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Oral Feeding Patterns of Prematurely Born Infants and their Relationship to Expressive Language Outcome

Ava Harvey, MS-4¹; Rawad Obeid, MD^1,2; Michelle Jankowski, MAS¹; Nicole Rikard, OTRL²; Laura Bashir, MS, RD, CSP²

¹Oakland University William Beaumont School of Medicine, Rochester Hills, MI; ²Corewell Health Children’s Hospital, Royal Oak, MI

Background

Premature birth (< 37 weeks’ gestation) is linked to oral feeding difficulties and expressive language delays.

Up to 80% of preterm infants experience feeding issues during NICU stay.¹
42% continue to have feeding problems into early childhood.^1,2
5-12% of children ages 2-5 are diagnosed w/ speech or language delay, with prematurity as a risk factor.³

Oral motor skills develop through exposure to varied food textures.⁴

Limited intake of solids reduces muscle strength for chewing and speech.^4,5

Expressive language development is closely tied to oral motor skills and feeding experiences.¹
Long-term impacts of early feeding patterns on language outcomes in preterm infants remain unclear.⁶

Specific Aims

To assess the oral feeding patterns of premature infants at 12 months corrected age (CA), focusing on whether their diets are primarily liquid-based (breast milk/synthetic formula), pureed, or solid consistencies.
To examine whether the diet consistency at 12 months CA influences early oral motor and expressive language development in the second year of life.

Methods

Design: Retrospective chart review
Setting: Neurodevelopment Clinic at Corewell Health Children’s Hospital (Feb 2020-Feb 2024)
Inclusion: Attended both 2^nd and 3^rd follow-up visits
Exclusion: Genetic syndromes or missing follow-up visits above
Assessments:

2^nd visit (between 7-12 months corrected age): Feeding pattern (liquid, pureed, solid diet) via occupational therapist assessment
3^rd visit (between 13-20 months corrected age): Expressive language outcome via pediatric neurologist assessment

Analysis: Chi-square and logistic regression (p < 0.05)

Adjusted analyses controlled for: gestational age, birth weight, mother age at delivery, NICU length of stay, bronchopulmonary dysplasia, and periventricular leukomalacia

Results

Figure 1. Percentage of cohort consuming each type of diet at their 2^nd follow-up visit, occurring between 7-12 months corrected age.

Figure 2. The distribution of the dominant oral feeding pattern among preterm infants at their 2^nd follow-up visit between 7-12 months corrected age (CA) with and without expressive language delays assessed at their 3^rd follow-up visit between 13-20 months CA. **Values of p < 0.05 were considered to be statistically significant.

Figure 3. Forest plot demonstrating the unadjusted and adjusted odds ratios with 95% confidence intervals for language delay risk in relation to oral feeding patterns from logistic regression analysis. Adjusted analyses controlled for gestational age, birth weight, NICU length of stay, bronchopulmonary dysplasia, and periventricular leukomalacia. **Values of p < 0.05 were considered to be statistically significant.

Discussion

Key Findings and Interpretation:

Infants fed pureed diets at 7-12 months CA had 8.9x higher odds of expressive language delay at 13-20 months CA.
Liquid diets were also associated with delay, though only marginally significant after adjustment.
Delayed exposure to textured foods may hinder oral motor and sensory development.

Thus, impacting speech acquisition during critical neurodevelopmental windows.

Early, age-appropriate feeding transitions and multidisciplinary support (speech, OT, nutrition) are crucial for promoting language outcomes.

Limitations:

Possible recall bias
Lack of data on parental feeding behaviors
Single-center design limiting generalizability

Strengths:

Comprehensive neurodevelopmental evaluations
Use of both unadjusted and adjusted analyses

Future research should explore:

Long-term outcomes later through childhood
Intervention strategies
Neural mechanisms through neuroimaging

References

Pados BF, Hill RR, Yamasaki JT, Litt JS, Lee CS. Prevalence of problematic feeding in young children born prematurely: a meta-analysis. BMC Pediatr. 2021;21:110. doi:10.1186/s12887- 021-02574-7
Kamity R, Kapavarapu PK, Chandel A. Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management. Children. 2021;8(12):1158. doi:10.3390/children8121158
Othman A. Child Developmental Delays and Disorders: Speech and Language Delay. FP Essent. 2021;510:17-21
Bean A. Oral-Motor Skills. In: Volkmar FR, ed. Encyclopedia of Autism Spectrum Disorders. Springer; 2013:2091-2092. doi:10.1007/978-1-4419-1698-3_1685
Webber C, Blissett J, Addessi E, Galloway AT, Shapiro L, Farrow C. An infant-led approach to complementary feeding is positively associated with language development. Matern Child Nutr. 2021;17(4):e13206. doi:10.1111/mcn.13206
McGowan EC, Vohr BR. Neurodevelopmental Follow-up of Preterm Infants: What Is New? Pediatr Clin North Am. 2019;66(2):509-523. doi:10.1016/j.pcl.2018.12.015

Acknowledgements

Thank you to my mentor, Dr. Rawad Obeid, for his exceptional guidance, unwavering support, and insightful feedback. I would also like to thank Michelle Jankowski, whose invaluable statistical expertise was critical in analyzing the data and interpreting the findings of this study, as well as Nicole Rikard, Laura Bashir, and Shirley Qu.