What is meant by prematurity and low birth weight?
Prematurity is birth prior to 37 weeks gestation, with low weight → 2,500 grams or 5.5 pounds
Very low birth weight: (VLBW) Weight that is less than 1500 grams or 3.3 pounds
What is the role of the SLP in the NICU?
- Feeding and Oral Motor Development → In order to be discharged, infants should be able to take nutrition orally.
- Hearing Conservation & Aural Habilitation → noisy and over stimulating intensive cares
- Child Behavior and Development
- Parent/Child Communication
- Family support
suckling
A primitive form of sucking that includes extension and retraction of the tongue as well as up-and-down jaw movements and loose closure of the lips
sucking
A more mature pattern, which differs from suckling in that more intraoral negative pressure is generated, the tongue tip is elevated rather than extended and retracted, lip approximation is firmer, and jaw movement is more rhythmic.
rooting
Causes the infant to turn the head toward the source of tactile stimulation (gentle rubbing) of the lips or lower cheek.
phasic bite
When teeth and gums are stimulated (bottle/nipple in mouth) baby has a bite-and-release pattern
List 7 considerations for readiness for oral feeding
- Gestational age: At least 35-37 weeks
- Severity of medical condition: respiratory disorders contribute to delays for readiness for oral; feeding
- Respiratory/cardiovascular stability: infants needing oxygen support, with apnea or periodic breathing are more delayed in readiness for oral feeding
- Motoric stability: oral tone, posture, and quality of oral movements
- Coordination of sucking, swallowing and breathing: mature suck consists of 10 or more sucking bursts with breathing interspersed with suck/swallow; consider evaluating in non-nutritive sucking
- Behavioral state organization: infant must be able to maintain an alert state long enough to complete feeding
- Demonstration of hunger: exhibits rooting, may exhibit non-nutritive sucking, crying
List 3 options for non-oral feeding
- Nasogastric (N-G): tube through nose descending in pharynx & stomach
- Orogastric (gavage): tube is inserted through the mouth
- Nasojenunal: tube inserted into the second part of the intestine
why non-oral feeding might need to be considered
Non-oral feeding might need to be considered when the neurological system of the baby is so immature that his/her body can’t handle oral feeding or when other medical conditions are contributing to the intolerance of enteral feeding (by way of the intestines), which can result in excessive vomiting and lead to esophagitis and oral defensiveness.
List some ways an SLP can facilitate feeding. What is the purpose of non-feeding oral stimulation?
- Positioning: using a “Boppy” pillow, infant seat or tumbleform seating.
- Jaw stabilization: finger on the baby’s chin, just below the lower lip, another finger on the temporo-mandibular joint, and a third finger under the chin.
- Negative resistance: to help infants suck instead of biting
- Using specialized feeding equipment: to influence sucking when natural breastfeeding is not possible
- Modifying temperature and consistency: chilling liquids to increase swallowing rate and decrease pooling of liquid in the pharynx. Thickening liquids for easier swallowing
- Oral stimulation in feeding: by stroking, touching the nipple, allowing the baby to close on the nipple and start sucking
- Non feeding oral stimulation:
Which state is most ideal for intervention?
→Quiet alert. SLP can provide something for baby to look at, listen to, or suck to maintain this state.
lists the 6 Infants stages
The 6 infants states are: deep sleep, light sleep, drowsy, quiet alert, active alert and crying.
Canonical babbling is a benchmark for what abilities in the 2nd year of life?
Canonical babbling is a benchmark for the acquisition of words and word combinations
Failure to produce these syllables by 10 months of age predicts delays in acquisition of words and word combinations in the second year life
How is the Corrected Gestational age computed and what is it used for?
CGA is the functioning age, it should be used as a standard comparison during the child’s first year of life. Chronological Age (CA) – weeks premature = Corrected Gestational Age (CGA) i.e. 3 months (12 weeks) - 8 weeks premature = 4 weeks CGA (Janice)
Research for language development on children who are candidates for a cochlear implant, suggest that the device is most beneficial for expressive and receptive language development when implanted by what age?
before 2 years of age promotes the efficient acquisition of expressive language, as well as receptive language and speech intelligibility.
Paul listed 3 ways to help parents become aware of their pre-intentional infant’s communication.
- Teach the parents that although the infant participates in structuring interaction, the infant has very little choice about how to interact → Because of his immaturity
- Teach the parents that the most important thing they can do for their babies is to enjoy them.
- Teach them that communication that enhances development has 2 major characteristics:enriching and responsive
When can SLPs model interactive behaviors, which foster communication with their infants?
Once the clinician is sure of that the parent is sensitive to the infant’s readiness to interact.
Parents should demonstrate understanding that infants alertness moments happen spontaneously throughout the day and be encouraged to take advantage of their baby’s alertness whenever they observe it.
how can SLPs model interactive behaviors, which foster communication with their infants?
clinician can help the parents to integrate ordinary care taking activities with interactive stimulation using TIPS
Take turns: coach parents to engage in back and forth interactions with babies i.e. songs, peek-a-boo
Imitate: coach families to play “monkey see, monkey do” by mirroring any infant actions
Point things out: coach families to engage in joint attention
Set the stage: coach parents to establish anticipatory sets by repeating simple games and songs the child likes
- What is the big transition of infants 9 – 18 months?
Children move from being participants in interactions to being intentional communicators “learn how to mean”
Why does waiting become an even more important technique that parents should use?
Waiting helps the child transition to intentional behaviors. It is an important technique to give the child an opportunity to respond and to allow him to understand that a response is needed. Waiting teaches the child to initiate the interaction.
How can book-reading become an important tool for encouraging communication development?
They can be used to scaffold language acquisition, and foster both language and literacy development& facilitate communication development:
What is the role of communicative temptations?
- To increase the frequency of communication in at-risk children and to give them practice with using intentional behavior and seeing its positive results
- To elicit initial communicative behavior from children who are not yet demonstrating such behavior spontaneously
Example of communicative temptations?
- Put child’s hand in a cold, wet, or sticky substance such as pudding or paste
- Roll a ball to the child. After several rolls back and forth, substitute a car or other wheeled toy
- Blow up a balloon, and let the air out. Then hand the deflated balloon to the child
- Open a jar of bubbles, blow some bubbles, then close the jar tightly and hand it to the child
- Hold a food item the child does not like near his mouth
How might the information about communication needs in Prelinguistic period be related to older clients and those on the autism spectrum who are also pre-intentional or early intentional communicators
Children on the autism spectrum have splinter skills, they can be older or even display some more mature skills in other areas but have symbolic play scale skills of a 17-19 months old. Since autism mostly affects social behaviors and communication abilities using some of the techniques of communicative temptations to elicit communicative behavior; or techniques like waiting in order to help them become intentional communicators.
