Speech-Language Pathologists in the NICU (Neonatal Intensive Care Unit)

Speech-language pathologists who work in neonatal intensive care units (NICUs) have one of the most challenging roles in the entire career field. With patients far too young to communicate with and unable to express their symptoms and feelings directly, NICU SLPs have to be experts in diagnostic matters and understanding normal childhood development processes.

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Since newborns can’t speak anyway, some parents are initially confused when a speech-language pathologist is included as a part of their child’s care team. But SLPs are the specialists most familiar with swallowing disorders that can dramatically impact a newborn’s ability to take in food during the critical early months of childhood development. In some NICUs, such as in Ohio’s Dayton Children’s Hospital, an SLP is assigned to evaluate every premature baby admitted to the unit for possible feeding difficulties.

All premature babies are at risk of experiencing feeding difficulties. It’s not until they reach 40 weeks that all the muscles required for normal feeding are fully developed—and with children with certain childhood diseases, it can take even longer.

Because infants are often passive participants in the feeding process, a NICU SLP can expect to work as much with new parents as with the babies themselves. ASHA, the American Speech Language Hearing Association, cites family-centered practices as among the core competencies required of NICU SLPs:

  • Parent/caregiver education and counseling
  • Parent empowerment
  • Culturally sensitive delivery of educational content

Speech Language Pathology is an Emerging Concept in Neonatal Intensive Care

Approximately 13 percent of all births in the United States are pre-term. The survival rate for these babies has increased by 20 percent since 1990 and the demand for specialists who can continue to improve those numbers is growing.

The addition of SLPs to NICU care teams is relatively recent. Their role in the NICU is still developing, but they may be among the first specialists to see a medically-stable neonate. A neonate’s ability to gain weight in the days and weeks after being born comes down to the ability to feed, and an SLP can be the key to making that happen. Weight gain in neonatal newborns has been shown as a predicting factor in the baby’s ability to avoid future complications, like retinopathy, that can result from premature birth.

The first thing the SLP will do with a newborn is to make an assessment using a variety of tools and techniques. They may conduct an Apgar test to provide a comparative evaluation of the infant’s muscle tone, reflex, irritability, and other developmental factors. They will visually assess the physical development of the infant and may conduct a series of neurological tests that evaluate brain development. They may use ultrasound, videofluroscopy, endoscopic examination, and auscultation to determine the physical layout of the baby’s mouth and throat structures.

Once the SLP has diagnosed any feeding issues, they will work in conjunction with the rest of the care team to develop a treatment plan. This plan may include goals for the infant to improve their food intake, shorten the length of feeding sessions, or increase the baby’s comfort as assessed by various visual or behavioral signals offered during the feeding.

It’s vital to assess the infant’s ability to coordinate the suck-swallow-breathe reflex; a failure to engage motor skills in the correct sequence can lead to aspiration and further breathing complications or even pneumonia.

Oral motor intervention is the primary treatment for issues in this area and can include:

  • Non-nutritive sucking (NNS)
  • Oral/perioral stimulation
  • Preceding simulation

These interventions have proved effective in reducing the time it takes to transition from nasogastric tubes to normal feeding routines.

Creating a Path to Normal Development

Feeding is the most immediate goal for neonates in the NICU, but the SLP also has long-term developmental goals in mind. Although the baby won’t be expected to speak for years after their discharge, elements of their care in the NICU can impact the development of speaking ability over the long term.

Studies conducted by speech-language pathologists have begun to reveal that even mundane aspects of infant care in the NICU like how the neonates are positioned in the isolettes and the amount of ambient noise in the room can affect their muscle development and ability to perceive and adopt the sounds of speech later in life.

SLPs now recommend low-noise environments in the NICU and the use of physical supports such as swaddling and Kangaroo Mother Care (a method of establishing skin-to-skin contact between infant and mother) to help reduce the potential impacts on speech development processes.

Finally, the SLP has an important role to play in the infant’s long-term speech development by properly educating parents and caregivers. Although the immediate interaction will revolve around demonstrating to parents the proper way to feed the infant at home, the SLP will also discuss the long-term prognosis for normal speech development. They may provide the parents with exercises to perform with the baby, or provide them with signs and signals to watch for that could indicate improper physical development and require further intervention.

Although working as an SLP in a neonatal care setting can be extremely demanding and emotionally draining, it can also offer tremendous rewards. Watching a preemie the size of a rabbit develop into the size of a full-term baby, healthy and eating normally, and ready to go home with its parents, is among the greatest accomplishments any SLP can hope for in a career.

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