NOMAS® International Online Continuing Education
Online CEU instruction for Occupational Therapy, Speech Pathology and Nursing professionals

PLEASE BE AWARE...
You have access to the course content for seven days only. You may sign in and out as often as you like during that time frame, but you are limited to seven days beginning the day you first sign in.
Welcome! These online courses focus on evaluation, treatment and therapeutic intervention in the NICU for neonates and subsequently for older infants and children who present with feeding disorders.

Individuals who provide services to these patients may come from a variety of educational and professional backgrounds but all have one goal in common: to resolve oral, pharyngeal, and esophageal phase swallowing and feeding disorders in the neonatal and pediatric populations. These courses are designed to help you meet that goal.


Feeding Solutions: Strategies for the NICU
Online Conference featuring Linda Lowman, M.Ed, NLP, Brenda Takata, OTR/L, MHA, NLP and Marjorie Palmer, M.A., NLP, CCC-SLP - Founder and Director NOMAS
To receive ASHA CEUs and receive your certificate, the participant must complete and submit the quiz that's included at the end of the course.

Conference Description:

Originally recorded in March of 2024, this course is recommended, designed, and directed toward those professionals who have the primary responsibility of feeding preterm and sick term infants in the Intensive Care Unit (NICU).

Developmental readiness to feed, stress cues, and signs of stress that impact feeding will be discussed. Neonatal sucking patterns (normal, disorganized, and dysfunctional), based on the NOMAS (Neonatal Oral-Motor Assessment Scale) will be observed and described. Once a diagnosis of the suck is determined, feeding intervention strategies and therapeutic techniques will be suggested and prescribed. Strategies for successful feeding in infants who present with both the disorganized and dysfunctional suck will be discussed.


View Feeding Solutions: Strategies for the NICU | Learning Outcomes and Order of Talks
The Course Objectives for "Feeding Solutions: Strategies for the NICU" are:

  1. Identify the three neonatal sucking patterns and provide one intervention strategy for the disorganized and dysfuntional feeder.
  2. Identify the difference between regulation and pacing when feeding a baby.
  3. Recognize stresses as they relate to the feeding experience and determine readiness to feed based on cues.

Marjorie Meyer Palmer M.A., NLP, CCC-SLP

Financial disclosure: Ms. Marjorie Meyer Palmer receives financial reimbursement as a NOMAS® Instructor and for teaching this course.
Non-financial disclosure: founder and director of NOMAS® International and the author of NOMAS®

Linda B. Lowman, M.Ed., NLP

Financial disclosure: Ms. Linda Lowmman receives financial reimbursement for teaching this course.
Non-financial disclosure: Ms. Linda Lowmman is a NOMAS® Certification Course Instructor who is a full-time employee of Winne Palmer Hospital for Women and Babies in Orlando, Florida.

Brenda Takata, OTR/L, MHA, NLP, SWC

Financial disclosure: Ms. Takata receives financial reimbursement for teaching this course.
Non-financial disclosure: Ms. Takata has no relevant non-financial relationships.
Presenters and Course Topics:

How Do You Know Your Baby is Ready?
Linda Lowman
M.Ed, NLP - NICU Development Specialist, NOMAS© Course Instructor, Winnie Palmer Hospital for Women and Babies

When Everything Works Well: Description of Normal Suck in Preterm/ Term Infants
Marjorie Palmer
M.A., NLP, CCC-SLP - Founder and Director NOMAS® International

How Important is Respiration for Successful Feeding? What is a Disorganized Suck
Marjorie Palmer
M.A., NLP, CCC-SLP - Founder and Director NOMAS® International

Let’s Get Organized: Solutions, Intervention Strategies for the Disorganized Feeder
Brenda Takata
OTR/L, MHA, NLP - Registered Occupational Therapist, NOMAS© Course Instructor, Emanate Health-Queen of the Valley Campus, West Covina, California

Linda Lowman
M.Ed, NLP - NICU Development Specialist, NOMAS© Course Instructor, Winnie Palmer Hospital for Women and Babies

Something is NOT Working: The Infant with the Dysfunctional Suck
Marjorie Palmer
M.A., NLP, CCC-SLP - Founder and Director NOMAS® International

How Do We Fix This? Intervention Strategies for the Dysfunctional Feeder
Marjorie Palmer
M.A., NLP, CCC-SLP - Founder and Director NOMAS® International

What is Lying Below the Surface: Underlying Medical Conditions that Impact Oral Feeding Success
Marjorie Palmer
M.A., NLP, CCC-SLP - Founder and Director NOMAS® International

Tried and True: Solutions and Intervention Strategies that Work
Brenda Takata
OTR/L, MHA, NLP - Registered Occupational Therapist, NOMAS© Course Instructor, Emanate Health-Queen of the Valley Campus, West Covina, California

NOMAS® International Summit 2020
Online Conference featuring Sudarshan R. Jadcherla, MD, Peter Bingham, MD, James M. Helm, Ph.D, M. Kathleen Philbin, RN, Ph.D, Linda Lowman, M.Ed, NLP, Brenda Takata, OTR/L, MHA, NLP and Marjorie Palmer, M.A., NLP, CCC-SLP - Founder and Director NOMAS
For successful completion one quiz must be passed at the end. To receive ASHA CEUs the participant must DOWNLOAD, complete, and either FAX, mail, or send electronically OR just provide your ASHA membership number.

Summit Description:

Originally recorded in September of 2020, this impactful seminar includes...

What Lies Beneath: Determining Factors for Successful Neonatal Feeding
Sudarshan R. Jadcherla, MD - Professor of Pediatrics
Feeding, Neuroplasticity & Brain Disorders
Peter Bingham, MD - Professor of Neurology & Pediatrics
NIDCAP Approach to Care: Listening to Each Infant's Voice
James M. Helm, Ph.D - Infant Development Specialist
Feeding Preterm Infants: Science and Conjecture
M. Kathleen Philbin, RN, Ph.D - Independent Research, Consultant
What Does Development Have to Do With It?
Linda Lowman, M.Ed, NLP - NICU Development Specialist, NOMAS© Course Instructor, Winnie Palmer Hospital for Women and Babies
Feeding Disorders in the NICU that Result from a Deviant Sensory System
Brenda Takata, OTR/L, MHA, NLP - Registered Occupational Therapist, NOMAS© Course Instructor, Emanate Health-Queen of the Valley Campus, West Covina, California
A Closer Look at the Three Phases of Swallow in the Neonate: what Goes Wrong and What Can You Do To Help?
Marjorie Palmer, M.A., NLP, CCC-SLP - Founder and Director NOMAS© International
Interactive Treatment Practicum.
Three hours of an Interactive Treatment Practicum to Solve Those Feeding Challenges in the NICU with case studies, problem solving, and development and collaboration of successful treatment strategies.

It's an amazing event!

You can qualify for a discount as a NOMAS® Certified Professional! If you have a current license, you can get 10% off, if you're certifed but your license has expired, you can get 5% off. Click on the appropriate button below and know that you will have to provide your NOMAS® License / Certification number.

$450.00


Series One - Course of 11 Talks
Neonatal and Pediatric Feeding Disorders: Evaluation and Treatment in the NICU and After Discharge.
For successful completion one quiz must be passed at the end. To receive ASHA CEUs the participant must DOWNLOAD, complete, and either FAX, mail, or send electronically OR just provide your ASHA membership number.

Course Description:

The 11 talks in this online course focus on feeding difficulties in term and preterm infants, evaluation and treatment of sensory and motor-based feeding problems after discharge from NICU or special care nursery, videofluoroscopic studies of infants and children showing examples, procedure and diagnosis, and weaning from tube to oral feeding using a sensory-based protocol.

The full course is made up of all 11 talks. Each talk runs about 1 hour. Talks may also be purchased and viewed individually with some exceptions. Please see CEU statements below, for CEU details.

View Series One Courses | Learning Outcomes and Order Talks
Series One Learning Outcomes:

  • Describe the changing anatomy and physiology of the infant oral mechanism and its impact on feeding.
  • Analyze disorganized and dysfunctional sucking patterns in the poor feeder as described by the NOMAS®.
  • Identify specific feeding problems in the NICU so as to implement Diagnostic-Based Intervention.
  • Differentiate sensory from motor-based feeding disorders.
  • Explain the relationship between gastroesophageal reflux and esophageal motility as it relates to the intake of solid food.
  • Discuss the Palmer Protocol for Sensory-Based Weaning from tube to oral feeding.
Presenter: Marjorie Meyer Palmer M.A., CCC-SLP

Non-financial disclosure: founder and director of NOMAS® International; current member, the American Academy of Cerebral Palsy and the NIDCAP Federation International.

Financial disclosure: Ms. Palmer is financially compensated for teaching live courses on feeding and online continuing education courses on feeding. She conducts certification courses for the NOMAS® and administers the non-exclusive copyright license renewal program for NOMAS® Certified Professionals. She is sole distributor of the "Fantastic Feeding Dropper."
NOTE: Talk 2 may be taken alone but Talk 3 must be taken with Talk 2. Talk 9 may be taken alone but Talk 10 must be taken with Talk 9.
All 11 Series One Talks
SPECIAL - Order all 11 talks in Series One for $375!

Introductory, intermediate and advanced material ($850 if taken individually)

1. Anatomy and Physiology of the Oral Mechanism: Reflexive to Volitional
$40. Introductory. Runs: 44:16


Course Objectives
1. List the Six Primitive Oral Reflexes.
2. Explain Changes in Oral Anatomy: Birth to Six Months.
3. Describe Volitional Bolus Transfer During the Management of Solid Food.

Describes anatomical/physiologic changes that occur during the first six months of life and beyond. Discussed: primitive oral reflexes, the first transition in feeding, and the development of the volitional bolus transfer. Participants will view changing oral-motor patterns from reflexive to volitional.


2. Evaluation of Neonatal Sucking Based upon the NOMAS®
$95. Introductory. Advanced. Runs: 45:19


Course Objectives
1. List the Two Types of Normal Suck Patterns.
2. List Three Characteristics of Jaw & Tongue Movement in the Disorganized Suck.
3. Describe at least Four Characteristics of Dysfunctional Suck.

Introduces sucking patterns of the neonate based on the NOMAS®. Describes observable characteristics of jaw and tongue function during dysfunctional suck; coordination of suck / swallow / breathe; disorganized suck; and evaluation process.


3. Diagnostic Based Treatment for the Infant with Feeding Disorders (must be taken with #2).
$190. Introductory. Advanced (includes courses #2 and #3). Runs: 49:33


Course Objectives
1. Suggest Ways to Improve Neonatal Feeding in the NICU.
2. Difference between External Pacing and Regulation For the Disorganized Feeder.
3. Use of Therapeutic Techniques for the Dysfunctional Feeder.

Prescriptive treatment based on diagnosis of suck pattern. Discusses therapeutic techniques to improve feeding with infants who present with dysfunctional suck and intervention strategies for those infants with disorganized suck. Describes when use of particular techniques is contra-indicated.


4. Sensory and Motor Aspects of Neonatal Sucking.
$55. Intermediate. Runs: 52:44


Course Objectives
1. Recognize the differences between motor and sensory disorders of neonatal sucking.
2. Identify four characteristics of a motor based feeding disorder.
3. Describe three types of sensory feeding problems.

View aspects of sensory/motor function during non-nutritive/nutritive suck. Discusses deviant oral-motor patterns; clinical signs of an “altered sensory system” including perseveration, habituation, poor adaptability; visceral hyperalgesia.


5. Dysphagia versus Prematurity.
$75. Advanced. Runs: 43:26


Course Objectives
1. Describe the feeding difficulty for a premature infant with a disorganized suck.
2. Recognize the clinical signs of dysphagia.
3. Know when to appropriately refer for an MBS study.

View clinical and videofluoroscopic presentations of premature infants from 31 weeks PCA and compare their performance to infants with dysphagia secondary to such medical conditions as TEF, esophageal stricture, neurological issues, GER and dysmotility.


6. Neonatal and Pediatric Swallow Studies: Procedure, Interpretation, and Diagnosis.
$95. Advanced. Runs: 41:34


Course Objectives
1. Properly Select Position, Utensil, And Consistencies For The MBS.
2. Describe The Oral, Pharyngeal, And Esophageal Phases Of Swallow.
3. Accurately Diagnose The Problem.

View a variety of modified barium swallow (MBS) studies with neonatal/pediatric patients; analyze oral, pharyngeal, esophageal phases of swallow; examples of dysphagia in all phases will be viewed.


7. Differential Diagnosis of Motor vs. Sensory-Based Feeding Disorders.
$40. Introductory. Runs: 42:46


Course Objectives
1. Describe jaw and tongue movements of the child with hypertonicity.
2. Explain persistent oral-motor patterns in a child with hypotonicity.
3. Identify clinical signs of sensory-based oral feeding disorder.

Discusses deviant oral-motor patterns secondary to both oro-facial hypotonia and hypertonia; sensory-based oral feeding aversion; underlying etiologies; and differential diagnosis.


8. Treatment and Transitions for Sensory-Based Feeding Disorders.
$65. Intermediate. Runs: 64:41


Course Objectives
1. Explain the use of "incremental progression" as a treatment strategy.
2. Outline the "wheat germ" program.
3. Identify clinical signs of sensory-based oral feeding disorder.

Introduction to “Incremental Progression” as a therapeutic intervention strategy for management of sensory-based oral feeding problems. Uses case studies to outline subtle changes in placement, volume, texture, utensils. Discusses the CHEW program for development of mastication; “Wheat Germ Program” for transition from pureed foods to solids.


9. Gastroesophageal Reflux and Esophageal Dysmotility: ID and Management, Part I.
$95. Advanced. Runs: 57:51


Course Objectives
1. Describe the correlation between gastroesophageal reflux and esophageal dysmotility.
2. Conduct a competent clinical (bedside) feeding evaluation.
3. Accurately diagnose esophageal phase dysphagia when it is the underlying etiology of an oral feeding disorder.

Outlines types of GER; provides examples of relationship between GER/esophageal dsymotility; discusses clinical signs of esophageal dysmotility; view MBS studies.


10. Gastroesophageal Reflux and Esophageal Dysmotility: ID and Management, Part II (must be taken with #9).
$185 (includes #9 and #10). Advanced. Runs: 36:02


Course Objectives
1. Describe the three types of gastroesophageal reflux.
2. Explain esophageal dysmotility and its impact on the transition onto solids.
3. Plan effective intervention strategies for progression onto solids.

Discusses therapeutic management for esophageal phase dysphagia using “Incremental Progression” to implement subtle changes in consistency, volume, bolus size while insuring adequate caloric intake/weight gain; provides review of underlying etiologies, preferred texture consistencies.


11. Weaning from Gastrostomy Tube onto Oral Feeding.
$95. Advanced. Runs: 45:30


Course Objectives
1. Describe the process of transitioning from continuous drip feeding onto bolus.
2. Determine when it is appropriate to implement a 60-hour wean.
3. Be able to select the appropriate candidate for weaning.

Discusses the Palmer Protocol for Sensory-Based Weaning in detail; outlines five phases of progression; case studies presented.

Series Two - Course of 12 Talks
NOMAS® International Symposium Talks
Course Description:

The 12 talks in this online course focus on the etiology, diagnosis, and treatment of feeding difficulties in the term and preterm infant. Evaluation and treatment strategies for the “difficult to feed” infant both in the NICU or special care nursery are discussed as well as those feeding issues that persist after discharge.



View Series Two Courses | Learning Outcomes and Order Talks
All 12 Series Two Talks
SPECIAL - Order all 12 talks in Series Two for $375!

Introductory, intermediate and advanced material (Save $45!)

1. Diseases and medical conditions of the infant that interfere with successful feeding.
$35. Intermediate instructional level. Runs: 53:00. CEU: .05


Course Objectives
1. Identify infants at high risk for feeding difficulties.
2. Identify strategies for supporting successful feedings.
3. Identify infants appropriate for referral to a feeding specialist.

Learning Outcome:
Identify infants at risk for feeding difficulties and explain strategies for supporting successful feeding.

Carlos Botas M.D., Director, Neonatal Services Kaiser Permanente Medical Center; Associate Clinical Professor of Pediatrics, UC San Francisco School of Medicine. Dr. Botas has no financial or nonfinancial relationships to disclose.


2. Non-nutritive suck (NNS): measurement, context, and use in predicting feeding skills.
$35. Advanced instructional level. Runs: 59:30. CEU: .1


Course Objectives
1. Understand rationale for measurement, and tools and validation for measuring non-nutritive suck in the NICU.
2. Understand qualitative and quantitative aspects of NNS ontogeny in premature newborns.
3. How NNS evaluation relates to feeding performance in light of immediate/contextual factors that influence NNS behavior.

Learning Outcome:
Describe the qualitative and quantitative aspects of NNS ontogeny in premature infants and how these relate to feeding performance.

Peter Bingham M.D., Associate Professor of Neurology and Pediatrics, University of VT, Burlington, VT. UC San Francisco School of Medicine. Dr. Bingham has no financial or nonfinancial relationships to disclose.


3. Maturation of the gastrointestinal tract: when is baby ready to feed?
$35. Advanced instructional level. Runs: 44:00. CEU: .05


Course Objectives
1. Describe the normal maturation of gastrointestinal motility in the premature.
2. Describe the normal maturation of digestion and absorption in the premature.
3. Describe disorders that impact upon the normal developmental process and interfere with feeding.

Learning Outcome:
Describe the normal maturation of gastrointestinal motility in the premature infant and identify disorders that impact the normal developmental process.

Carol Lynn Berseth, M.D., Director, Medical Affairs North America, Mead Johnson Nutrition. UC San Francisco School of Medicine. Dr. Berseth is a salaried employee of Mead Johnson Nutrition and has no nonfinancial relationships to disclose.


4. Development of self-regulation in the NICU newborn.
$35. Intermediate instructional level. Runs: 37:00. CEU: .05


Course Objectives
1. Describe self regulation and identify regulatory behaviors of full term newborns or less mature or premature newborns.
2. Describe factors which impact infant self regulation.
3. Identify and describe developmental recommendations to facilitate self regulation.

Learning Outcome:
Explain self-regulation in the newborn and describe factors that impact the development of regulatory behaviors.

Kathleen A. VandenBerg, PhD., Master NIDCAP Trainer; Director, Neurodevelopmental Center Division of Neonatology, Department of Pediatrics, University of California San Francisco School of Medicine. Dr. VandenBerg has no financial or nonfinancial relationships to disclose.


5. Maturation of the premature infant: sleeping, breathing, and feeding.
$35. Intermediate instructional level. Runs: 39:00. CEU: .05


Course Objectives
1. Identify the components of state, breathing, and oral control needed for feeding.
2. Correctly identify immature breathing and apnea that will interfere with feeding.
3. Identify risk factors for aspiration and how to diagnose aspiration.

Learning Outcome:
Describe the components of state, breathing, and feeding in the premature infant and identify risk factors for aspiration.

Anna Dusick, M.D., formerly, Medical Director, Waisman Center; Visiting Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health. Dr. Dusick has no financial or nonfinancial relationships to disclose.


6. Cue-based, co-regulated approach to feeding.
$35. Intermediate instructional level. Runs: 38:00. CEU: .05


Course Objectives
1. Describe the significance of focused feeding assessment.
2. Identify short-term effectiveness of using a co-regulated feeding approach with enhanced auditory assessment.
3. Describe the skill of infant oral feeding using a dynamic systems theory framework.

Learning Outcome:
Describe the skill of infant oral feeding using a focused feeding assessment.

Suzanne Thoyre, PhD., Director, Doctoral and Post-Doctoral Programs; Associate Professor, University of North Carolina, Chapel Hill. Dr. Thoyre has no financial or nonfinancial relationships to disclose.


7. Kangaroo Care: Science underlying practice and issues of implementation.
$35. Intermediate instructional level. Runs: 60:00. CEU: .1


Course Objectives
1. Describe the literature that establishes importance of experience on the fetal brain.
2. Describe the benefits of kangaroo care for both infants and mothers.
3. Discuss the issues associated with early and often kangaroo care in high-tech nurseries.

Learning Outcome:
Explain the benefits of kangaroo care for both infants and mothers.

James M. Helm, PhD., Infant Development Specialist, Clinical Assoc. Professor of Pediatrics, Adjunct Assistant Professor Special Education, University of North Carolina School of Medicine.Dr. Helm has no financial or nonfinancial relationships to disclose.


8. Effects of cranial shape and pharyngeal arch function in the preterm and high-risk infant.
$35. Advanced instructional level. Runs: 87:00. CEU: .1


Course Objectives
1. Appreciate the impact of developmental care-giving on the synactive development of first order neurons and cranial nerves in response to head shape.
2. Discuss the neurodevelopmental differences between oral-tracheo and naso-tracheal intubation.
3. Plan appropriate care-giving strategies to impact synactive development of the head and neck areas.

Learning Outcome:
Describe the differences between oro-tracheo and naso-tracheal intubation and their impact on early feeding in the context of the synactive development of the head and neck.

John Chappel, M.A., RPT., NIDCAP Certified Pediatric Physical Therapist, Morristown Memorial Hospital, Morristown, New Jersey. Mr. Chappel has no financial or nonfinancial relationships to disclose.


9. Olfaction: the unexplored sense and its relationship to early feeding.
$35. Advanced instructional level. Runs: 68:20. CEU: .1


Course Objectives
1. Describe a typical feeding and the reasons it is efficient.
2. Describe how feeding matures for increased intake in the infant.
3. Identify problems that can occur with the flow rate of the feeding.

Learning Outcome:
Explain the ways in which odors may affect newborn feeding performance.

Peter Bingham M.D., Associate Professor of Neurology and Pediatrics, University of VT, Burlington, VT. Dr. Bingham has no financial or nonfinancial relationships to disclose.


10. Feeding in the typical newborn: breast feeding and bottle feeding, Part I
$35. Intermediate instructional level. Runs: 66:00. CEU: .1


Course Objectives
1. Review basic neuroanatomy and developmental neurobiology of olfaction.
2. Discuss the ways in which odors affect newborn behavior.
3. Discuss how knowledge of these effects might contribute to supporting early growth and development of sick newborns.

Learning Outcome:
Explain the maturation of feeding skills in the normal newborn.

Anna Dusick, M.D., formerly, Medical Director, Waisman Center; Visiting Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health. Dr. Dusick has no financial or nonfinancial relationships to disclose.


11. Feeding in the atypical newborn: breast feeding and bottle feeding, Part II
$35. Intermediate instructional level. Runs: 63:00. CEU: .1


Course Objectives
1. Identify feeding problems that can be unsafe for the infant’s health.
2. Identify support to assist oral feeding in the infant with atypical development.
3. Explain using tube feedings in the least intrusive and most developmentally helpful manner to support growth in the infant with atypical development.

Learning Outcome:
Identify feeding problems in the atypical infant and describe the use of supportive interventions that may be used to assist the infant.

Anna Dusick, M.D., formerly, Medical Director, Waisman Center; Visiting Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health. Dr. Dusick has no financial or nonfinancial relationships to disclose.


12. Visceral hyperlgesia and esophageal dysmotility for solids in older infants secondary to gastroesophageal reflux.
$35. Advanced instructional level. Runs: 42:00. CEU: .05


Course Objectives
1. Define characteristics and recognize visceral hyperalgesia in the older infant.
2. Explain correlation between gastroesophageal reflux and visceral hyperalgesia.
3. Understand why the feeding problems of these patients are often mis-diagnosed as “behavioral.”

Learning Outcome:
Describe the characteristics of visceral hyperalgesia and explain why infants with this condition are often mis-diagnosed as having behaviorally based feeding problems.

Marjorie Meyer Palmer, M.A., CCC-SLP, Neonatal/Pediatric Feeding Specialist. Ms. Palmer's disclosures can be found in the Series One Talks.

Series Three - Course of 2 Talks
Clinics in Pediatric Feeding

Course Description:

This series addresses those challenging issues that frequently arise during feeding therapy with pediatric patients. Such issues include but are not limited to difficulty with the transition from liquids to pureed foods, an inability to transition onto age appropriate solids, lack of the development of mastication, and sensory-based feeding aversion. Each clinic addresses a primary issue and presents one or more case studies with evaluation results and treatment strategies for the remediation of the primary feeding problem. Other issues may be discussed that are beyond the scope of the main subject but are important considerations when providing feeding therapy. These may include issues such as inadequate tongue base retraction, pharyngeal pooling, gastroesophageal reflux, esophageal dysmotility, and/or a hypersensitive gag resulting in a sensory-based oral feeding aversion.

View Series Three Courses | Learning Outcomes and Order Talks
Series Three Learning Outcomes:

  • List a minimum of three etiologies that underlie a sensory-based oral feeding aversion.
  • Identify two characteristics of feeding difficulty that occur during the esophageal phase of swallow..
  • Describe three variables that can be modified as part of a feeding program to help a child make the transition from liquids to pureed foods.
  • List two oral-motor issues and two oral-sensory issues that interfere with the successful transition from pureed food to solids.
  • Explain the Feeding Transition Readiness assessment tool.
  • Define three different categories of foods that may be used in a feeding program.
Presenter: Marjorie Meyer Palmer M.A., CCC-SLP

Non-financial disclosure: founder and director of NOMAS® International; current member, the American Academy of Cerebral Palsy and the NIDCAP Federation International.

Financial disclosure: Ms. Palmer is financially compensated for teaching live courses on feeding and online continuing education courses on feeding. She conducts certification courses for the NOMAS® and administers the non-exclusive copyright license renewal program for NOMAS® Certified Professionals. She is sole distributor of the "Fantastic Feeding Dropper."

1. Transition from Liquids to Pureed Food and Beyond.
Cost: $105. Runs: 1 hour. Offered for 0.1 CEUs (Occupational Therapists, and Nurses only).


Course Objectives
1. List a minimum of three etiologies that underlie a sensory-based oral feeding aversion.
2. Identify two characteristics of feeding difficulty that occur during the esophageal phase of swallow.
3. Describe three variables that can be modified as part of a feeding program to help a child make the transition from liquids to pureed foods.

Introduces sucking patterns of the neonate based on the NOMAS®. Describes observable characteristics of jaw and tongue function during dysfunctional suck; coordination of suck / swallow / breathe; disorganized suck; and evaluation process.


2. Transition from Pureed Food to Solids.
Cost: $135. Runs: 2 hours. Offered for 0.2 CEUs (Occupational Therapists, and Nurses only).


Course Objectives
1. List two oral-motor issues and two oral-sensory issues that interfere with the successful transition from pureed food to solids.
2. Explain the Feeding Transition Readiness assessment tool.
3. Define three different categories of foods that may be used in a feeding program.

This course discusses the child who has not yet made the transition from pureed food to solids and outlines both sensory and motor issues. Treatment strategies are outlined and a Feeding Transition Readiness tool is explained and included in the five pages of handouts.

Series Four - Course of 6 Talks
NOMAS® Online Day One
ASHA does not offer credit for individual talks in this Series.

For successful completion a quiz must be passed for all 6 talks. To receive ASHA CEUs, the participant must download, fill out, and mail or FAX the CEU Participant Form OR just provide their ASHA Membership Number.

Course Description:

This course provides an opportunity to attend the lecture portion offered to participants in the 3-day NOMAS® Certification Course. It will discuss the true nature of neonatal reflexive sucking; the differentiation of subtle movements of the jaw and tongue during active nutritive sucking; the clinical signs of sensory problems during non-nutritive sucking; and how to begin to recognize the characteristics of disorganized and dysfunctional sucking patterns and the way in which they compare to normal. This course will provide six lectures, each of which includes slides, video and five pages of downloadable handouts. The lectures include:

1) Anatomy and Physiology of the Infant Oral Mechanism;
2) Introduction to the NOMAS® (Neonatal Oral-Motor Assessment Scale);
3) Differentiation of Normal, Disorganized, and Dysfunctional Sucking with a review of the administration and scoring of the NOMAS®;
4) A Look at Breastfeeding: similarities and differences between breast and bottle feeding based on the NOMAS®;
5) Sensory Aspects of Neonatal Sucking;
6) Therapeutic Intervention for the Disorganized and Dysfunctional Feeder;

Upon completion of the entire course participants must complete a True/False quiz with 100% accuracy in two attempts and submit it online in order to be granted a Certificate of Completion.

Each participant must sign and submit the Letter of Agreement before the course can be made available.

This course will be offered for .7 ASHA CEUs. For ASHA you must download, complete and send the ASHA CE Participant form that is available on the website.

This course will be offered for .7 AOTA CEUs.

This course will be offered for .7 CEUs for the California Board of Registered Nursing.

THIS ONLINE COURSE DOES NOT PROVIDE BEDSIDE PRACTICUM IN THE NICU, RELIABILITY TESTING, OR CERTIFICATION AND LICENSING IN THE USE OF THE NOMAS®.

Once you have completed this NOMAS® Online: Day 1 course you will be eligible to complete the 3-day Certification Course in one of the following ways:

1) register at one of the NOMAS® training sites for just days 2 and 3 of the course for a pro-rated tuition rate;
2) schedule days 2 and 3 to be held at your NICU with a Licensed NOMAS® Instructor. It is recommended that for this option you have 8-10 people per course;
3) Sponsor a 3-day NOMAS® Certification Course at your hospital for which you may attend with a full tuition waiver;

Please contact Marjorie@nomasinternational.org for additional information on options listed above.

View Series Four Courses | Learning Outcomes and Order Talks
Series Four Learning Outcomes:

  • Explain anatomy and physiology of the infant oral mechanism.
  • Identify the components and types of neonatal sucking.
  • Differentiate normal from disorganized and dysfunctional sucking.
  • Outline similarities and differences with breast and bottle feeding.
  • List three types of sensory feeding problems in the neonate.
  • Identify "diagnostic-based" treatment strategies for infants with a disorganized and dysfunctional suck.
Presenter: Marjorie Meyer Palmer M.A., CCC-SLP

Non-financial disclosure: founder and director of NOMAS® International; current member, the American Academy of Cerebral Palsy and the NIDCAP Federation International.

Financial disclosure: Ms. Palmer is financially compensated for teaching live courses on feeding and online continuing education courses on feeding. She conducts certification courses for the NOMAS® and administers the non-exclusive copyright license renewal program for NOMAS® Certified Professionals. She is sole distributor of the "Fantastic Feeding Dropper."

Series Four - NOMAS® Online Day 1

In an effort to disseminate information and to further educate professionals in the field about neonatal sucking based upon the NOMAS® and the diagnosis of sucking patterns the first day of the 3-day NOMAS® Certification Course will be offered online.

This course does NOT provide the bedside practicum in the NICU or the Reliability that is required for Certification and NOMAS® Licensure, pre-requisites for the Administration and Scoring of the NOMAS®.*

The NOMAS® Online: Day 1 includes slides, videos, and lecture on the following:

Anatomy/physiology of the infant oral mechanism;
Introduction to NOMAS®;
Administration of NOMAS® and scoring of 9 practice babies on video;
Sensory aspects of neonatal sucking;
Similarities/differences between breast and bottle feeding;
Diagnostic-Based intervention strategies for infants with a disorganized and dysfunctional suck;

PARTICIPANTS WHO COMPLETE ONLY THE NOMAS® ONE DAY ONLINE COURSE ARE NOT QUALIFIED TO USE THE NOMAS® FOR THE DIAGNOSIS OF NEONATAL SUCKING PATTERNS*

*In order to obtain Reliability and Licensure in the Administration and Scoring of the NOMAS® a participant will be required to schedule two days in their NICU for a Licensed NOMAS®Instructor to conduct the bedside practicum and reliability. This may be scheduled with each participant individually and can accommodate up to four participants at bedside who have completed the NOMAS® ONLINE: DAY ONE Course. Participants may also make arrangements to attend a previously scheduled NOMAS®
To purchase, the "SERIES FOUR - NOMAS® Online Day 1 course," click here.
Series Five - Course of 2 Combined Talks
Developmental Cues: Readiness to Feed; and How to Support a Successful Feeding Experience in the NICU
This course will provide a description of infant stress signs accompanied by videos of infants during routine nursery procedures such as handling, diaper change, checking vital signs, etc.) and will help the participant to differentiate those infants who are demonstrating readiness cues to feed versus those infants who are too tired, stressed, or uncomfortable to feed. Subsystems of preterm infant behavior will be reviewed and observed on video. Participants will view infants during both non-nutritive and nutritive sucking activity and learn ways in which to calm infants who are stressed in order to improve their oral feeding skills.

In order to receive a Certificate of Completion for this course a participant must complete a 10-question True/False quiz with 100% accuracy in two attempts and submit online.

To receive ASHA CEUs, the participant must download, fill out, and mail or FAX the CEU Participant Form OR just provide their ASHA Membership number upon completion of the course.

View Series Five Courses | Learning Outcomes and Order Talks
Series Five Learning Outcomes:

Participant will:
  • List five infant stress signs
  • Identify three Initial Observation Sequences
  • Explain the advantage of a side-lying position for feeding
  • Describe the “en face” infant feeding position
  • Provide intervention strategies and therapeutic techniques to improve oral feeding skills in the neonate
Presenter: Linda Lowman, M.Ed., NLP/T

Non-financial disclosure: Ms. Lowman is a member of the NIDCAP Federation International.

Financial disclosure: Ms Lowman receives financial reimbursement for teaching NOMAS Certification Courses and related feeding courses for NOMAS International.

Series Six - Course of 2 Combined Talks
Evaluation of Neonatal Sucking: An Introduction to the NOMAS: How, When, Why?
The two talks in this Series were presented during the most recent course in the Diagnostic Treatment based on the NOMAS® Course that is offered only to those professionals who are Certified/Licensed in the Administration and Scoring of the NOMAS®. For this reason this Series is considered Advanced and may be challenging for those who are unfamiliar and/or not trained in the Administration and Scoring of the NOMAS®.

In order to receive a Certificate of Completion for this course a participant must complete a 10-question True/False quiz with 100% accuracy in two attempts and submit online.

To receive ASHA CEUs, the participant must download, fill out, and mail or FAX the CEU Participant Form OR just provide their ASHA Membership number upon completion of the course.

View Series Six Courses | Learning Outcomes and Order Talks
Series Six Learning Outcomes:

  • Describe three primitive oral reflexes in the infant under three months corrected age
  • Name two characteristics of both a disorganized suck and a dysfunctional suck as described on the NOMAS®
  • Explain the importance of respiration during neonatal feeding
  • List two underlying medical conditions that may be the cause of a disorganized suck.
  • Describe the use of “Imposed Regulation” for the treatment of esophageal dysmotility.
Presenter: Marjorie Meyer Palmer M.A., CCC-SLP

Non-financial disclosure: founder and director of NOMAS® International; current member, the American Academy of Cerebral Palsy and the NIDCAP Federation International.

Financial disclosure: Ms. Palmer is financially compensated for teaching live courses on feeding and online continuing education courses on feeding. She conducts certification courses for the NOMAS® and administers the non-exclusive copyright license renewal program for NOMAS® Certified Professionals. She is sole distributor of the "Fantastic Feeding Dropper."

California Board of Registered Nursing:

The Series One course is offered for .85 CEUs (8.5 Contact Hours) for successful completion of the full course. .15 CEUs (1.5 Contact Hours) is granted for successful completion of any two talks. Provider #CEP 13879.

The Series Two course is approved for .9 CEUs (1 contact hour is granted for successful completion of any two talks less than one (1) hour in length. Total course of all 12 talks is 9 contact hours. Provider #CEP 13879.

Series Three is offered for up to 0.3 CEUs (up to 3 contact hours). For successful completion a quiz must be taken at the end of each course. Provider #CEP 13879.

Series Four is offered for .7 ASHA CEUs. For successful completion one quiz must be taken at the end of this course which consists of six separate talks. There is no continuing education credit awarded for single talks. Provider #CEP 13879.

Series Five is offered for .2 ASHA CEUs. For successful completion one quiz must be taken at the end of this course which consists of six separate talks. There is no continuing education credit awarded for single talks. Provider #CEP 13879.

Series Six is offered for .1 ASHA CEUs. For successful completion one quiz must be taken at the end of this course which consists of two combined talks. There is no continuing education credit awarded for single talks. Provider #CEP 13879.
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ASHA CEU Credits
Form download and submission information
View ASHA CEU Application Form Information
ASHA CEU Application Form

This form must be submitted to receive ASHA CEU credits!
  • Download the ASHA CEU Application Form by clicking here
  • Print, fill-out and fax completed form to: 800.424.5570 OR mail form to:
    Therapeutic Media
    1528 Merrill Road
    San Juan Bautusta, CA 95045-9602.
  • Therapeutic Media will forward completed forms to ASHA along with course results.
ASHA CEU credit will not be given unless the CEU form is completed and submitted.