Maternal reported long-term outcomes of early feeding challenges from hospital discharge to early childhood

Abstract

Background

Feeding difficulties are common in early infancy and may persist beyond the neonatal period, affecting growth, development, and the parent-infant relationship. While existing research has largely focused on short-term breastfeeding outcomes, there is limited understanding of how early feeding challenges evolve across infancy and early childhood.

Aim

To examine associations between maternal-reported feeding challenges experienced during the birth hospitalisation and the presence of ongoing feeding difficulties in infancy and early childhood, and to describe the frequency, nature, and progression of early and current feeding concerns.

Methods

A cross-sectional online survey was completed by 147 mothers of children born between 2020 and 2023, predominantly from Australia, who experienced feeding difficulties from birth. The questionnaire included structured and open-ended questions regarding hospital feeding experiences, post-discharge outcomes, and current feeding status. Descriptive statistics and Fisher’s Exact Tests were used to examine associations between early feeding challenges and current feeding difficulties.

Results

Feeding difficulties during the initial hospital stay were reported by 68% of participants, and 32.7% of the children were reported to have current feeding problems. Early sucking difficulties and tongue-tie were significantly associated with ongoing feeding concerns (p = 0.039 and p = 0.036, respectively). Tube feeding and the absence of breastfeeding during hospitalisation were more commonly reported among infants with early feeding difficulties. Nearly one-third of infants required hospital readmission post-discharge, most commonly for feeding-related complications.

Conclusion

Maternal reports suggest that early feeding challenges identified during hospitalisation are commonly reported and may be associated with ongoing feeding difficulties in infancy and early childhood. These findings highlight the importance of early identification, multidisciplinary assessment, and consistent feeding support prior to discharge. Further prospective research is needed to determine which screening and support approaches most effectively improve long-term feeding outcomes.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12887-026-07335-y.

Introduction

Feeding difficulties are common in early infancy and represent a major global problem, affecting a significant proportion of newborns across diverse populations [1]. Prevalence estimates range from 25% to 45% in typically developing children [2] and may rise to 72% in infants with acquired conditions during acute care hospitalisation, such as traumatic brain injury [3]. These challenges may include latching difficulties, poor sucking reflexes, or anatomical anomalies such as tongue-tie, and can contribute to early cessation of breastfeeding, maternal stress, and reduced confidence in caregiving [4]. In some cases, feeding issues become persistent and multifactorial, with implications for long-term growth, neurodevelopment, and caregiver well-being [5, 6].

The early postnatal period is a critical window for establishing successful breastfeeding and responsive feeding interactions [7, 8]. However, many families face barriers during this transition, including inadequate support, inconsistent hospital practices, and insufficient screening for oral-motor difficulties [9–11]. This is particularly true for mothers who undergo caesarean sections or experience medical complications, which can delay skin-to-skin contact and disrupt early bonding and lactation physiology [9, 12]. Feeding issues in the early days are often poorly addressed, despite growing evidence linking them to long-term impacts on parent-infant relationships, mental health, and developmental trajectories [13–15].

Although extensive research exists on breastfeeding rates and determinants in the immediate postnatal period [16], few studies have explored the progression and resolution of early feeding challenges into later infancy and childhood [17, 18]. Longitudinal data on this topic are critical for identifying infants at risk of persistent feeding problems and for designing early intervention models. Some studies have begun to explore the long-term outcomes of specific conditions, such as tongue-tie, preterm birth, or neurodevelopmental risk factors [19–21], but there remains a lack of comprehensive, family-centred research that reflects the lived experience of families navigating these difficulties over time.

The potential costs of delayed or inadequate feeding support are substantial. Suboptimal feeding practices have been associated with increased healthcare utilisation, including higher rates of re-hospitalisation, early weaning, and referrals for specialist care [22, 23]. The economic burden includes both public health expenditures and out-of-pocket costs for families, particularly those requiring multidisciplinary feeding support [24, 25]. Moreover, disruptions to early feeding interactions can undermine maternal self-efficacy and contribute to anxiety or depression, further compounding the risk of feeding problems [8, 13, 15].

Despite growing awareness of the importance of early feeding support, there remains a lack of longitudinal research examining the progression of feeding difficulties from infancy into early childhood. Most existing studies focus on short-term breastfeeding outcomes, with limited insight into whether early feeding challenges resolve or persist as children grow [17]. A greater understanding of these patterns is essential to inform clinical guidelines and improve long-term support for affected families. Therefore, the aim of this study was to explore the relationship between early feeding challenges experienced during the initial hospital stay and the presence of ongoing feeding difficulties in infancy and early childhood. This study also sought to describe the frequency and nature of early feeding challenges and categorise current feeding issues reported by mothers.

Methods

Study design

This study followed a quantitative cross-sectional design using an original, purpose-built questionnaire. The study aimed to explore the relationship between early feeding challenges in the hospital and ongoing feeding difficulties in infants and young children. Mothers who had more than one child born in a hospital during the study period and who experienced feeding difficulties were permitted to submit separate entries for each child. Each completed questionnaire corresponded to a single infant, and responses were treated as independent infant-level observations; no within-participant repeated-measures analyses were undertaken.

Data collection

Participants were recruited through an online advertisement that included a link directing them to the Participant Information Statement and Informed Consent Form. Consent was obtained electronically, with participants indicating agreement by selecting “yes” before proceeding. Once consent was provided, participants accessed a self-administered online questionnaire specifically designed for this study. The questionnaire was available online from April 2023 to January 2025.

The questionnaire was purpose-designed for this study and developed in collaboration with four speech-language pathologists with expertise in neonatal and infant feeding, including clinicians working in neonatal intensive care units, paediatric feeding therapy, and lactation contexts, as well as two lactation consultants. Questionnaire items were informed by existing literature and previously published surveys examining breastfeeding experiences, bottle feeding, readiness for oral feeding, and early feeding challenges. Prior to distribution, the questionnaire was reviewed by academic supervisors and experienced clinicians for clarity, relevance, and face validity. Informal trialling was undertaken within the research team; however, formal pilot testing with participants was not conducted.

The questionnaire comprised 20 closed-ended questions and 20 related sub-questions. The first three questions collected demographic information about the mother and the infant. Additional sections included five questions and two sub-questions about pregnancy and birth, five questions and ten sub-questions about feeding, six questions and eight sub-questions regarding infant feeding support received at the hospital, and one question with two sub-questions on current feeding practices in infancy or early childhood (e.g., Did you have difficulties with breastfeeding your child in the hospital?, Did you seek help from breastfeeding professionals after you left the hospital?).

Although the questionnaire was developed to collect a broader dataset, only the items relevant to the aims and analyses of the present study were included in this manuscript. The questionnaire has not been previously published, and the items relevant to this study are provided as supplementary material (Supplementary Material 1). The questionnaire was available on the REDCap platform and completed anonymously.

Participants

Participants were recruited via convenience sampling through online advertisements distributed on social media platforms and parent-focused online forums related to infant feeding and early parenting. The target population comprised mothers of infants and young children born between 2020 and 2023 who experienced feeding difficulties during the neonatal period, before hospital discharge after birth.

Participants were predominantly born in hospitals across multiple states in Australia, with a small proportion of participants reported births in hospitals located in the United States, the United Kingdom, Brazil, Ghana, and other countries. Given the small number of participants from countries outside Australia, the study was not powered to conduct meaningful comparisons between Australian and international respondents. As such, analyses were not stratified by country. Because of the exploratory nature of the study and the use of convenience sampling, no formal a priori sample size calculation was undertaken.

Data analysis

Data was exported from REDCap into into IBM Statistical Package for the Social Sciences – SPSS (version 28, IBM Corp., Armonk, NY) for statistical analysis. Descriptive statistics were used to summarise participant characteristics and survey responses, reported as means and standard deviations or medians and interquartile ranges, as appropriate. Inferential statistics were used to examine associations between early feeding challenges and current feeding difficulties, and to compare subgroups. Distribution of continuous variables was assessed visually and through normality testing, which indicated non-normal distributions; therefore, non-parametric tests were applied where appropriate. Chi-square tests were used for categorical variables where all expected cell counts were sufficient; otherwise, Fisher’s Exact Test was applied. Statistical significance was set at p < 0.05 with a power of 0.80.

Ethics approval

Ethical approval for this study was obtained from the University of Sydney Human Research Ethics Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards (Approval No. 2022/852). The study was conducted in accordance with the ethical standards of the University of Sydney Human Research Ethics Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Raw data are restricted to the principal investigator and supervisors to ensure the confidentiality of participants.

Results

A total of 147 completed survey responses were included in the final analysis, each corresponding to an individual child with feeding difficulties identified during or after the birth hospitalisation period. Incomplete questionnaires were automatically excluded by REDCap and were not accessible to the research team. Because the survey was anonymous, it was not possible to determine how many mothers contributed more than one response; however, each response was treated as an independent infant-level observation. The average maternal age was 36.9 years (SD = 6.2), the mean gestational age at birth was 36.8 weeks (SD = 5.4), and infants were 1 year and 1 month (4 months to 2.4 years) when mothers responded the survey. Just over half of the infants were delivered vaginally (53.1%), while the remainder were born via caesarean Sect.  (46.9%). Of the 147 infants, 71.4% (105) were in the maternity ward after birth, 18.3% (27) were in the neonatal intensive care unit (NICU), and 6.8% (10) were in the special care nursery. During the hospital stay, 19% of infants required tube feeding. Despite these challenges, 89.8% of mothers reported initiating breastfeeding in the hospital, and 51% received professional support with feeding before discharge.

The information about early feeding challenges reported during the initial hospital stay is described in Table 1. Out of 147 participants, 68% of mothers reported that their infants experienced feeding problems during the initial hospital stay. The most commonly reported difficulties were issues with sucking (49%), followed by tongue-tie (23.8%) and sleepy infant behaviours that interfered with effective feeding (22.4%). A smaller proportion of mothers reported concerns related to aspiration, such as coughing or choking (8.2%), or marked “other” types of difficulty (10.2%). Among mothers who reported tongue-tie, the professionals identified as having diagnosed or raised concerns regarding the condition included lactation consultants/IBCLCs, speech-language pathologists, nurses, midwives, dentists, physicians, oral motor specialists, and obstetricians. In some cases, mothers also described identifying concerns themselves prior to later professional confirmation. Because these data were based on maternal report and professional terminology varied considerably across responses, diagnoses could not be independently verified and were interpreted descriptively only. These findings highlight that nearly two-thirds of newborns in this cohort encountered at least one feeding challenge before discharge.

Table 1.

Early feeding challenges reported during initial hospital stay

Infants’ information	n (%)
Feeding problems during hospital stay	-
Yes	100 (68%)
No	47 (32%)
Type of feeding difficulty	-
Sucking	72 (49%)
Tongue-tie	35 (23.8%)
Sleepy infant	33 (22.4%)
Other	15 (10.2%)
Signs of aspiration (cough/choking)	12 (8.2%)

The reasons for infants to return to the hospital after discharge are presented in Table 2. Of the 147 infants represented in this study, 43 (29.3%) were re-hospitalised after discharge from the birth hospital. Feeding-related concerns were the most common reason for readmission, with 44.2% of these infants returning due to feeding problems and an additional 41.9% due to weight loss, often associated with poor feeding. Other reasons included respiratory concerns (11.6%) and jaundice (11.6%). These data suggest that early feeding challenges not only persisted after discharge for many families but were significant enough to require further inpatient care.

Table 2.

Reasons for infant re-hospitalisation following discharge

Infants who returned to the hospital	n (%)
Reason for re-hospitalisation	-
Feeding problems	19 (44.2%)
Weight loss	18 (41.9%)
Other	17 (39.5%)
Jaundice	5 (11.6%)
Breathing problems	5 (11.6%)

A subgroup analysis revealed a statistically significant difference in hospital readmission rates based on whether feeding difficulties were observed during the initial hospital stay. Among infants who experienced early feeding challenges, 35% required readmission after discharge. In contrast, only 17% of those without identified hospital feeding difficulties were readmitted. This difference was statistically significant (p = 0.032), with an odds ratio of 2.63, indicating that infants with early feeding difficulties were more than twice as likely to be readmitted. These findings underscore the potential long-term implications of unresolved feeding challenges and highlight the importance of timely intervention during the birth admission period.

The feeding difficulties identified after hospital discharge are described in Table 3. At the time of data collection, 48 children (32.7%) were reported to have ongoing feeding difficulties beyond the neonatal period. Within this group, thematic analysis of open-text responses revealed that 23.5% described their child’s feeding difficulty in non-specific or varied terms (e.g., sensory concerns, reflux, or avoidant/restrictive food intake disorder - ARFID), while 23.5% indicated picky eater or feeding refusal, 21.6% identified oral motor or latching difficulties, 21.6% reported risk of aspiration or choking, and 9.8% referenced ongoing structural concerns such as tongue-tie or lip-tie. These results reflect the heterogeneous and persistent nature of feeding challenges, even years after birth.

Table 3.

Current feeding difficulties

Feeding difficulties after hospital discharge	n (%)
Current feeding difficulties
No	99 (67.3%)
Yes	48 (32.7%)
Type of feeding difficulty	-
Other / Unclear	12 (23.5%)
Picky eater / Feeding refusal	12 (23.5%)
Oral Motor / Latching	11 (21.6%)
Signs of aspiration (cough/choking)	11 (21.6%)
Tongue-tie/lip-tie	5 (9.8%)

At the time of questionnaire completion, children ranged in age from approximately 4 months to 2.4 years. Forty-eight children (32.7%) were reported to have current feeding difficulties at the time of maternal report. Of the total sample, 33 children (22.4%) were reported to be receiving ongoing professional support for feeding difficulties when the questionnaire was completed. These data indicate that a substantial proportion of children with current feeding concerns were engaged with healthcare professionals at the time of reporting, although the study did not capture the type, timing, or duration of feeding-related interventions.

The relationship between early hospital factors and the type of feeding difficulties reported in early childhood is outlined in Table 4. This analysis aimed to identify whether specific birth-related experiences, such as breastfeeding during hospital stay, tube feeding, or intubation, were associated with later feeding presentations. Among infants who were not breastfed in the hospital, higher proportions of oral motor/latching difficulties (28.9%) and picky eating or feeding refusal (28.9%) were reported compared to their breastfed counterparts. Similarly, signs of aspiration (e.g., coughing or choking during feeding) were more common among those who were not breastfed (18.4%), though none of these associations reached statistical significance. Infants who were tube-fed during hospitalisation were more likely to experience aspiration (41.7%) and picky eating (33.3%) later in life, while those who were intubated at birth showed elevated rates of feeding refusal (44.4%) and tongue-tie/lip-tie (11.1%). Across all hospital factors examined, Fisher’s Exact Test did not yield statistically significant associations.

Table 4.

Associations between birth environment factors and early feeding outcomes

Early hospital factor	Type of feeding difficulty	Yes (%)	No (%)	p-value
	Oral Motor/Latching	11 (28.9%)	27 (71.1%)	0.089
	Signs of aspiration	7 (18.4%)	31 (81.6%)	0.206
Breastfed in Hospital	Picky eater/Feeding refusal	11 (28.9%)	27 (71.1%)	0.414
	Tongue-tie/lip-tie	2 (5.3%)	36 (94.7%)	0.187
	Other/Unclear	9 (23.7%)	29 (76.3%)	0.695
Feeding Tube	Oral Motor/Latching	1 (8.3%)	11 (91.7%)	0.248
	Signs of aspiration	5 (41.7%)	7 (58.3%)	0.113
	Picky eater/Feeding refusal	4 (33.3%)	8 (66.7%)	0.462
	Tongue-tie/lip-tie	1 (8.3%)	11 (91.7%)	1.000
	Other/Unclear	2 (16.7%)	10 (83.3%)	0.703
	Oral Motor/Latching	0	9 (100.0%)	0.095
	Signs of aspiration	2 (22.2%)	7 (77.8%)	1.000
Intubation at Birth	Picky eater/Feeding refusal	4 (44.4%)	5 (55.6%)	0.199
	Tongue-tie/lip-tie	1 (11.1%)	8 (88.9%)	1.000
	Other/Unclear	2 (22.2%)	7 (77.8%)	1.000

A detailed comparison of early feeding difficulties and ongoing concerns is presented in Table 5. Fisher’s Exact Test was used to examine associations between specific feeding issues identified during the hospital stay (e.g., sucking, tongue-tie, sleepy infant, aspiration signs) and the type of current feeding difficulty reported by mothers. While most comparisons did not reach statistical significance, one noteworthy association emerged: children with a history of tongue-tie who later presented with sucking difficulties were significantly more likely to report ongoing feeding issues (p = 0.039). Other early difficulties, such as sucking problems, aspiration signs, and sleepy infant behaviours, showed elevated percentages of persistent feeding challenges in some categories, particularly when compared across different feeding presentations (e.g., sucking + aspiration = 58.3%), though these did not reach statistical significance.

Table 5.

Longitudinal comparison of early feeding difficulties and ongoing concerns

Early feeding difficulties	Current feeding difficulty	Yes (%)	No (%)	p-value
Sucking	Sucking	6 (54.5%)	5 (45.5%)	0.113
	Tongue-tie	3 (60.0%)	2 (40%)	0.587
	Sleepy infant	2 (66.7%)	1 (33.3%)	1.000
	Signs of aspiration	7 (58.3%)	5 (41.7%)	0.143
	Other/Unclear	20 (83.3%)	4 (16.7%)	0.318
Tongue-tie	Sucking	4 (36.4%)	7 (63.6%)	0.039*
	Tongue-tie	0	5 (100%)	1.000
	Sleepy infant	0	3 (100%)	1.000
	Signs of aspiration	2 (16.7%)	10 (83.3%)	1.000
	Other/Unclear	3 (12.5%)	21 (87.5%)	1.000
Sleepy infant	Sucking	6 (54.5%)	5 (45.5%)	0.488
	Tongue-tie	2 (40%)	3 (60%)	1.000
	Sleepy infant	0	3 (100%)	0.255
	Signs of aspiration	5 (41.7%)	7 (58.3%)	1.000
	Other/Unclear	11 (45.8%)	13 (54.2%)	0.770
Signs of aspiration	Sucking	1 (9.1%)	10 (90.9%)	1.000
	Tongue-tie	1 (20%)	4 (80%)	0.503
	Sleepy infant	0	3 (100%)	1.000
	Signs of aspiration	1 (8.3%)	11 (91.7%)	1.000
	Other/Unclear	3 (12.5%)	21 (87.5%)	1.000
Other/Unclear	Sucking	1 (9.1%)	10 (90.9%)	0.248
	Tongue-tie	3 (60%)	2 (40%)	0.092
	Sleepy infant	2 (66.7%)	1 (33.3%)	0.150
	Signs of aspiration	5 (41.7%)	7 (58.3%)	0.143
	Other/Unclear	3 (12.5%)	21 (87.5%)	0.093

^*Significant = p < 0.05

Discussion

Feeding difficulties in infancy are a common concern, yet their persistence and long-term implications remain underexplored. In this study sample, a substantial proportion of mothers (68%) reported that their infants experienced feeding challenges during the initial hospital stay, with approximately one-third (32.7%) continuing to face ongoing feeding issues beyond discharge. These findings do not provide estimates of population prevalence, but rather reflect the experiences of mothers who self-selected to participate in a study focused on feeding challenges. Importantly, the data highlight that, for many families, early feeding difficulties do not resolve spontaneously and may evolve into persistent concerns requiring ongoing management. Although no statistically significant associations were found between most birth-related experiences and later feeding difficulties, descriptive trends were observed among infants with early sucking difficulties or tongue-tie, who later presented with specific types of feeding challenges, including ongoing sucking or oral-motor coordination issues.

One statistically significant finding (p = 0.039) was observed among infants diagnosed with tongue-tie who later developed sucking difficulties, suggesting a potential trajectory from anatomical restriction to functional impairment. Although most comparisons in the stratified analyses did not reach statistical significance, several trends pointed toward persistent feeding concerns in infants with early oral-motor or aspiration-related issues. While these findings should be interpreted cautiously, the observed patterns highlight the potential importance of early recognition and structured intervention prior to discharge, as the trajectory of feeding problems appears to begin in the newborn period and can extend well into early childhood.

The proportion of early feeding difficulties observed in this study is consistent with existing research, particularly among infants with perinatal complications or those admitted to neonatal intensive care units (NICUs), where rates can reach up to 80% [18]. However, this study expands on previous findings by showing that feeding concerns are not confined to the NICU population but are also common among infants born at term and without significant medical complications.

Moreover, early feeding problems, especially those related to oral-motor coordination and anatomical restrictions, have been shown to increase the risk of long-term developmental concerns, including impaired growth, delayed weaning, and cognitive or behavioural challenges later in childhood [19]. Among these, tongue-tie (ankyloglossia) has gained particular attention due to its well-established impact on effective breastfeeding. Research indicates that untreated ankyloglossia can limit tongue mobility, reduce milk transfer, and contribute to nipple pain, early cessation of breastfeeding, and maternal distress [20]. Interventions such as frenotomy have been associated with improvements in both latch and maternal comfort, but identification of tongue-tie often varies between services. This variability in diagnostic practice is important to consider when interpreting the present findings, particularly given ongoing variation in perspectives regarding the diagnosis, prevalence, and functional significance of ankyloglossia in infant feeding. In the current study, tongue-tie data were based on maternal report, and diagnoses could not be independently verified through clinical assessment or medical record review. The current findings support the importance of careful assessment and management of structural and functional oral-motor issues in the immediate postnatal period, particularly in infants experiencing persistent feeding difficulties.

Beyond their clinical presentation, feeding difficulties often carry emotional and relational consequences that affect both the infant and the wider family system. The process of feeding is not only physiological but deeply relational, serving as one of the first domains through which parents and infants co-regulate and build attachment. In this study, mothers of children with persistent feeding concerns described a range of ongoing challenges, many of which likely extended beyond nutrition to affect daily routines, emotional wellbeing, and family functioning. Previous research has demonstrated that feeding difficulties are associated with increased maternal stress, anxiety, and a diminished sense of parenting competence [12, 22]. When parents feel unsure about how to support their child’s feeding, they may become more directive or controlling at mealtimes, which can exacerbate the feeding problem and further strain the parent-child relationship [21, 23].

In addition to their relational impact, persistent feeding difficulties have been associated with increased rates of maternal anxiety and depressive symptoms, especially when parents feel unsupported or overwhelmed by the complexity of their infant’s needs [24]. This is particularly concerning given that maternal mental health plays a key role in shaping infant outcomes during the first year of life. When anxiety or low mood is present, parents may become less responsive or more controlling during mealtimes, which can reinforce negative feeding behaviours and limit a child’s ability to develop autonomy around eating [25]. This cycle, wherein feeding difficulties exacerbate maternal distress, which in turn worsens the feeding relationship, can have lasting implications for both the child’s development and the parent’s emotional wellbeing.

The repercussions of early feeding difficulties also extend into the healthcare system, with considerable implications for resource use and public health expenditure. In this study, nearly one in three infants required hospital readmission following discharge, with feeding-related concerns, including poor weight gain, dehydration, and jaundice, cited as leading causes. These findings are consistent with existing literature, which identifies inadequate feeding support in the postnatal period as a preventable contributor to hospital readmission during the first weeks of life [13]. Globally, suboptimal infant feeding practices have been linked to increased healthcare costs, both in the short term, through emergency presentations and extended inpatient care, and in the longer term, through the management of developmental, nutritional, and behavioural sequelae [26]. For families, this burden is also personal and emotional, as unexpected readmissions disrupt bonding, increase anxiety, and can lead to financial hardship due to time away from work and out-of-pocket expenses [14]. The evidence presented here adds weight to the growing call for hospital systems to invest in proactive feeding assessments and postnatal support strategies before discharge. By identifying at-risk infants early and intervening appropriately, health services may not only reduce costs but also improve outcomes for children and families alike.

The findings of this study also point to the critical importance of structured early screening for oral-motor difficulties before hospital discharge. Among the infants who continued to experience feeding problems beyond the neonatal period, a substantial proportion had early issues related to sucking or tongue-tie, conditions that can be identified with relatively simple assessments. One model of early detection gaining international attention is the Teste da Linguinha (Neonatal Tongue Screening Test), a mandatory screening protocol introduced in Brazil under Federal Law No. 13.002/2014. This policy requires all newborns to undergo a standardised lingual frenulum screening before discharge, conducted by trained professionals such as speech-language pathologists [15, 27].

Importantly, this screening tool is not limited to the identification of anatomical tongue restrictions. It involves an assessment of oral-motor structures and functions, including the coordination of sucking, swallowing, and the effectiveness of feeding, whether breast or bottle. By combining structural examination with real-time functional assessment of feeding behaviours, the Neonatal Tongue Screening Test supports hospital staff in identifying infants who may not be feeding efficiently, even if a visible anatomical concern is not present. Recent studies evaluating the impact of this program have demonstrated significant benefits, including earlier diagnosis of ankyloglossia, timely referrals for frenotomy, improved breastfeeding rates, and increased maternal satisfaction with hospital care [15, 27]. In the context of this study, where tongue-tie was significantly associated with long-term feeding difficulties, the implementation of such a screening tool could be a low-cost, high-impact strategy for prevention. While debates continue internationally regarding the diagnostic criteria and clinical thresholds for tongue-tie intervention, the growing body of evidence supports universal screening as a foundational step toward equitable, effective feeding support for all newborns.

The potential developmental consequences of early feeding difficulties extend well beyond infancy. Oral-motor challenges in the neonatal period have been linked not only to feeding inefficiency but also to later delays in speech and language development. This is largely due to the shared neuromuscular structures and motor coordination patterns involved in both feeding and early speech production. Several studies have demonstrated that infants with persistent feeding difficulties are at increased risk of later expressive language delays and articulation disorders, particularly when early oral-motor patterns remain unaddressed [28].

Furthermore, prolonged feeding concerns can impact cognitive development through multiple mechanisms, including reduced nutritional intake, chronic stress, and altered parent-child interaction during a critical period for neurodevelopment [29]. These findings reinforce the importance of timely, multidisciplinary intervention that not only addresses feeding as a functional task but also considers its broader developmental significance. Within this context, the role of allied health professionals, particularly speech-language pathologists and occupational therapists, becomes essential in bridging the gap between early feeding function and future communication, learning, and self-regulation outcomes.

Strengths, limitations, and future research directions

A notable strength of this study is its prospective design, which allowed for the systematic collection of data on feeding difficulties from the initial hospital stay through the post-discharge period. This approach enabled the identification of early feeding challenges and their potential progression, providing valuable insights into the continuity of feeding issues in infants. Additionally, the inclusion of a diverse sample population enhances the generalizability of the findings across different demographics and healthcare settings.

However, the study is not without limitations. One constraint is the reliance on parental self-reporting for data collection, which might be based on subjective interpretation of feeding difficulties. While parental insights are invaluable, the absence of objective clinical assessments, such as standardised feeding evaluations or diagnostic tools, limits the ability to corroborate reported difficulties with clinical findings. Additionally, reported diagnoses such as tongue-tie could not be independently verified, and variation likely existed in the professional backgrounds and diagnostic criteria used across respondents. Furthermore, the study did not account for potential confounding variables such as socioeconomic status, maternal education, or access to postnatal support services, which could influence feeding outcomes, and did not differentiate between emergency and elective caesarean sections, limiting interpretation of how birth context may have influenced early feeding experiences.

An additional limitation relates to post-discharge feeding interventions. While the questionnaire captured whether children were receiving professional support for feeding difficulties at the time of maternal report, it did not collect detailed information regarding the type, timing, duration, or intensity of feeding-related interventions. As a result, it was not possible to determine which children received specific interventions that may have influenced feeding skill development, nor to examine the relationship between intervention exposure and feeding outcomes. These data were therefore reported descriptively and should be interpreted within the context of the study’s cross-sectional design.

Future research should aim to incorporate objective measures alongside parental reports to provide a more comprehensive understanding of infant feeding difficulties. Longitudinal studies tracking infants over extended periods could elucidate the long-term impacts of early feeding challenges on growth, development, and parent-child relationships. Moreover, investigating the efficacy of early intervention programs, such as hospital-based feeding assessments or targeted support for at-risk populations, could inform best practices and policy development. Collaborative efforts between healthcare providers, researchers, and policymakers are essential to address the multifaceted nature of feeding difficulties and to implement effective strategies for prevention and management.

Conclusion

This study reinforces the importance of recognising early feeding difficulties as a clinically significant and potentially persistent concern. The high prevalence of oral-motor challenges such as sucking difficulties and tongue-tie, and their association with long-term feeding problems, highlights the need for proactive screening and intervention prior to hospital discharge. These difficulties not only affect nutrition and breastfeeding success but also have broader implications for maternal mental health, child development, and healthcare resource use, and may place additional emotional and psychological demands on parents navigating early feeding challenges.

By implementing structured in-hospital feeding assessments and ensuring that families receive appropriate support from trained professionals before going home, healthcare systems have the opportunity to reduce avoidable readmissions and improve long-term developmental outcomes. Future models of care should consider caregiver wellbeing alongside infant feeding outcomes, recognising the reciprocal relationship between parental confidence, emotional wellbeing, Public health initiatives such as the Neonatal Tongue Screening Test serve as models of low-cost, high-impact interventions that could be adapted internationally. Moving forward, greater investment in early feeding support and interprofessional collaboration will be essential in promoting infant health, support parental wellbeing, empowering parents, and creating a more responsive standard of postnatal care.

Authors’ contributions

SRK conceptualized the study, designed the methodology, collected and analysed the data, and wrote the original manuscript draft. HB supervised the study, contributed to methodology development, and reviewed and edited the manuscript. MCLP, PKS, and ACLB collected data and contributed to reviewing and editing the manuscript. KD supervised the study, contributed to methodology development, and reviewed and edited the manuscript. All authors read and approved the final manuscript.

Funding

The authors received no specific funding for this research.

Data availability

Data cannot be shared publicly because of ethical restrictions and participant confidentiality requirements approved by the University of Sydney Human Research Ethics Committee (HREC). The dataset contains sensitive health information, and open sharing of raw data was not included in the participant consent process. Researchers who meet the criteria for access to confidential data may request access through the University of Sydney HREC at human.ethics@sydney.edu.au or via the Ethics and Integrity Office: [https://www.sydney.edu.au/research/our-research/ethics-and-integrity.html](https://www.sydney.edu.au/research/our-research/ethics-and-integrity.html?utm_source=chatgpt.com).

Declarations

Ethics approval and consent to participate

This study was approved by the University of Sydney Human Research Ethics Committee (HREC) (Approval No. 2022/852). All procedures involving human participants were conducted in accordance with the ethical standards of the University of Sydney Human Research Ethics Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained electronically from all participants before completing the online survey.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.