#468 - 🚀 [Tech Tuesday] - What Would A Shared Language For Feeding Look Like At The Bedside?

Hello friends 👋

Feeding in the NICU is rarely one person's job, yet the language around it changes from nurse to therapist to physician to parent. In this Tech Tuesday episode, Ben and Daphna sit down with Lisa Kleinz and Erin Lesage of Dr. Brown's Medical to unpack feeding together, a philosophy built on team approach, family at the center, and feeding that begins on day one rather than at first bottle. They discuss what separates cue-based feeding from a truly standardized Infant-Driven Feeding® Program, the outcomes reported so far, and why nearly half of NICU graduates still struggle with feeding at home. A practical conversation about culture, consistency, and shared language.

https://www.drbrownsmedical.com/infant-driven-feeding-program/infant-driven-feeding-program-about/

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The transcript of today's episode can be found below 👇

Ben Courchia, MD (00:03) Hello everybody, welcome back to the Incubator Podcast. We're back today for this Tech Tuesday episode. Daphna, you're in the studio with me today, which feels like it's been a while — together.

Daphna Yasova Barbeau, MD (00:20) Well, since we've been in the studio, I think it's apropos that we're here on a Tech Tuesday with some guests we've been very much looking forward to recording with.

Ben Courchia, MD (00:42) Absolutely. We're very happy and proud to bring to the show the team from Dr. Brown's Medical. We're joined today by Lisa Kleinz and Erin Lesage. Lisa, Erin, welcome to the podcast.

Lisa Kleinz (01:03) Thank you.

Ben Courchia, MD (01:05) I'm just going to quickly introduce the two of you and then we'll get started talking about the work you're doing. Erin, you're the Director of Sales for Dr. Brown's Medical, and you're a certified neonatal therapist with nearly 20 years of clinical experience as a NICU (Neonatal Intensive Care Unit) speech-language pathologist specializing in neonatal and pediatric feeding and swallowing. Lisa, you're the Director of Education for Dr. Brown's Medical. You're a certified neonatal therapist and a founding member of the Neonatal Therapy Certification Board, with over 25 years of experience as a speech pathologist and developmental care specialist in both Level III and Level IV NICUs. So one of the things we're here to talk about today is the work Dr. Brown's is doing, specifically this mission of Feeding Together. We're interested to hear what that means and what pillars support this vision. I'm going to let Daphna start — she said she had the first question today.

Daphna Yasova Barbeau, MD (02:05) Thanks for letting me have it — Ben usually gets the first question. I alluded to it a little before we got started, but one of the things that really struck me reading about Dr. Brown's Medical — a separate entity within Dr. Brown's — is that the vast majority of your team are clinicians: SLPs (Speech-Language Pathologists), RNs (Registered Nurses), clinician educators. Why was it so important for Dr. Brown's to recruit people who had a passion for innovation and education, but were clinicians first? Lisa, maybe you can take this one.

Lisa Kleinz (02:56) Thank you for having us — we're honored to be here and to talk to your community. It really goes along with our focus on Feeding Together, and the belief that feeding takes a community. We have a unique lens as therapists and nurses — we've been in units, we understand them, we've worked with them. We want everyone to work together, which we'll talk more about with our whole Feeding Together philosophy. We want to be able to relate to what people are going through, and we've all fed babies for a long time, so we can relate to what's going on in the NICU.

Daphna Yasova Barbeau, MD (03:45) I love that — we're going to get to the details of Feeding Together, but I totally agree, feeding for babies in the NICU is a team sport. I can really appreciate how, coming from the industry lens, it's so important to understand how those team dynamics work. I'll let Erin take this one — how has your neonatal background helped with disseminating evidence and educating other clinicians at the bedside?

Erin Lesage (04:26) It's been completely key to being able to partner with them in a way that's probably unique — having someone who's sat in their space and can share those experiences as we navigate the path together, whatever the challenge or advancement is. It brings a natural partnership to the table right from the start, instead of coming in with our products and saying, "Here, look at my display." We're partnering with them from the beginning, saying, "I get what this whole journey is, but I don't know your specific story — I want to hear it and be part of it." Just having that mindset and sharing it with them starts the connection at a higher level right from the start.

Daphna Yasova Barbeau, MD (05:39) I love that.

Lisa Kleinz (05:40) I'll add — I think it also helps in practical situations. We've all been in a NICU where someone comes in with their product and just wants to sell it, which is fine, but because we've worked in the NICU, when a nurse or therapist tells us what's going on, we've been there and can actually help. We're not just here to sell products — we care about the feeding experience for babies and families, and we want to help the NICU solve problems, not just provide products. It's about changing the feeding culture and practice, so it's so much more than just selling a product.

Daphna Yasova Barbeau, MD (06:31) I love that — perfect segue. You're already hinting at some of the pillars of Feeding Together. So what is Feeding Together, for people hearing that term for the first time?

Erin Lesage (06:44) It really is that simple belief — that philosophy that better feeding experiences happen when everyone works together. Lisa and I were talking about how complex feeding is, just from a physiological standpoint for the infant. But it truly takes a team to meet all the pieces that need to be met, with the family at the center. It takes all of us working together to give babies and families the best possible start. It's a philosophy that no one should have to solve feeding challenges alone — it's just too big.

Ben Courchia, MD (07:39) So what does that mean in practice? The concept of Feeding Together makes a lot of sense, but I'm wondering what that vision looks like at the bedside in an ideal world — obviously every unit works through that process differently. For clinicians and physicians, the feeding aspect of neonatal care can feel unpredictable — we don't know as much as we'd like, so it's a bit chaotic. What does an ideal scenario look like at the bedside with that philosophy in mind? I'll let you take it first, Lisa — you've been smiling at this question.

Lisa Kleinz (08:34) There are so many components to it, which is why we have four pieces to our Feeding Together framework. But in the big picture, it looks like a team approach — feeding doesn't belong to one group. Years ago people said, "Well, speech has feeding," but now we know it's a team approach and all of us need to be involved. At the center of that, like Erin mentioned, is the family. We've come so far from a single-entity model to developmental care that involves the whole family. What's essential is that feeding doesn't start with breast or bottle feeding — feeding starts from day one. In the perfect bedside scenario, we're all involved from day one, we have common language, consistency as a unit, standardization of feeding practices and products, and the family is at the core, working with us to provide the best possible feeding outcomes from day one.

Ben Courchia, MD (09:50) Erin, any thoughts on that, or can I follow up with another question?

Erin Lesage (09:57) Just that alignment needs to happen for parents to feel empowered — maybe not right away, but eventually. I think we're getting better with alignment across disciplines, but it's a big task.

Ben Courchia, MD (10:12) You're referring to the four pillars — let me go over them again. You've started alluding to two of them: supporting feeding culture, and education and support. The other two I'd like to talk about are evidence-based feeding products and evidence-based feeding practices. I feel like these are separate pillars but very much connected — what does that look like at the bedside when you're able to implement both? I think for many people, the bottles and nipples being used can feel like novelties, but we don't always realize there's evidence behind the design of these products. Could you speak to that?

Erin Lesage (11:10) If we think about the products — we take great pride in having conversations from the beginning with providers in the field using these products. They were using them long before we had a medical division at Dr. Brown's, so we learned a lot right from the start. We didn't come into the hospital saying, "Use these, they're the best thing ever." We heard from people using the products asking about them, and that sparked our interest in helping more. Sandy Abishan, our President of the Medical Division, will tell you it starts with asking: what are the problems out there, what challenges are people having with feeding, and could a product created with that insight and testing address those needs in a way we'd never have known otherwise? It starts with asking what problems clinicians and parents are having when feeding their infants, and whether that could be a potential solution — not asking, "What product should we build?" and hoping someone has that problem. We're always starting with the problem in our division, always talking about problems and trying to create a plan to help.

Ben Courchia, MD (13:03) A very solution-driven approach. Lisa, one term associated with feeding practices is often variability — we see a lot of people doing different things. From your experience at Dr. Brown's, which practices have you identified as truly evidence-based, and how did you go about making those determinations?

Lisa Kleinz (13:30) This continues from what Erin was talking about — the inconsistencies in feeding are numerous. We want to engage with what the literature says, not just what we're saying, and the literature talks about inconsistencies from all over the world. When we talk to hospitals, they tell us it's inconsistent — one nurse might say one thing, a physician or therapist has different information. When you dig deeper and ask the parents, they'll say one of their biggest struggles was that people were telling them different things and they got different information all the time. We take all of this — the whole concept of feeding culture, which isn't just in the hospital, but the hospital administration and the parents — so many people are part of this culture. Thankfully, we've moved from a volume-driven culture. It's well known now that cue-based feeding has better outcomes for babies, but we don't want to stop there. The literature and families tell us that if you ask five different people in a NICU and a parent what cue-based feeding means, you'll get different answers. So we want more standardization in feeding practices, where the language is the same and we're not just stopping at cue-based feeding.

Daphna Yasova Barbeau, MD (15:34) Lisa, this is a perfect opportunity — we did a wonderful trivia night with you at our last conference, and we had mostly physicians in attendance. A lot of our listeners are physicians or physicians in training, but we're also fortunate to have listeners who are nurses and therapists. Some people might not recognize the term you just used — cue-based feeding or infant-driven feeding. Can you tell us a bit about that, the benefits, and why it's important that therapy teams have moved toward it? Ben has a question too.

Ben Courchia, MD (16:21) I just want to add — for people listening who couldn't define cue-based feeding, maybe you can give them the answer.

Lisa Kleinz (16:33) The reason you can't define it easily is that if you look it up in the literature, it has many different meanings. I've done a literature search and found different definitions. People usually use it to mean that we look at the baby's cues for when to start oral feeding — but how do we do that, and what language is used? That's where the Infant-Driven Feeding (IDF) program comes in — it takes cue-based feeding to the next level, with a standardized, systematic way to address feeding: not just when we start feeding the baby, but when and why, with standardized language everyone uses. It also addresses what feeding looks like in terms of quality, and how to progress feeding systematically while still individualizing for each baby. It's being recognized more and more — the National Association of Neonatal Nurses (NANN) just released new feeding guidelines calling for a systematic way of using shared language and standardized practice.

Daphna Yasova Barbeau, MD (17:50) I can interject a concept I've really liked, which touches on the pillar of supporting feeding culture. People often think the goal is just getting enough volume into the baby to go home. But there's really a shift where the goal is setting up the baby for feeding enjoyment for the rest of their life, not just getting them home. Maybe you can talk about why infant-driven feeding supports this developmental model — especially with the idea that "all care is brain care." Every time we interact with or feed a baby, we have an opportunity to improve their developmental experience. How can we help people understand that feeding is paramount to developmental care in the NICU, rather than just getting the baby home so the family can deal with it later? How do we get people to see each feed as a developmental, skill-learning exposure?

Lisa Kleinz (19:04) It comes down to looking at the culture of feeding. Changing culture isn't just about adapting a tool — it's about a whole program for feeding, rooted in developmental care from the basics. Feeding is for life, but it starts at day one, and we want units to start from day one with everyone interacting with the baby, and that information translated to parents. Feeding isn't a task — it's a relationship, the same way developmental care is a relationship every time you enter the isolette. Our job is to look at the infant, see what the baby is telling us, and respond — starting with the first interaction, the lighting, how you're touching the baby's face — all of that feeds into feeding later on. We know that 42% of NICU babies have feeding problems later on.

Daphna Yasova Barbeau, MD (20:22) Even if they went home having met their goals, we don't always recognize they'll still struggle with feeding — nearly half of them will struggle with feeding at home.

Lisa Kleinz (20:34) Absolutely — and that's a worldwide statistic. The article by Britt Pados, where she cites that number, draws from other countries too, not just the United States, and I know you have international listeners. It's really about changing the whole concept of feeding from day one. The Infant-Driven Feeding program isn't just about scoring the baby once we introduce breast or bottle — it starts from day one with neuroprotection, developmental care, and teaching everyone involved that every experience matters. We're shaping babies' brains. As for outcomes, infant-driven feeding has numerous published benefits: reduced length of stay, reduced time to full oral feeding, improved staff satisfaction because there's now a systematic approach instead of everything feeling all over the place, and hugely important — increased parent satisfaction, since it puts everyone on the same page instead of parents hearing different things from different people. We had a parent tell us IDF helped her not just feed her baby, but learn how to parent her baby, because she learned the cues so well from working with staff. It also leads to increased breastfeeding rates — we're Dr. Brown's Medical, but we focus heavily on breastfeeding, and infant-driven feeding encompasses that too. Hospitals that have implemented IDF have increased breastfeeding rates both in the hospital and after discharge. Something I'm especially excited about, since it's a newer benefit, is a study last year out of a Virginia hospital system that implemented IDF and saw fewer speech and OT (Occupational Therapy) referrals six months later. That's why we're here — to improve feeding outcomes for babies and families. When feeding doesn't go well, it affects a family for life. Feeding is so much more than getting volume in — it's a relationship, sometimes tied to attachment for families.

Ben Courchia, MD (22:55) Lisa, I think, as you alluded to earlier, one of the biggest aspects of parenting in the early years is feeding — at least in the first year of life, fifty to sixty percent of parenting is feeding. So it's more than a task or a checkbox — it's how we build bonds with our children in those early years. I couldn't agree more. I wanted to ask Erin a follow-up — people may listen and think Dr. Brown's is just trying to get their product out there, but that's not really the point, as Lisa has alluded to. For units interested in adopting the Feeding Together mission, how can they get involved, and what resources are available to help them take that first step?

Erin Lesage (24:07) The connection can come from a variety of ways — sometimes we're at conferences and people start the conversation there, or they visit our website, drbrownsmedical.com, where there's a Contact Us page. That's where the conversation starts, and it's truly a conversation where the partnership begins, because we don't know upfront whether the Infant-Driven Feeding program is what your unit needs — maybe you've already got great things going and don't need it. Often there are little gaps — maybe a lot of staffing change, and everyone has different levels of information about feeding, so you want to get everyone back on the same page, and IDF can do that. Or maybe you're doing great with breastfeeding, but most premature infants going home need supplemental bottle feeding, so you want that nice transition between oral, breast, and bottle feeding — and you might look at the program for that. I'm giving examples because it really depends on your story. Our account managers connect with customers to figure out if this seems appropriate given what they discover — we call it a discovery call: what's going on, tell me about your unit, your feeding practice, what's going great, and where you'd like things to be different. It's really just that conversation, and then we see if this could be helpful — often it is, because feeding is so complex and involves so many people. Then it's about working with the team to learn all the pieces involved — we don't just sell the program, we partner through purchasing and implementation, making sure you have all the supplemental materials to help roll it out to your unit, since everyone should be involved in feeding at some level. That includes training, information, incorporating this into rounds day-to-day, and making sure you're talking about how this new, consistent way of communicating about feeding is working for your unit and families. We stay the course and are there as a resource along the way. It starts with a conversation, and then we provide resources — we have many, from overviews of all the evidence and literature to QI (Quality Improvement) projects that have been done. We also have contacts who've graciously agreed to speak with people interested in doing the program, to share how it worked for them or what they needed to get it funded, since funding is sometimes the issue. We have many resources, from overviews to more in-depth pieces as needed.

Ben Courchia, MD (28:09) I think this goes back to the point Daphna made at the beginning — the benefit of having a wide team of therapists making up Dr. Brown's Medical, where these consultations happen with people who have true experience and expertise and can add real value to the conversation and the teams you're engaging with. That shouldn't be understated. I see time flying by, and I want to get to some questions we drafted with Daphna beforehand — one thing we've learned meeting you and hearing about your work is that Dr. Brown's is not just a baby bottle company. You make an important point of defining yourselves as an innovation company. How do you see yourselves in that identity, as a company dedicated to innovation rather than a single type of product? Lisa, do you want to take that one?

Lisa Kleinz (29:27) We consider ourselves innovative because we don't just create products to create products — as Erin described, it's about solving problems. We want to help hospitals, families, staff, and babies solve problems. It begins with listening, as Erin described in detail. Where are we going? Wherever families and babies need us to go. We can't define our innovation as "we have a goal to launch this many products per year" — it's about going where the community needs us to go, solving problems, and working with teams to determine that.

Ben Courchia, MD (30:19) Would you say, Erin, that this identity shift means the center of your work becomes the patient and family rather than the product?

Erin Lesage (30:32) Absolutely. The clinicians feeding those infants, working every day with those little ones, are kind of the liaison for us — they'll say, "Hey, if you guys could make this product," and we ask, "Why, what's going on?" and they share what these babies need, and we say, "Tell us more, we want to learn." It's about filling in those gaps and making feeding a seamless, positive experience from the start — we don't finish eating, we all continue to eat throughout life. The clinicians, nurses, and unit leaders — we're always listening, and I can tell you that the products the Medical Division of Dr. Brown's has developed truly come from our partners, the customers out there in the trenches every day. We listen to them, and they're the ones who give us the ideas, which come from filling those gaps and meeting those needs.

Daphna Yasova Barbeau, MD (32:01) I love that — you've done such a nice job specifically finding out what the community needs and meeting them where they are. I've been impressed by Dr. Brown's Medical's education initiative, whether or not hospitals are ordering from you. I want to highlight the webinar series — there's such a wealth of information for anybody who's heard a term they didn't understand, or is dealing with a baby with a complex medical need like a cleft palate. How can people access your resources and not miss your scheduled webinar series?

Lisa Kleinz (32:51) You can reach out to us through our Contact Us page at medinfo@drbrownsmedical.com. You'll get emails about our four quarterly webinars a year. This is another area where we want to fill the gaps — we evaluate what people are asking for, and that's how we decide topics. They're free webinars, with CEUs (Continuing Education Units) available for multiple disciplines. They're not about our products — our webinars are about education in the field and what people need to be more successful in their roles.

Daphna Yasova Barbeau, MD (33:38) I'll highlight a few, if you don't mind: The Infant-Driven Feeding Program; The Evidence That Will Change Your Feeding Practice; From Feeding to Eating; Assessment and Oral Feeding Interventions for Infants with Tracheostomy Tubes; The Late Preterm Infant, Where a Few Weeks Really Matter in Feeding; Grit and Grace and the Goal to Breastfeed, Achieving the Goal; and Integrated Multidisciplinary NICU. Just a wealth of information — very cool.

Erin Lesage (34:06) One more thing — this past year we onboarded a whole Scientific Advisory Board of professionals in the field, who bring a unique perspective to our team and act as a sounding board for us when we have new ideas. I wanted to point that out — it's a new addition to our team.

Ben Courchia, MD (34:42) I was just going to mention, with no bias whatsoever, that the Scientific Advisory Board includes Raquel Garcia-Rocky, who's a good friend of ours and has been on the show. I'm absolutely not biased in giving her a big shout-out.

Erin Lesage (34:58) Yes — and we're actually looking for a provider now, a neonatologist, to get that same kind of feedback.

Erin Lesage (35:12) That's a shout-out request for me.

Daphna Yasova Barbeau, MD (35:14) I love that. My last question — what does the future of Feeding Together look like? What's your goal five, ten years from now?

Lisa Kleinz (35:32) It's hard to make a goal because we're going to go wherever people take us, but I'd like to say we've helped improve feeding outcomes for babies and families. I'd love to see that 42% number go down. How we get there really depends on the need and our conversations with customers and families. We want every baby to have positive feeding experiences from the start.

Ben Courchia, MD (36:06) The website has this — I'm not usually a fan of acronyms, I'll be honest, they don't usually work for me, but this one I find clever: the "SUCCESS" algorithm for more consistent, inclusive, standard-of-care practices. S — Support Development, U — Unify the Team, C — Change the Culture, C — Create Experiences, E — Establish Systems, and the double S's — Strategize Interventions and Sustain Progress. I think that encompasses the process well, especially when it comes to nutrition — I'll give this one a pass.

Lisa Kleinz (36:44) Wouldn't it be great — for example, if you as a physician say the baby had an Apgar score of X, everybody knows what that means. Wouldn't it be great if we could do the same with feeding, so the language is the same no matter where you practice — how you communicate with families, and what we're providing to that baby? Wouldn't it be great if we could all be on the same page with systematic, standardized language?

Ben Courchia, MD (37:12) Absolutely — we've talked about this on the podcast too. The language we currently use, like whether feeds are "tolerated" versus "not tolerated," is absolutely archaic. There's definitely an opportunity to use better, more granular terms, and I think that's the work you're tackling. Kudos to you and the Scientific Advisory Board for taking that on. Time has flown by — Erin, any parting thoughts? I want to give you the opportunity to close us out today.

Erin Lesage (37:46) Just that everybody should know we genuinely care about the feeding community, and we know we have a unique space in this work. We want to utilize that to bring everyone together to have conversations and keep moving forward — we don't know exactly where we'll be, whether as a leader or a partner, but we want to make sure we're moving forward. We're very grateful to be in such a unique space to bring people together and make it sustainable.

Ben Courchia, MD (38:26) A great message to conclude the interview with. Thank you, Lisa Kleinz and Erin Lesage, for coming on the show. People can learn more at drbrownsmedical.com — we'll link to the website in the show notes. Congratulations again on these great initiatives and the work you're doing.

Erin Lesage (38:47) Thank you both so much.