Importance: No evidence-based treatment protocol currently exists for infants with vocal cord paresis (VCP).

Objective: To assess the impact of feeding position on feeding success among infants with unilateral VCP and examine other variables that may be associated with feeding success.

Design: Retrospective descriptive study.

Setting: Midwestern pediatric hospital serving rural and urban populations.

Participants: Sixty-seven infants age <1 yr diagnosed with unilateral VCP by otolaryngologist while inpatient.

Outcomes and Measures: Bottle or breastfeeding without the use of a thickening agent at discharge and without readmission for feeding difficulties ≤3 mo of discharge was considered feeding success.

Results: Chart review was completed for 67 infants with unilateral VCP. Infants fed in side lying were more likely to feed without use of a thickened liquid than infants fed in upright (70% vs. 17%; p = .01). Infants who had patent ductus arteriosus (PDA) ligation and infants who were premature were more likely to need thickener and to be readmitted for feeding difficulties.

Conclusions and Relevance: Further study is required to investigate the use of side-lying position versus upright position for feeding infants with VCP. Using the side-lying position allowed more infants to feed without thickener agents, and patient characteristics, including history of PDA ligation and prematurity, correlated with the need for thickened liquids and readmission. Consensus on the safety and efficacy of thickening breast milk is limited, so this information may allow more infants to breastfeed or drink expressed breast milk safely by bottle. It also provides medical providers information that can possibly prevent readmissions.

What This Article Adds: The results of this study can inform occupational therapy feeding practice through use of the side-lying position, as well as being aware of patient characteristics that are correlated with increased feeding difficulties.

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