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Okoli C., & Pawlowski S.D (2004). The Delphi method as a research tool: An example, design considerations and applications. Information & Management, 42, 15–29. http://dx.doi.org/10.1016/j.im.2003.11.002 [ Google Scholar] Question 5: Is there a need for the development of a validated clinical assessment instrument to use in clinical practice with neonatal dysphagia in the international arena?

Jadcherla S. (2016). Dysphagia in the high-risk infant: Potential factors and mechanisms. American Journal of Clinical Nutrition, 103( 2), 622S–6288S. http://dx.doi.org/10.3945/ajcn.115.110106 [ PMC free article] [ PubMed] [ Google Scholar] Question 3: Comment further on the sections and items in the NFAS if all your opinions/suggestions could not be expressed in the previous questions. Additional information could be offered that may not have been included by the preceding closed questions.

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Lau C., & Smith E.O (2011). A novel approach to assess oral feeding skills of preterm infants. Neonatology, 100, 64–70. http://dx.doi.org/10.1159/000321987 [ PMC free article] [ PubMed] [ Google Scholar] Thoyre S.M. (2007). Feeding outcomes of extremely premature infants after neonatal care. Journal of Obstetetrics, Gynecology and Neonatal Nursing, 36( 4), 366–376. http://dx.doi.org/10.1111/j.1552-6909.2007.00158.x [ PubMed] [ Google Scholar] As part of initial assessment the clinician should be able to recommend compensatory strategies to support successful feeding in the neonate. Strategies to consider may include modifying the positioning of the neonate during breast/bottle feeding, type of bottle/nipple used or external pacing during breast/bottle feeding. These strategies may empower the mother to feel in control of the feeding process and may build her confidence in meeting her infant’s nutritional needs. World Health Organization (WHO) (2001). International Classification of Functioning, Disability and Health (ICIDH-2). Retrieved March 10, 2011, from http://www.who.int Three themes were identified linked to the content sections of the first questionnaire. The first content theme was the Need for a valid assessment tool. The second theme was Content of the NFAS and the last was Scoring criteria. Only the first theme’s results are discussed with this objective. Questions 4 and 5 in the first questionnaire investigated the rationale for the development of the NFAS. All participants ( n = 5; 100%) agreed that the development of a valid clinical assessment tool was a relevant area of study and confirmed the need for such a tool. Some participants also provided further comments to reflect their agreement.

Rommel N. (2006). Assessment techniques for babies, infants and children. In Cichero J. & Murdoch B., Dysphagia: Foundation, theory and practice (pp. 466–486). San Diego, California: John Wiley & Sons, Ltd. [ Google Scholar] Swigert N.B. (2010). The source for pediatric dysphagia. East Moline, IL: LinguiSystems. [ Google Scholar] there is definitely a need for a well-researched assessment tool for use with infants…’ [Participant 4, Female, SLT] Pressman H. (2010). Dysphagia and related assessment and management in children with HIV/AIDS. In Swanepoel D. & Louw B. (Eds.). Prechtl H.F.R., & Beintema D.J (1964). The neurological examination of the full term newborn infant. Clinics in Developmental Medicine, 12, 1–49. [ Google Scholar]

Hall K.D. (2001). Pediatric dysphagia: Resource guide. San Diego, CA: Singular Thomson Learning. [ Google Scholar] World Health Organization (WHO) (2012). Born too soon. Retrieved December 17, 2015, from http://www.who.int section G [parent-neonate interaction] and H [use of compensatory strategies] are not that relevant to first-time assessment…I view it as part of treatment already…consider removing it from the current instrument’. [Participant 5, Female, SLT] Successful swallowing requires the coordination of 31 muscles and five cranial nerves. Neonatal anatomy, physiology, primitive oral reflexes and underlying cranial nerve function should be assessed.

Wolff P.H. (1959). Observations on human infants. Psychosomatic Medicine, 221, 110–118. http://dx.doi.org/10.1097/00006842-195903000-00004 [ PubMed] [ Google Scholar] Bahr D.C. (2001). Oral Motor Assessment and treatment: Ages and stages. Boston, MA: Allyn and Bacon. [ Google Scholar] De Matteo C., Matovich D., & Hjartarson A (2005). Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Developmental Medicine & Child Neurology, 47( 3), 149–157. http://dx.doi.org/10.1017/S0012162205000289 [ PubMed] [ Google Scholar] Faculty of Humanities (2004). Undergraduate syllabi and regulations. University of Pretoria, Pretoria. [ Google Scholar]The recommended scoring system of the NFAS (theme three) included allocation of marks if a skill and/or behaviour was present or absent. The clinician would then calculate a score for each section and a final score for feeding difficulties to conclude the assessment. The higher the score, the more likely a neonate could be diagnosed with OPD. Theme three dealt with the Scoring criteria. Statements were made, such as: Dawson B., & Trapp R.G (2004). Basic and clinical biostatistics. (4th edn). New York: Lange Medical Books/McGraw-Hill. [ Google Scholar] National Department of Health (2015). National consolidated guidelines for the prevention of mother-to-child transmission of HIV and the management of HIV in children, adolescents and adults. Retrieved July 26, 2016, from: http://www.doh.co.za Karl D.J. (2004). Using principles of newborn behavioural state organization to facilitate breastfeeding. American Journal of Maternal Child Nursing, 29( 5), 292–298. http://dx.doi.org/10.1097/00005721-200409000-00006 [ PubMed] [ Google Scholar] Brazelton T.B. (1973). Neonatal behavioural assessment scale. Clinics in Developmental Medicine No. 50. Philadelphia, PA: J.P. Lippincott. [ Google Scholar]

Arvedson & Brodsky, 2002; Clark, 2009; Hall, 2001; Van Haastert, De Vries, Helders & Jongmans, 2006 Da Costa S.P., & Van Der Schans C (2008). The reliability of the Neonatal Oral-Motor Assessment Scale. Acta Paediatrica, 97, 21–26. http://dx.doi.org/10.1111/j.1651-2227.2007.00577.x [ PubMed] [ Google Scholar]

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The purpose of clinical assessment is to observe the oral preparatory and/or oral stage of swallowing and make certain inferences about the pharyngeal stage, provide baseline feeding and swallowing data for further management and to determine progress. Hodgman J.E., Hoppenbrouwers T., & Cabal L.A (1993). Episodes of bradycardia during early infancy in the term-born and preterm infant. American Journal of Disabled Children, 147( 9), 980–984. http://dx.doi.org/10.1001/archpedi.1993.02160330050017 [ PubMed] [ Google Scholar] Brandao E., Dos Santos I., & Lanzillotti R.S (2013). Validation of an instrument to assess patients with skin conditions. Acta Paula Enfermage, 26( 5), 460–466. [ Google Scholar] Palmer M.M., Crawley K., & Blanco I (1993). Neonatal Oral-Motor Assessment Scale: A reliability study. Journal of Perinatology, 13, 28–35. [ PubMed] [ Google Scholar] Identify the significance and/or relevance of diagnostic procedures such as video fluoroscopic swallowing study, the infant focused feeding assessment, and those used in the evaluation of gastroesophageal reflux