Multiple methods have been evaluated to improve the nutritional management of preterm infants; however, nursing assessment for early identification of feeding intolerance symptoms has not yet been addressed. It is crucial for nurses to understand potential physical change they may observe when the preterm infant is experiencing feeding intolerance. Currently, there are no nursing assessment standards of care guidelines that provide focus to feeding intolerance symptoms. Nutritional management of very-low-birth-weight preterm infants varies by institution, which can be a disadvantage when attempting to identify and describe components for the nurse assessment. However, within the literature, there is noteworthy agreement on the symptoms that are commonly associated with feeding intolerance and of the symptom operational definitions. These components are necessary for developing nursing standard of care guidelines that are designed to encourage judicious reporting of early signs/symptoms of feeding intolerance to health care providers, which, in turn, may improve patient outcome. © 2012 Elsevier Inc.