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RESULTS: We found the test-retest agreement of NOMAS to be ‘fair’ to ‘almost perfect’ (Cohen’s kappa [kappa] between and ), whereas the inter-rater agreement with respect to the diagnosis was ‘moderate’ to ‘substantial’ (Cohen’s kappa, between and ). As a diagnostic tool, however, the current version of NOMAS cannot be used for both full-term and preterm infants. For a measuring instrument such as NOMAS, one should aim at reliability coefficients for inter-rater and test-retest agreement of at least . A Cohen’s kappa of or less we find unacceptable. Nonetheless, by observing sucking and swallowing according to a protocol much useful information can be gathered about the development of an infant’s sucking skills. For instance, whether the infant is able to co-ordinate sucking and swallowing, whether the infant can maintain sucking, swallowing and breathing during the continuous phase and whether the infant is able to suck rhythmically with equally long bursts. In addition, NOMAS offers useful aids for intervention.

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