Publication Date


Document Type


First Advisor

Olson, Janet

Second Advisor

Gladfelter, Allison

Degree Name

Ph.D. (Doctor of Philosophy)

Legacy Department

School of Interdisciplinary Health Professions


The purpose of this study was to examine the relationship between measures of physiological stability/instability during feeding. An additional aim was to determine if behaviors associated with physiological stability were also perceived as readiness or stress cues. Participants included 5 preterm infants (<37 weeks gestation) with no craniofacial anomalies. Infants were videotaped when they were taking at least 90% of prescribed volume. This study analyzed the common behaviors seen in preterm infants during bottle feeding to determine if there were associations with measures of physiological stability. Behaviors were also analyzed to determine which were perceived as indicating stress or readiness to feed by novice observers. Coding was conducted offline using Noldus Observer software.

Results revealed a statistically significant relationship between behaviors classified as stress cues and HR instability. There was not a significant association between stress cues and RR or SPO2. Binomial testing identified specific preterm infant feeding behaviors that were more often classified as stress cues, with significance noted in audible swallow and vocalization. Several of the specific preterm infant feeding behaviors were more often classified as stress cues by novice observers. This was not the case for readiness cues, which couldn’t be clearly classified. Vocalization was hypothesized a priori to be a readiness cue, however was more often perceived as a stress cue by novice observers. This finding reveals the need for additional study to identify different types of vocalizations and operationalize them in order to support caregiver’s perceptions and ability to respond appropriately, in order to maintain stability.

Additionally, there was a significant association of HR with preterm infant feeding behaviors, specifically those classified as stress cues. A significant association was found with audible swallow and furrowed brow with HR instability, which implies that feeders should pay close attention to these behaviors during the feeding. Heart rate has the potential to be used as a diagnostic tool as it may predict when specific behaviors are impacting physiological stability. Caregivers could then be taught to respond to those behaviors appropriately, thus supporting stable HR. The clinical implications of this have the potential to maximize overall feeding outcomes.


93 pages




Northern Illinois University

Rights Statement

In Copyright

Rights Statement 2

NIU theses are protected by copyright. They may be viewed from Huskie Commons for any purpose, but reproduction or distribution in any format is prohibited without the written permission of the authors.

Media Type