The power of pretend: Caregiver perspectives on sham feeding for infants with long-gap esophageal atresia.

INTRODUCTION

Neonates with long-gap esophageal atresia (LGEA) experience oral aversion and prolonged feeding difficulties, even after surgical repair. Sham feeding-providing non-nutritive oral experiences-may support feeding skill development and caregiver bonding prior to anastomosis. This study explores the clinical and psychosocial impact of sham feeding in this population.

METHODS

We conducted a mixed-methods study of neonates who sham fed following implementation of a standardized protocol at our tertiary hospital. Demographic, surgical, and feeding data were collected via retrospective chart review. Mothers' perspectives were captured through semi-structured interviews, which were audio-recorded, transcribed, and thematically analyzed using a structured framework. Coding was iterative and refined through team consensus.

RESULTS

Eight infants with LGEA underwent sham feeding. Most were female (75 %) with a mean gestational age of 36.8 weeks. The majority (75 %) had type A EA, while 2 (25 %) had type C EA-TEF. Mean age at final surgery was 96 days. Half underwent primary anastomosis, while the remainder underwent traction. Six (75 %) had an anastomotic leak. Eight mothers participated in qualitative interviews. Five major domains emerged: (1) parental experience, including improved bonding and restored normalcy; (2) impact of sham feeding, encompassing avoidance of oral aversion; (3) support and communication, highlighting provider knowledge and peer connections; (4) logistical and practical challenges, such as privacy concerns and navigating feeding routines, and (5) knowledge and expertise acquired and transferred.

CONCLUSION

While clinical benefits remain unproven, sham feeding appears to offer meaningful psychosocial benefits for caregivers of infants with LGEA. These findings support ongoing use and evaluation of sham feeding.