Mapping the Evidence for Allied Health Interventions for Preterm Infants With Feeding Aversion: A Scoping Review

To identify and map the evidence on allied health professional led interventions for preterm infants with feeding aversion, and to critically examine the literature to inform clinical practice and highlight research gaps.

A Joanna Briggs Institute scoping review was conducted. Systematic searches of MEDLINE, AMED, Embase, Emcare, PsycINFO, CINAHL and grey literature identified studies published between 2000 and 2024. All study designs were eligible. Data on study characteristics, interventions and outcomes were extracted and synthesised descriptively.

Thirty-five studies were included from 4016 records, with intervention studies comprising 37.1% (n = 13). Fifty-six intervention techniques were identified, most commonly targeting infants' environments (88.6%), behaviour (80%), body structures and movements (65.7%), and physiological states (62.8%). Interventions were delivered across outpatient (68.7%), home (43.7%), community (15.6%) and educational (12.5%) settings. Outcomes most frequently related to oral intake (72%), growth (64%), mealtime behaviours (40%), oral skills (32%) and caregiver outcomes (36%).

The evidence base for allied health interventions in this population is diverse but limited. Findings support clinical decision-making and highlight the need for more rigorous research to strengthen evidence and inform service delivery.

What is already known on the subject Negative oral or feeding experiences are already known to increase the risk of feeding aversion. A range of interventions for feeding aversion are described in the literature, but no single best-practice approach has been established. Very few studies focus specifically on preterm infants and few focus on infants under 2 years more generally. What this study adds to the existing knowledge This study mapped allied health interventions for preterm infants with feeding aversion, identifying fifty-six intervention techniques across eight intervention targets: the feeding environment, infant behaviour, body structures and movements, physiological systems and state, sensory organs and/or functions, relationships, participation, and knowledge. It highlights the importance of multidisciplinary team working in feeding aversion intervention and demonstrates that the intervention can be delivered across a range of settings, including outpatient, community, and telehealth services. What are the clinical implications of the study? This study defined feeding aversion by clinical presentation rather than diagnosis, capturing infants with medical complexity and comorbid needs which better reflects the complexity of patients seen in clinical practice. By mapping allied health intervention techniques, targets, dose, and settings for improving oral feeding in preterm infants with feeding aversion, it provides professionals with a practice profile against which to reflect on their own approach. The findings also support multidisciplinary working as the gold standard for feeding aversion intervention and suggest that early intervention may yield better outcomes than delaying treatment until the child is older.