Ineffective infant suck-swallow response

Domain 2. Nutrition
Class 1. Ingestion
Diagnostic Code: 00295
Nanda label: Ineffective infant suck-swallow response
Diagnostic focus: Suck-swallow response

Introduction to Nursing Diagnosis: Ineffective Infant Suck-Swallow Response

A nursing diagnosis of ineffective infant suck-swallow response (IISSR) is a condition that is diagnosed in infants when an infant has difficulty initiating and maintaining a suck-swallow reflex for feeding. This can lead to a lack of progress in the growth and development of the infant, so it is important that appropriate action is taken when an infant is diagnosed with this nursing diagnosis. The goal of care is to improve the infant’s ability to feed and promote their growth and development.

NANDA Nursing Diagnosis Definition

The NANDA nursing diagnosis definition for Ineffective Infant Suck-Swallow Response is “Failure of infants to initiate and maintain a coordinated suck-swallow reflex during feeding."

Defining Characteristics

The defining characteristics of Ineffective Infant Suck-Swallow Response are further divided into subjective and objective components. Examples of objective indicators of IISSR include the following:

• Peristaltic difficulty
• Lack of progression from suck to swallow
• Gagging or choking during feeds
• Extended time for feeds

Subjective indicators of IISSR can include reports of abdominal pain, nausea, or vomiting after feeding or loss of appetite.

Related Factors

Related factors for IISSR can include both medical and situational factors. Medical conditions that can contribute to IISSR include anatomical or neurological defects, gastroesophageal reflux disease, oral motor dysfunction, and post-nasal drip. Situational factors such as sickness, fatigue, anxiety, or poor positioning during feeding can also influence an infant's ability to effectively initiate and sustain a suck-swallow reflex.

At-Risk Populations

Infants who are born prematurely are at a higher risk of developing and/or experiencing IISSR, as are those born with congenital anomalies, low birthweight, physical disabilities, and ones who were exposed to certain drugs or substances during pregnancy.

Associated Conditions

Infants with IISSR can have an increased likelihood of failure to Thrive, aspiration, GERD, and dehydration due to prolonged or inadequate feedings.

Suggestions for Use

When diagnosing an infant or child with IISSR, it is important to assess the infant’s swallowing ability via a Modified Barium Swallow Study, evaluation of oral-motor structures, identification of positioning and posture techniques for improved success with feedings, as well as general assessments for overall health status.

Suggested Alternative NANDA Nursing Diagnoses

Suggested alternative NANDA nursing diagnoses to consider when diagnosing an infant or child with ineffective infant suck-swallow response, include Feeding Self-Care Deficit, Impaired Swallowing, Risk for Aspiration, or Risk for Nutrition Deficit.

Usage Tips

When using NANDA nursing diagnoses to describe an infant or child with IISSR, nurses should remember to include factors related to the diagnosis, such as associated conditions, related factors, and at risk populations. Additionally, it is important to list the evidence-based interventions that can help improve, maintain, or prevent the manifesting problem.

NOC Outcomes

Below is a list of potential NOC Outcomes related to Ineffective Infant Suck-Swallow Response:

• Feeding Self-Care – The ability of an infant or child to safely and effectively consume and utilize food for nutrition and health.
• Oral Mucosa Integrity – The ability to maintain an intact oral mucosa.
• Oral Motor Control – The ability to control oral movements.
• Swallowing Ability – The ability to swallow food or fluid without aspirating.

Evaluation Objectives and Criteria

When evaluating an infant or child with IISSR, some objectives and criteria to look for include the infant’s ability to demonstrate coordination in their suck-swallow reflex, reduced incidence of aspiration, and successful feeding sessions (with minimal/no discomfort).

NIC Interventions

Potential NIC Interventions related to Ineffective Infant Suck-Swallow Response can include:

• Swallowing Intervention – Providing the infant/child with methods that can help improve the suck-swallow reflex.
• Nutritional Screening – Assessing the individual’s nutritional status on an ongoing basis.
• Infant/Child Teaching – Educating the individual and their caregiver about the procedures needed to optimize the infant’s/child’s oral motor functioning.
• Positioning/Posture – Positioning the infant/child correctly for effective feeding and safe swallowing.

Nursing Activities

Nursing activities related to this diagnosis can include providing emotional support and psychosocial support for both the infant/child and their family members. Nurses should also offer education regarding techniques for promoting safety with feeding, positioning and posture assistance, as well as discussing nutrition and diet options to meet the infant/child’s nutritional needs.

Conclusion

Ineffective infant suck-swallow response is a complex nursing diagnosis that requires individualized management and monitoring to ensure the infant’s/child’s wellbeing and development. Nurses should be aware of potential contributing factors and associated conditions, while taking a holistic approach to care by not only considering evidence-based interventions and nursing activities, but also offering emotional and psychosocial support to both the infant/child and their caregivers.

Frequently Asked Questions

• What is Ineffective Infant Suck-Swallow Response?
  Ineffective Infant Suck-Swallow Response (IISSR) is a condition that is diagnosed in infants when an infant has difficulty initiating and maintaining a suck-swallow reflex for feeding.
• What are the associated conditions for IISSR?
  Infants with IISSR can have an increased likelihood of failure to Thrive, aspiration, Gastroesophageal Reflux Disease (GERD), and dehydration due to prolonged or inadequate feedings.
• What can nurses do to help an infant or child with IISSR?
  Nurses can assess the infant’s swallowing ability via a Modified Barium Swallow Study, provide positioning and posture techniques to improve feeding success, educate the infant/child and their caregiver about techniques for promoting safety with feeding, and offer emotional and psychosocial support.
• What are some potential NOC Outcomes related to IISSR?
  Potential NOC Outcomes related to Ineffective Infant Suck-Swallow Response can include Feeding Self-Care, Oral Mucosa Integrity, Oral Motor Control, and Swallowing Ability.
• How can healthcare professionals evaluate an infant or child with IISSR?
  When evaluating an infant or child with IISSR, healthcare professionals should look for the infant’s ability to demonstrate coordination in their suck-swallow reflex, reduced incidence of aspiration, and successful feeding sessions (with minimal/no discomfort).

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