The Fourth Annual NOMAS® International Symposium in San Francisco
"It's All About Feeding!" - October 10-12th, 2014
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Join professionals from many disciplines and three continents as they share their expertise and perspectives on feeding NICU infants. The 2014 NOMAS International Symposium - the fourth annual - will take place in San Francisco in October. Bringing together the most knowledgeable and experienced professionals in the fields of neonatal and pediatric feeding disorders, the symposium is a multi-disciplinary approach to feeding with presentations by Neonatologists, Pediatric Neurologists, Pediatric Gastroenterologists, Developmental Pediatricians, Nursing and Lactation specialists, NIDCAP Certified Developmental Specialists, Physical Therapy, Occupational Therapy, Nutrition, and Speech Pathologists.

Marjorie Meyer Palmer, M.A., CCC-SLP
NOMAS® International



Symposium Objectives

  • Identify and treat early feeding problems in infants with a variety of medical diagnoses
  • Outline differences in early sucking that are indicative of an "altered sensory system"
  • Describe developmental care in the nursery and its relevance to successful feeding
  • Explain dysphagia in the infant and predictors of adverse developmental outcome and feeding difficulties
  • Differentiate when laryngeal penetration in a NICU infant is significant and when it is not

1. Browse The Symposium Curriculum (click a day to see/hide events)

Day 1 - MAIN CONFERENCE - Friday, October 10th

08:00Welcome! Marjorie Meyer Palmer, M.A., CCC-SLP Founder and Director, NOMAS International.
08:15Context of the NICU Newborn: struggle for self-regulation in preparation for oral feeding. Kathleen A. VandenBerg, PhD.
09:15Gastrointestinal Development: implications for infant feeding. Josef Neu, M.D.
10:45Biorhythms of Suck/Swallow/Breathe during Infant Feeding. Ira H. Gewolb, M.D.
11:45Is it Neurologic?: dysphagia and neurologic disease in the newborn and young infant Peter Bingham, M.D.
12:45Panel Discussion; questions and answers.
2:30Predictors of Adverse Developmental Outcome and Feeding Difficulties. Ira Adams-Chapman, M.D.
4:00Sensory Aspects of Neonatal Sucking: early identification. Marjorie Meyer Palmer, M.A., CCC-SLP


7:00 Coffee / exhibits.
MEDICAL MODULE (8:00-9:30)
A.Olfaction and Early Feeding - Peter H. Bingham, M.D.
There is evidence that newborns and premature infants have a good sense of smell that helps organize their behavior. The way in which odors influence feeding responses of sick newborns in the NICU will be explained and suggestions for the modification of the olfactory environment of the sick newborn and young infant in order to promote their healthy growth will be discussed.
B.Diagnosing GER in Infants: a new accelerometric technique - Ira H. Gewolb, M.D.
Current methods of diagnosing gastroesophageal reflux in infants are invasive, cumbersome, and often lack reproducibility. The advantages and disadvantages of these current methods will be discussed and a new technology will be introduced. This new non-invasive technology can assess both acid and non-acid reflux and the ways in which it can benefit the field of early diagnosis of gastroesophageal reflux in infants will be discussed.
C.Diagnostic Criteria for Infant Feeding Disorders – Paul E. Hyman, M.D.
NICU conditions and prematurity predispose infants to having functional feeding disorders. The reasons for using symptom-based diagnostic criteria for infant feeding disorders will be discussed and the ways in which early recognition of infant feeding disorders will improve patient care will be reviewed.
BREAK (9:30)
NURSING MODULE (10:00-11:30)
A.Co-Regulation as a Strategy for Successful Feeding in the NICU – Suzanne Thoyre, PhD, RN, FAAN
The emergent skill of infant oral feeding will be described using a dynamic systems framework. Shifts in system complexity as a necessary component of assessment will be identified along with key skills required of the parent or professional for provision of an infant-guided, co-regulated feeding approach.
B.Improving Breast Feeding Success for the Preterm Infant - Kittie Frantz, RN, CPNP-PC
Skin to Skin maternal "laid back position" with "baby-led" attachment for the facilitation of better breast feeding in the preterm infant will be explained. Components of the infant suckle at the breast will be described and suggestions will be given for improved feeding for those infants who have difficulty. Ways to assist the nursing mother to improve her milk supply will be discussed.
C.Assessment of Readiness to Feed from a Nursing Perspective - gretchen Lawhon, PhD, RN, CBC, FAAN
The necessary organizational stability within the synactive theory for an infant to feed will be described and observable behaviors in the infant who is showing readiness to feed will be identified. Strategies to support the infant in actively participating in feeding will be explained.
LUNCH (11:30-1:00)
A.Total Body Development and its Relationship to Early Feeding - John Chappel,M.A., PT
The unique network of the aero-digestive system kinematics as it pertains to feeding difficulties will be explained and the inter-relationships and co-morbidities in the cervical spine and cranium that are impacted by the birth process, prematurity, and intubation will be described. Examples will be provided and participants will have the opportunity to analyze strategies that proactively will serve to prevent feeding and digestive problems in the NICU infant.
B.Understanding the NIDCAP Approach in the NICU and its Relationship to Successful Oral Feeding - Kathleen A. VandenBerg, PhD
The theoretical background and core neurodevelopmental concepts necessary to understand the NIDCAP approach in the NICU will be explained. Competencies, sensitivities, and self-regulatory behaviors related to successful oral feeding in high-risk infants will be identified as well as the impact of stress and the environment on feeding behavior. Specific individualized developmental family-centered care and behavioral strategies to stabilize and support oral feeding skills will be described.
C.Successful Feeding in the NICU: a preventative model - Kristy Fuller, OTR
Supportive pre-feeding and feeding strategies that provide a foundation for optimal oral feeding performance for all babies in the NICU will be outlined. Strategies to support unit practice with an emphasis on "qualitative" rather than "quantitative" feeding performance will be described and case studies will be utilized to help explain a preventative model that supports feeding success and ways to assist the NICU team and family in the implementation of this model.
BREAK (2:30-3:00)
A.Feeding Difficulties in Preterm Infants: evaluation procedures and treatment strategies – Pamela Dodrill, PhD
The potential impact of gestational age and co-morbidities on the attainment of early oral feeding milestones in preterm neonates will be described. A variety of assessment tools that can be used to evaluate oral feeding in this population will be reviewed and participants will learn evidence-based intervention techniques that can be used to assist with the establishment of early oral feeding.
B.Evaluation and Treatment of Feeding Disorders in Infants with Cardiac Disease - Laura Niemann, OTR/L
Common cardiac diagnoses and their impact on feeding will be identified and available assessment tools used for the complex neonate in the cardiac unit will be reviewed. Participants will develop an understanding of OT Pathways for both evaluation and treatment as it relates to feeding neonates in a cardiac unit.
C.Premature Infant Swallowing: patterns of tongue-soft palate coordination based upon videofluoroscopy - Kara Fletcher Larson, M.S., CCC-SLP
Videofluoroscopic findings of laryngeal penetration will be discussed and participants will learn when it is and is not clinically significant. Abnormal patterns of infant swallow will be identified and management strategies for pharyngeal reflux will be discussed.
ADJOURN (4:30)

Day 3 - IN-DEPTH FOCUS GROUPS (8:00-11:30) / DISCUSSION (3:00-3:30) - Sunday, October 12th

07:30 - 8:00 Coffee / exhibits.
A.Introduction to the EFS (Early Feeding Skills) Checklist -Suzanne Thoyre, PhD, RN, FAAN
The Early Feeding Skills checklist will be described as a means of identifying infant adaptations to the challenge of feeding. Participants will learn to identify the infant feeding responses that represent readiness for oral feeding, oral motor skills, the ability to organize swallowing, and the ability to engage in sufficient breathing to maintain physiologic stability. Behavioral patterns that infants adopt to protect their airway and attain sufficient breathing during feeding will be reviewed.
B.Clinical Application of the NNNS and its relationship to Feeding- Rosemarie Bigsby, Sc.D., OTR, FAOTA
The dynamical systems theory and its application to neonatal feeding will be explained. The components of the NICU Network Neurobehavioral Scale (NNNS) and summary scores will be reviewed and participants will learn how the NNNS can contribute to a contextual systems approach to infant feeding, incorporating autonomic, sensory, physiologic, motor, postural, and behavioral observations.
C.Training in Infant Feeding Management: a simulation to assist in interpreting vital signs during feeding – Pamela Dodrill, PhD
Normal and abnormal physiologic parameters for preterm neonates during feeding will be described. Participants will learn to accurately interpret case history information, identify medical equipment, and interpret vital signs monitors used to monitor preterm neonates during feeding. The benefits of human patient simulation in developing and maintaining clinical skills for monitoring during feeding will be outlined.
LUNCH (11:30-1:00)
DISCUSSION: Questions and Answers With Nils Bergman, M.D. (3:00-3:30)
What it means to feed an infant in the NICU: what is successful feeding?
Neurobehavioral techniques to support breast feeding in preterm infants will be described and the validity of the data provided to justify stomach capacity in the neonate and preterm feeding frequency will be addressed. Some of the consequences of failure to abide by biologically expected parameters for infant feeding that are easily predictable will be discussed.
ADJOURN (3:30)
Days 1-3 (inclusive) are offered for 1.85 ASHA CEU's. Various levels; Professional Area.
Days 1-3 (inclusive) are offered for 1.8 AOTA CEU's. Therapeutic Media is an AOTA Approved Provider of Continuing Education. AOTA does not endorse specific course content, products, or clinical procedures.
Days 1-3 (inclusive) 18 Contact Hours. Therapeutic Media is a Provider for Continuing Education by the California Board of Registered Nursing, Provider #CEP 13879.