Erin took time to understand

“I appreciated how Erin took time to understand the served population, staff make-up and needs, and our educational goals in her delivery and facilitation of the training. Erin’s presentation had a strong research basis that allows for concrete reflection, coupled with clinical and theory content.”

Knowledgeable and supportive of our team

“Erin Ross was knowledgeable and supportive of our team.  She skillfully set a tone of respect, collaboration and encouragement.”

Excellent course!

“Excellent course! I learned so much that I can take back to my practice. I feel I will be more likely to be to make better decisions regarding infant feeding.”

Erin Ross led a tremendous and dynamic workshop

“Erin Ross led a tremendous and dynamic workshop—extremely thorough and packed with solid, research-based information. I learned a huge amount. My brain feels like it grew a size. Erin’s presentation skills are excellent: to engage an auditorium for 2 days straight is quite an achievement. I like that she incorporates props, videos and photos. Her own presentation style is engaging, relatable/approachable, and very collaborative. Her information and answers to questions were all practical and respectfully communicated. I very much enjoyed these two days. I like how Erin’s approach incorporates the baby and parents’ perspective and experience. Thank you!”

Erin is an excellent presenter

"Erin is an excellent presenter. She is very knowledgeable and provides information backed by research and years of practice. She teaches applied knowledge you can use the next day in your practice.”

Enhanced my skills

“A comprehensive workshop for feeding. Enhanced my skills.”

This course is phenomenal!

“This course is phenomenal! It teaches you how to problem-solve and think about all the factors that impact bottle feeding! Erin gives great real-life examples and suggestions that you can put into practice right away. Excellent!"

I learned many new things about specialized bottle feeding.

“I learned many new things about specialized bottle feeding. I was pleasantly surprised at how much this conference validated many strategies I use as an OT."

Thank you so much for sharing your time with us.

“Erin is most knowledgeable and provides her information in a way that all in attendance can relate to and use techniques in their practice immediately. Thank you so much for sharing your time with us.”

Evidence-based practice is essential for optimizing outcomes in medicine and therapy.  SOFFI SM is grounded in evidence, and has been studied in several settings.

SOFFI SM   is the ONLY evidence-based intervention to date that assessed feeding skills both within the NICU setting AND after discharge, when parents were the primary feeders.  Additionally, it is the FIRST intervention that is designed for both premature infants, and infants with medical comorbidities.

Horner, S., Simonelli, A. M., Schmidt, H., Cichowski, K., Hancko, M., Zhang, G., & Ross, E. S. (2014). Setting the Stage for Successful Oral Feeding: The Impact of Implementing the SOFFI Feeding Program With Medically Fragile NICU Infants. J Perinat Neonatal Nurs, 28(1), 59-68.

In 2013, Horner, et al, published data from a tertiary-level NICU, with approximately 600 admissions per year.  Data related to feeding, growth and length of stay from a convenience sample of 81 infants pre-SOFFI SM training, compared to 75 infants recruited post-SOFFI SM training.  65 infants were preterm; 91 were term infants with medical comorbidities. Nearly 2/3 of each cohort had Neonatal Morbidity Index scores of 4 or 5 and were not significantly different (p=0.65).At 3-5 months post-term, semi-structured parent phone interviews related to feeding and growth at home were conducted (n=128).

Outcomes at NICU discharge:

At the time of discharge, length of stay and growth (g/kg/day) were not significantly different for either the preterm or term infants prior to or after SOFFI SM implementation.  Preterm infants did reach full oral feedings on average 8.5 days sooner (p=.01) in the cohort cared for after SOFFI SM implementation.  Shifting the focus from volume-driven to infant-led feedings may have improved feeding experiences without negatively impacting length of stay or growth outcomes.  Additionally, to date there is no evidence-based intervention that we know of that reliably shortens length of stay.

Outcomes after discharge:

Parents were interviewed by telephone when their infant was 3-5 months post-term.  At that time, several outcomes were significantly improved in the cohort of infants who were cared for after SOFFI SM implementation.  Specifically improvements were noted with fewer feeding problems (53% vs. 75%, p=.01), less arching with meals (10% vs 30%, p=.003), less spitting/vomiting with meals (35% vs. 59%, p=.006), and fewer infants were seeing a feeding therapist (25% vs 44%, p=.03).  Additionally, two additional questions trended towards significance (p=.06), “gagging with meals”(10% vs 21%) and “discomfort with meals” (10% vs. 21%).


Horner, S., Ross, E., Hancko, M., Simonelli, A. M., Cichowski, K., & Schmidt, H. (2014). The Impact of the SOFFI on Feeding Outcomes of Medically Fragile NICU Infants. Paper presented at the The Physical and Developmental Environment of the High Risk Newborn, St. Petersburg, FL.

A presentation at the Physical and Developmental Environment of the High Risk Newborn, this was a subanalysis of the original cohort.  When looking at the outcomes of infants with a Neonatal Morbidity Index score of 4, there were no differences in the number of infants discharging from the hospital either orally feeding exclusively, NG or G-Tube fed exclusively, or a combination of these methods.  However, during the parental interviews at 3-5 months post-term, significantly more infants were fully orally fed (p<.03) in the group that were cared for in the hospital after implementation of SOFFI SM.   Additionally, more of these infants were demonstrating fewer feeding problems, less arching with meals, less spitting/vomiting with meals, less gagging during meals, and fewer infants seeing a feeding therapist (p<.05).

Hanin, M., Nuthakki, S., Malkar, M. B., & Jadcherla, S. R. (2015). Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP. Dysphagia, 30(2), 121-127.

In 2015, a group of researchers implemented the SOFFI SM framework and tested the feasibility of feeding trials while on nasal continuous positive airway pressure with a cohort of term infants with bronchopulmonary dysplasia (BPD).  The SOFFI SM  algorithm guided decisions regarding baseline physiological and behavioral stability, and the need to stop a feeding trial.  Data from infants with BPD (37-42 weeks post menstrual age) that were orally fed while on NCPAP (n = 26) were compared with those that were exclusively gavage fed on NCPAP (n = 27). The cohorts were similar in demographic characteristics such as gender, gestational age, and birth weight, and clinical characteristics such as frequency of intraventricular hemorrhage and surgically corrected patent ductus arteriosus were similar (p > 0.05), as were characteristics of respiratory and airway function (p > 0.05). However, infants in NCPAP-oral fed group acquired full oral feedings 17 days earlier (median) versus infants who were not orally fed during NCPAP (p < 0.05).