Quiz: Supporting Parents and Infants during Early Feedings

1. The primary emotion families have when they have a child with a feeding problem is:
A. Fear
B. Hope
C. Anger
D. Happiness
2. The definition of “nourish” is to:
A. Feed
B. Support during a period of training or development
C. Nurture
D. Fertilize
3. March of Dimes “My NICU Baby” is an app for the phone that can be a resource available to families in
the NICU:
A. Yes
B. No
4. Babies who are born and then have to go into an intensive care unit experience a mismatch between
biological expectations and their experience
A. Yes
B. No
5. 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:
A. 5%
B. 3%
C. <1%
D. 7%
6. Staff in the NICU can help parents feel attached to their infant in the NICU by:
A. They include parents in decision-making
B. They encourage parents to get enough rest
C. They help parents provide for their infant
D. They tell families to go home and take a break
E. Both A and C
F. A, B and C
7. Parents need to be taught how to:
A. Understand the cues of their baby
B. Watch the monitor
C. Provide stability for their baby’s motor system
D. Provide rest breaks
E. Both A and B
F. A, C, and D
8. According to the study by Reyna and colleagues, after discharge from the ICU, mothers struggle with:
A. Adjusting volume/schedule
B. Managing other children
C. Getting all of the household things done
D. Paying bills
E. Picking a bottle system
 Quiz: Homeostasis as the Foundation for Feeding

1. 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):
A. Maintain Internal Regulation
B. Learn
C. Tolerate the environment
D. Look at your parent
2. The Synactive Organization of Behavioral Development has how many subsystems:
A. 3
B. 4
C. 5
D. 6
3. The Theory of Neuronal Group Selection is a foundational theory used by the American Physical Therapy
Association as part of their practice guidelines:
A. Yes
B. No
4. Most maladaptive behaviors during mealtimes are:
A. Escape/Avoidance behaviors
B. Attention seeking
C. Manipulative
D. Funny
5. A fetus’ uterine environment provides:
A. Low frequency sounds
B. Tastes from the amniotic fluid
C. Support for flexion of the arms and legs
D. All the above
6. Medical comorbidities limit the ability of the infant to tolerate:
A. External demands
B. Medication delivery
C. Maternal milk
D. Bathing
7. In the study by Johnson, et al., 2016, eating problems at 2 years were independently associated with nasogastric
feeding longer than:
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks
8. In the classical conditioning paradigm, nausea is an unconditioned stimulus that leads to appetite suppression,
which is called the:
A. Conditioned response
B. Conditioned stimulus
C. Unconditioned response
D. Unconditioned stimulus
 Quiz: Development of Internal Regulation

1. Physiologic stability affects feeding in part because:

A. Breathing slows in rate during sucking bursts
B. Staff won’t try an infant on NCPAP
C. Babies get tired during feeding
D. Parents are afraid
2. One comorbid factor associated with slower feeding progression is:
A. Teenage mother
B. Patent ductus arteriosus
C. ROP
D. Siblings present during feedings
3. One thing the autonomic nervous system involuntarily regulates are internal body functions:
A. True
B. False
4. Taste buds develop in the fetus between:
A. 5-7 weeks gestation
B. 8-10 weeks gestation
C. 11-13 weeks gestation
D. 15-17 weeks gestation
5. The Parasympathetic Nervous System:
A. Conserves energy
B. Slows the heart rate
C. Relaxes the sphincter muscles in the GI tract
D. Increases intestinal and gland activity
E. All of the above
6. Fetuses decrease swallowing when what taste is injected in the amniotic fluid:
A. Sweet
B. Sour
C. Umami
D. Bitter
E. Salty
7. Bottle fed infants have more anterior spillage than breast fed infants:
A. True
B. False
8. The majority of taste buds in the mouth of a newborn infant are found:
A. At the front of the mouth
B. On the inside of the lower lip
C. On the dorsal surface of the tongue
D. On the cheeks
 Quiz: Development of the Oral Motor System

1. The two kinds of sensory receptors in/around the larynx are:

A. Mature and Immature
B. Sensory and Motor
C. Mechano and Chemo
D. Alpha and Beta
2. One effect oral stimulation has had during one of the studies discussed was:
A. Poor weight gain in those in the oral stimulation arm
B. Better transition to solid foods
C. Less facial defensive behaviors
D. Enjoyment of hands-to-mouth
3. Suction is the first part of sucking to develop:
A. True
B. False
4. Volume is a direct result of the infant acquiring:
A. Compression
B. Breast milk
C. Suction
5. The average age that healthy preterm infants reach full oral feedings is:
A. 34 ½ weeks PMA
B. 35 ½ weeks PMA
C. 36 ½ weeks PMA
D. 37 ½ weeks PMA
6. Which of the follow is (are) considered an infant-led feeding approach:
A. Oral stimulation
B. Massage
C. Co-regulatory approach
D. SOFFI®
E. Both C and D
7. Which of these is a benefit of breast feeding compared to bottle feeding:
A. Fewer desaturations with breast feeding compared to bottle feeding
B. Smaller volumes
C. More frequent feedings
D. None of the above
8. All breastfed infants have longer length of stays:
A. True
B. False
 Quiz: Development of Feeding Across the First Year

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

1. Which of the following are associated with an increased risk of ongoing feeding problems:
A. Gastro-intestinal reflux disease
B. Neurologic disorders
C. Teenage mothers
D. Both A and B
E. None of the above
2. One comorbidity factor that is associated with a longer transition to full oral feedings is:
A. Lower birth weight
B. Absent parents
C. Adoptive situation
D. Surrogacy
3. One effect of respiratory issues on oral feeding is:
A. Longer transition to full oral feedings
B. Increased time spent awake
C. Increased neurologic problems
D. None of the above
4. One or more influence of cardiac issues on oral feeding is:
A. Increased vomiting
B. Babies spend more time playing
C. Difficulty with weight gain
D. A and B
E. A and C
5. The most common airway anomaly in infants is:
A. Laryngomalacia
B. Vocal fold nodules
C. Stenosis
D. Tracheal cleft
6. In the study by Sullivan, et al., 2000, what percent of parents identified that their child had an oral-
motor dysfunction:
A. Less than 5%
B. 5-10%
C. 72%
D. 100%
7. In the study by Rommel, et al, 2003, what percent of children referred to a tertiary multi-disciplinary
feeding clinic had GI issues:
A. 5%
B. 11%
C. 54%
D. 99%
8. 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:
A. True
B. False
 Quiz: Understanding the Language of the Newborn

1. One or more channel of communication in the Synactive Organization of Behavioral Development is:
A. Motor behaviors
B. Physiologic changes
C. Changes in awake/asleep/fussing
D. None of the above
E. All of the above
2. One behavior of readiness to engage in the physiologic system includes:
A. Appropriate digestion
B. Laughter
C. Grunting
D. Hiccups
3. One behavior of readiness to engage in the motor system includes:
A. Laughter
B. Kicking
C. Clapping
D. Rounded posture with tucked extremities
4. One behavior of readiness to engage in the attention/interaction system includes:
A. Calm, alert state
B. Drowsy state
C. Unclear whether infant is alert or asleep
D. Crying
5. One behavior indicating disengagement in the physiologic system includes:
A. Respiratory rate between 40-60 breaths/minute
B. Hiccups
C. Snoring
D. None of the above
6. The following behavior(s) indicating disengagement in the motor system include:
A. Flatness
B. Tightness
C. Muscle energy
D. None of the above
E. Both A and B
7. One behavior indicating disengagement in the behavioral state system includes:
A. Full range of behavioral states
B. Rapid transitions in states
C. Non-nutritive sucking
D. None of the above
8. 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:
A. True
B. False
 Quiz: The BROSS Approach

1. The first step in the BROSS framework is:

A. Obligatory
B. Integrated
C. Alternating
D. Stability in Bed with Handling
2. The defining characteristic of the Obligatory Step is:
A. The caregiver needs to intervene to help the infant regain physiologic stability
B. The baby can eat an entire bottle
C. The baby stays calm and happy
D. The baby is breathing within a sucking burst
3. In the alternating step, the word alternating refers to:
A. Alternating one oral feeding with one gavage feeding
B. Alternating breathing pauses with sucking bursts – not breathing within the sucking burst
C. Alternating breast then bottle feeding within a feeding
D. Alternating right side and left side at the breast
4. 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:
A. True
B. False
5. The defining characteristic of Integrated Step is:
A. The ability to integrate social interaction during feeding
B. Needing to integrate the feeder’s help to breathe while eating
C. Integrating crying when upset
D. Integrating the baby into the family unit
6. 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:
A. 1%
B. 10%
C. 60%
D. 80%
7. For the step coordinated, the word Coordinated refers to:
A. Coordinating sucking/swallowing and breathing that is rhythmic and predictable
B. Coordinating the transition between breast and bottle feeding
C. Coordinating across multiple different bottle systems
D. Coordinating feeding schedules
8. During the intermittent step, the infant takes brief catch breaths every __________ sucks:
A. 8-10
B. 11-13
C. 10-12
D. 2-3
E. single
 Quiz: Evidence Base for SOFFI®

1. Co-regulators and Observers are the same thing.

A. True
B. False
2. Research using SOFFI® by Horner and colleagues showed infants had a shorter length of stay after SOFFI® was
started.
A. True
B. False
3. In the feeding model for SOFFI® baseline stability is communicated by the infant through:
A. Physiologic stability
B. Motor stability
C. Behavioral state stability
D. A, B and C
E. A and C
4. Stability and instability of the baby are communicated through:
A. The monitors
B. The infant’s observable behaviors
C. The baby’s sucking
D. Parental confidence
5. In the study by Horner and colleagues, the majority of significant outcomes were seen in the 3-5 month
post-term time period:
A. True
B. False
6. Fewer infants seen by the SOFFITM staff after training had _____________ in the 3-5 month time period:
A. Feeding problems
B. Arching with meals
C. Spitting/vomiting
D. A Feeding Therapist
E. All of the above
7. Term babies who were in the SOFFI® group in the Horner study had a longer length of stay than the
study group:
A. True
B. False
8. In the Hanlin study, infants were fed on nasal CPAP by any professional staff member:
A. True
B. False
 Quiz: Interventions to Support Internal Regulation using SOFFI®

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

1. Identify at least one reported outcome of implementing feeding plans

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

1. One effect of long-term naso-gastric (NG) tube use on feeding development is:
A. More facial defensive behaviors
B. Better eating skill development than with G-Tubes
C. More sinus infections
D. Less stomach problems
2. One factor that impacts how tube feeding affects the development of normal eating and drinking skills:
A. Whether the tube was placed as a PEG or a Gastrostomy surgery
B. Exposure to taste and textures during sensitive periods
C. The number of times it comes out of the baby
D. Whether the parents put the tube in or professionals do
3. Breast milk is as effective as sucrose in alleviating pain during insertion of the tube:
A. True
B. False
4. According to the study by Ricciuto in 2015, food refusal was significantly associated with NG tube exposure
greater than:
A. 1 month
B. 2 months
C. 3 months
D. 4 months
5. 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:
A. True
B. False
6. One of the nutrients lost during continuous tube feedings is:
A. Calories
B. Calcium
C. Vitamin B
D. Fat
7. After flavor learning in utero, the next most important time to develop preferences appears to be during:
A. Middle school
B. Elementary school
C. Complementary feeding (beginning of purees/solids)
D. Preschool
8. To help an infant who is gagging/retching during tube feedings, consider:
A. A referral to gastro-enterology
B. A change in rate of infusion
C. A change in volume
D. All of the above