Supporting Safe Feeding Progression in Infants With Congenital Heart Disease: A Tool to Bridge Inpatient and Outpatient Care

Purpose: Infants with congenital heart disease (CHD) are at high risk for feeding difficulties, often resulting in delayed oral feeding progression, prolonged enteral tube dependence, and variability in clinical management. The purpose of this project was to develop a structured, risk-based Feeding Readiness Tool to support clinical decision making around oral feeding progression and improve continuity between inpatient and outpatient care. Method: As part of a quality improvement initiative, a multidisciplinary team of inpatient speech-language pathologists and an outpatient cardiology provider developed a three-tiered, color-coded Feeding Readiness Tool integrating cardiac status, aspiration risk, and associated clinical factors. The tool was piloted in select inpatient cases, with clinical application illustrated through three representative case studies corresponding to each readiness category (Green, Yellow, Orange). Feeding outcomes were measured using the Pediatric Functional Oral Intake Scale (p-FOIS) at discharge and 6 weeks postdischarge. Results: Across cases, the Feeding Readiness Tool categorization aligned with feeding trajectories. Infants in the Green and Yellow categories progressed to full oral feeding (p-FOIS Levels 5 and 6) within 6 weeks postdischarge, while the Orange case remained partially tube dependent (p-FOIS Level 3). The tool supported individualized, risk-stratified feeding plans and facilitated clearer communication across care teams during discharge planning and outpatient follow-up. Conclusions: This tool provides a practical, structured framework to support oral feeding progression in infants with CHD. Early application suggests it may enhance inpatient–outpatient communication, with potential to reduce variability in care, and may support more timely advancement of oral feeding when clinically appropriate. Further evaluation is needed to assess broader clinical outcomes.