Abstract
Prolonged use of gavage feedings is common in premature infants who have not yet acquired suck, swallow, and breathing coordination. Preterm infants must be developmentally mature to orally feed successfully. Als' Synactive Theory of Development offers a conceptual framework to facilitate understanding of how premature infants dynamically differentiate to attain developmental milestones such as oral feeding. Key clinical implications for neonatal nurses are contingent upon incorporating evidence-based research into practice and providing consistent quality care to improve feeding outcomes.