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Current methods used to identify feeding intolerance signs/symptoms in preterm infants rely heavily on nurses’ physical assessment and reporting of symptoms to the health care provider (HCP). Feeding intolerance, for the purposes of this discussion, is defined as “experiencing difficulty with the ingestion or digestion of formula or breast milk that causes a disruption in the current enteral feeding plan due to the manifestation of one or more of defined clinical symptoms including gastric residuals (>50% of feeding volume), abdominal distention, appearance of the abdomen (changes in color or suppleness), emesis and changes in the stool (minimal or lack of)” (Carter, 2012). It is critical to evaluate these assessment strategies to determine how reliable they are in identifying progression to feeding intolerance and more serious conditions such as necrotizing enterocolitis. Because the guidelines often vary by institutions, this can often be disadvantageous. However, the literature does provide some very consistent support and agreement on what is considered more reliable non-radiology measures that indicate a preterm infant is progressing to feeding intolerance. In addition, there are well known triggers for feeding intolerance that should be considered. There are also future methods, such as intra-abdominal pressure monitoring, that may be on the horizon for predicting feeding intolerance in preterm infants that are presently used in pediatric and adult populations.