure
- Expense of the bottle
- Where you purchase the bottle
- None of the above
The two types of pacing are:
- Fast and Slow
- Regulated and Rested
- Consistent and Intermittent
- Premie and Ultrapremie
When correctly implementing regulated pacing, the caregiver intervenes:
- If the baby is drooling
- Before the infant loses homeostasis, shows signs of distress
- If the infant chokes/coughs
- After 12 sucks without a breath
Pre- and Post-test weights:
- Are accurate ways to determine transfer of milk at breast
- Make mothers want to stop breast feeding
- Help mothers be reassured that their baby is eating enough
- Both A and C
- A, B, and C

Course Quiz

Supplemental Tube Feeding Considerations - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
One effect of long-term naso-gastric (NG) tube use on feeding development is:
- More facial defensive behaviors
- Better eating skill development than with G-Tubes
- More sinus infections
- Less stomach problems
One factor that impacts how tube feeding affects the development of normal eating and drinking skills:
- Whether the tube was placed as a PEG or a Gastrostomy surgery
- Exposure to taste and textures during sensitive periods
- The number of times it comes out of the baby
- Whether the parents put the tube in or professionals do
Breast milk is as effective as sucrose in alleviating pain during insertion of the tube:
- True
- False
According to the study by Ricciuto in 2015, food refusal was significantly associated with NG tube exposure greater than:
- 1 month
- 2 months
- 3 months
- 4 months
According to the study by Ricciuto in 2015, growth was worse for children who received a G-Tube compared to those with an N-G tube:
- True
- False
One of the nutrients lost during continuous tube feedings is:
- Calories
- Calcium
- Vitamin B
- Fat
After flavor learning in utero, the next most important time to develop preferences appears to be during:
- Middle school
- Elementary school
- Complementary feeding (beginning of purees/solids)
- Preschool
To help an infant who is gagging/retching during tube feedings, consider:
- A referral to gastro-enterology
- A change in rate of infusion
- A change in volume
- All of the above

Course Quiz

Interventions to Support Internal Regulation using SOFFI®- Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
A “just right challenge” related to feeding the premature and/or medically complex infant is:
- A feeding where the infant takes a whole bottle even if desaturating
- A feeding where the infant maintains homeostasis
- A feeding where the infant stays awake even if you have to wake them up
- None of the above
What should the feeder do if homeostasis is lost:
- Stop the feeding and help the infant regain stability; decide if the infant can continue
- Just keep increasing the oxygen
- Tell the next shift to try something else
- Stop the feeding and put the baby back to bed and leave- without re-stabilizing them
One or more benefit(s) of Kangaroo Mother Care on the mother, the parent-infant relationship is:
- Reduces maternal postpartum depression symptoms
- Helps to establish breastfeeding
- Increases parental sensitivity to infant cues
- All of the above
Benefits of Kangaroo Mother Care for the infant include:
- Increased stability
- Decreased pain
- Fewer REMs sleeps
- All of the above
One thing that can help to create a room environment for an attuned feeding is:
- A door or a shield for privacy and regulating socializing
- Having only staff feed the baby
- Turning on the television in the room
- Having medical rounds in the room during a feeding
Based upon newborn infant stomach volume studies , the optimal feeding schedule for newborn term infants would be:
- Every 20 minutes
- Every 1 hour
- Every 4 hours
- Letting a baby sleep for up to 5 hours between feedings
One benefit of using colostrum for oral care is:
- Dads can bring it from home
- It decreases clinical sepsis
- It never goes bad- does not need to be kept cold
- None of the above
Describe one or more benefits of positive oral experiences:
- They may help a baby transition from tube to oral feedings
- They help a baby keep calm or calm down
- They may help with weight gain
- All of the above

Course Quiz

Evidence Base for SOFFI® - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
Co-regulators and Observers are the same thing
- True
- False
Research using SOFFI® by Horner and colleagues showed infants had a shorter length of stay after SOFFI® was started.
- True
- False
In the feeding model for SOFFI® baseline stability is communicated by the infant through:
- Physiologic stability
- Motor stability
- Behavioral state stability
- A, B and C
- A and C
Stability and instability of the baby are communicated through:
- The monitors
- The infant’s observable behaviors
- The baby’s sucking
- Parental confidence
In the study by Horner and colleagues, the majority of significant outcomes were seen in the 3-5 month post-term time period:
- True
- False
Fewer infants seen by the SOFFI® staff after training had _____________ in the 3-5 month time period:
- Feeding problems
- Arching with meals
- Spitting/vomiting
- A Feeding Therapist
- All of the above
Term babies who were in the SOFFI® group in the Horner study had a longer length of stay than the study group:
- True
- False
In the Hanlin study, infants were fed on nasal CPAP by any professional staff member:
- True
- False

Course Quiz

The BROSS Approach - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
The first step in the BROSS framework is:
- Obligatory
- Integrated
- Alternating
- Stability in Bed with Handling
The defining characteristic of the Obligatory Step is:
- The caregiver needs to intervene to help the infant regain physiologic stability
- The baby can eat an entire bottle
- The baby stays calm and happy
- The baby is breathing within a sucking burst
In the alternating step, the word alternating refers to:
- Alternating one oral feeding with one gavage feeding
- Alternating breathing pauses with sucking bursts – not breathing within the sucking burst
- Alternating breast then bottle feeding within a feeding
- Alternating right side and left side at the breast
When the infant is in intermittent step, longer sucking bursts begin to appear while the infant remains stable and takes some breaths within the sucking burst:
- True
- False
The defining characteristic of Integrated Step is:
- The ability to integrate social interaction during feeding
- Needing to integrate the feeder’s help to breathe while eating
- Integrating crying when upset
- Integrating the baby into the family unit
Across the discharge, 1 and 4 month time periods of the study by Reyna, et al., 2012, mother’s on average talked to their infants only ______ percent of the feeding time:
- 1%
- 10%
- 60%
- 80%
For the step coordinated, the word Coordinated refers to:
- Coordinating sucking/swallowing and breathing that is rhythmic and predictable
- Coordinating the transition between breast and bottle feeding
- Coordinating across multiple different bottle systems
- Coordinating feeding schedules
During the intermittent step, the infant takes brief catch breaths every __________ sucks:
- 8-10
- 11-13
- 10-12
- 2-3
- single

Course Quiz

Understanding the Language of the Newborn - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
One or more channels of communication in the Synactive Organization of Behavioral Development is:
- Motor behaviors
- Physiologic changes
- Changes in awake/asleep/fussing
- None of the above
- All of the above
One behavior of readiness to engage in the physiologic system includes:
- Appropriate digestion
- Laughter
- Grunting
- Hiccups
One behavior of readiness to engage in the motor system includes:
- Laughter
- Kicking
- Clapping
- Rounded posture with tucked extremities
One behavior of readiness to engage in the attention/interaction system includes:
- Calm, alert state
- Drowsy state
- Unclear whether infant is alert or asleep
- Crying
One behavior indicating disengagement in the physiologic system includes:
- Respiratory rate between 40-60 breaths/minute
- Hiccups
- Snoring
- None of the above
One behavior indicating disengagement in the motor system includes:
- Flatness
- Tightness
- Muscle energy
- None of the above
- Both A and B
One behavior indicating disengagement in the behavioral state system includes:
- Full range of behavioral states
- Rapid transitions in states
- Non-nutritive sucking
- None of the above
Preterm infants with shifts between quiet sleep and wakefulness have better neonatal neuromaturation and fewer negative emotions compared to infants who cycle mostly between states of high arousal:
- True
- False

Course Quiz

Medical Issues that Impact Oral Feeding Skills - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
Which of the following are associated with an increased risk of ongoing feeding problems:
- Gastro-intestinal reflux disease
- Neurologic disorders
- Teenage mothers
- Both A and B
- A, B and C
One comorbidity factor that is associated with a longer transition to full oral feedings is:
- Lower birth weight
- Absent parents
- Adoptive situation
- Surrogacy
One effect of respiratory issues on oral feeding is:
- Longer transition to full oral feedings
- Increased time spent awake
- Increased neurologic problems
- None of the above
One influence of cardiac issues on oral feeding is:
- Increased vomiting
- Babies spend more time playing
- Difficulty with weight gain
- A and B
- A and C
The most common airway anomaly in infants is:
- Laryngomalacia
- Vocal fold nodules
- Stenosis
- Tracheal cleft
In the study by Sullivan, et al., 2000, what percent of parents identified that their child had an oral-motor dysfunction:
- Less than 5%
- 5-10%
- 72%
- 100%
In the study by Rommel, et al, 2003, what percent of children referred to a tertiary multi-disciplinary feeding clinic had GI issues:
- 5%
- 11%
- 54%
- 99%
The resting metabolic rate (energy needs) in children with genetic syndromes (especially Prader-Willi syndrome, Myelodysplasia and Trisomy 21) is lower than typically developing children:
- True
- False

Course Quiz

Development of Feeding Across the First Year - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
Two anatomical changes that influence feeding between 3 and 6 months of age include:
- Downward-forward growth of the mandible
- Increased space in the oral cavity and oro-pharynx
- Growth of the tongue
- Both A and B
Babies who leave the NICU may improve in their eating within the first 2 weeks post-discharge:
- True
- False
According to the study by Pickler, et al., 2012, one skill that typically improves after discharge includes:
- Ability to remain engaged in the feeding
- Ability to demand prior to the feedings
- Ability to grow
- Ability to transition from breast to bottle feedings easily
Developmental domains that influence eating skill development include:
- Gross/fine motor skills, oral motor skills and sensory skills
- Emotional/cognitive/self-regulatory skills
- Parent skills
- Both A and B
- A, B and C
Fine motor skills in the newborn are initially limited to:
- Finger splays
- Hands to mouth
- Reflexive grasps
- Playing with toys
Differences in sensory inputs from pureed to table foods include:
- Need to track pieces and changes in the visual inputs during eating
- Taste is bigger and there is more head shifting during chewing
- Textured foods may have sound as you chew them
- Both A and C
- A, B and C
Infant oral-motor movements are:
- Diagonal
- Vertical
- Multi-Directional
- Lateral
Earlier introduction to solid foods is related to:
- Failure to adjust for prematurity
- Desire to offer sweet foods
- Cost
- None of the above

Course Quiz

Development of The Oral Motor System - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
The two kinds of sensory receptors in/around the larynx are:
- Mature and Immature
- Sensory and Motor
- Mechano and Chemo
- Alpha and Beta
One effect oral stimulation has had during one of the studies discussed was:
- Poor weight gain in those in the oral stimulation arm
- Better transition to solid foods
- Less facial defensive behaviors
- Enjoyment of hands-to-mouth
Suction is the first part of sucking to develop:
- True
- False
Volume is a direct result of the infant acquiring:
- Compression
- Breast milk
- Suction
The average age that healthy preterm infants reach full oral feedings is:
- 34 ½ weeks PMA
- 35 ½ weeks PMA
- 36 ½ weeks PMA
- 37 ½ weeks PMA
Which of the follow is (are) considered an infant-led feeding approach:
- Oral stimulation
- Massage
- Co-regulatory approach
- SOFFI
- Both C and D
Which of these is a benefit of breast feeding compared to bottle feeding:
- Fewer desaturations with breast feeding compared to bottle feeding
- Smaller volumes
- More frequent feedings
- None of the above
All breast fed infants have longer length of stays:
- True
- False

Course Quiz

Development of Internal Regulation and Feeding - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
Physiologic stability affects feeding in part because:
- Breathing slows in rate during sucking bursts
- Staff won’t try an infant on NCPAP
- Babies get tired during feeding
- Parents are afraid
One comorbid factor associated with slower feeding progression is:
- Teenage mother
- Patent ductus arteriosus
- ROP
- Siblings present during feedings
One thing the autonomic nervous system involuntarily regulates are internal body functions:
- True
- False
Taste buds develop in the fetus between:
- 5-7 weeks gestation
- 8-10 weeks gestation
- 11-13 weeks gestation
- 15-17 weeks gestation
The Parasympathetic Nervous System:
- Conserves energy
- Slows the heart rate
- Relaxes the sphincter muscles in the GI tract
- Increases intestinal and gland activity
- All of the above
Fetuses decrease swallowing when what taste is injected in the amniotic fluid:
- Sweet
- Sour
- Umami
- Bitter
- Salty
Bottle fed infants have more anterior spillage than breast fed infants:
- True
- False
The majority of taste buds in the mouth of a newborn infant are found:
- At the front of the mouth
- On the inside of the lower lip
- On the dorsal surface of the tongue
- On the cheeks

Course Quiz

Homeostasis as the Foundation for Feeding - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
The definition of Homeostasis as it relates to development is “the ability to __________________ in the face of increasing challenges and demands” (pick the correct answer to fill in the space):
- Maintain Internal Regulation
- Learn
- Tolerate the environment
- Look at your parent
The Synactive Organization of Behavioral Development has how many subsystems
- 3
- 4
- 5
- 6
The Theory of Neuronal Group Selection is a foundational theory used by the American Physical Therapy Association as part of their practice guideline:
- Yes
- No
Most maladaptive behaviors during mealtimes are:
- Escape/Avoidance behaviors
- Attention seeking
- Manipulative
- Funny
A fetus’ uterine environment provides:
- Low frequency sounds
- Tastes from the amniotic fluid
- Support for flexion of the arms and legs
- All the above
Medical comorbidities limit the ability of the infant to tolerate:
- External demands
- Medication delivery
- Maternal milk
- Bathing
In the study by Johnson, et al., 2016, eating problems at 2 years were independently associated with nasogastric feeding longer than:
- 2 weeks
- 4 weeks
- 6 weeks
- 8 weeks
In the classical conditioning paradigm, nausea is an unconditioned stimulus that leads to appetite suppression, which is called the:
- Conditioned response
- Conditioned stimulus
- Unconditioned response
- Unconditioned stimulus

Course Quiz

Supporting Parents and Infants During Early Feedings in the NICU - Quiz

Your information
Name*
First Last
Phone*
Email*
Professional license number (examples: ASHA, AOTA, NANN)
The Quiz
The primary emotion families have when they have a child with a feeding problem is:
- Fear
- Hope
- Anger
- Happiness
The definition of “nourish” is to:
- Feed
- Support during a period of training or development
- Nurture
- Fertilize
March of Dimes “My NICU Baby” is an app for the phone that can be a resource available to families in the NICU:
- Yes
- No
Babies who are born and then have to go into an intensive care unit experience a mismatch between biological expectations and their experience:
- Yes
- No
Based upon the Kirkby study of 2007, the percent of healthy babies born between 32 and 36 weeks GA that discharge with the need of a supplemental tube is:
- 5%
- 3%
- <1%
- 7%
Staff in the NICU can help parents feel attached to their infant in the NICU by:
- They include parents in decision-making.
- They encourage parents to get enough rest
- They help parents provide for their infant
- They tell families to go home and take a break
- Both A and C
- A, B and C
Parents need to be taught how to:
- Understand the cues of their baby
- Watch the monitor
- Provide stability for their baby’s motor system
- Provide rest breaks
- Both A and B
- A, C, and D
According to the study by Reyna and colleagues, after discharge from the ICU, mothers struggle with:
- Adjusting volume/schedule
- Managing other children
- Getting all of the household things done
- Paying bills
- Picking a bottle system

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