Effective sucking behaviors and intact gag and cough reflexes are requirements for safe and successful oral feeding and signify achievement of neurological, behavioral, and physiological maturity. The preterm infant is distinctly disadvantaged, as many factors preclude feeding efficiency, including sucking ability (i.e., sucking initiation and coordination and rhythm of sucking/swallowing), gestational age, muscle tone, physiological instability (ie, respiratory or cardiac problems such as tachypnea, apnea, bradycardia, and patent ductusarteriosus), behavioral state, and minimal energy reserve. Immature respiratory, gastrointestinal, and nervous systems, as well as medical status, also contribute to feeding problems. The inability of preterm infants to take full nutrition orally prolongs gavage feeding and hospitalization. Some infants require extensive nutritional and occupational therapies to address feeding issues. A small percentage of infant’s never fully nipple-feed, requiring long-term gastric-tube feedings. These multiple factors and the environment were considered in developing the RNOFP