The SLP Must Be Familiar With These Aspects of the Feeding Process:
(even those that may primarily be the domain of other members of the NICU team)
(a) Modes (e.g., breast, bottle, tube)
(b) Function (e.g., ability to meet nutritional needs, physiologic cost, endurance)
(c) Oral-motor mechanism (e.g., structure, function, quality)
(d) Maturation of mechanical and neural control of sucking, swallowing, and breathing
(e) Relationship among nutritive and non-nutritive sucking, respiration, and oxygenation
(f ) Positioning and handling
(g) Feeding readiness cues
(h) Physiologic issues, such as metabolic and neurologic
(i) Competency of the infant as a partner
(j) Relationship with primary caregivers
(k) Tolerance of oral-facial and intraoral sensations
Directly from: Vergara, E., Anazalone, M., Bigsby, R., Gorga, D., Holloway, E., Hunter, J., Laadt, G., & Strzyewski, S. (2006). Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit. American Journal of Occupational Therapy, 60(6), 659-668.
NICU (Neonatal intensive care unit) has 3 levels of care:
I – Basic – postnatal care to healthy newborns; able to sustain and stabilize ill newborns until they can be transferred to a higher level of care.
II - Specialty – care to infants with moderate medical issues expected to resolve quickly or those recovering from serious illness
III – Subspecialty – care to infants with critical illness, extreme prematurity, or those requiring surgery
From: American Academy of Pediatrics, & American College of Obstetricians and Gynecologists. (2004). Guidelines for perinatal care (5th ed.). Elk Grove Village, IL
Precautions for SLPs working with neonates in NICU:
- If baby has bronchopulmonary dysplasia (BPD) (scarring and chronic lung disease due to ventilation for various breathing difficulties) the therapist must:
- Avoid stressing the baby because s/he needs to use the calories for breathing
- Be especially careful to prevent aspiration
- Ascertain that baby is getting enough oxygen during treatment. Oral feeding may mandate higher levels of oxygen during feeding. Oral stimulation may cause increase in saliva which increases aspiration risk.
2. Some babies need restricted fluid intake to decrease chance of congestive heart failure (why?)
3. A baby with necrotizing enterocolitis (NEC) usually is npo and receiving intravenous fluids. Oral feedings can result in severe diarrhea and tiny amounts in the mouth, even flavoring used with oral stimulation. Other means to decrease chance of oral sensitivity should be used.
Sensory:
Oral hypersensitivity can develop in babies not fed orally or those with treatment around mouth (either surgery, or tubes entering mouth or nose, or tape on tubes around oral area).
Treatment:
May involve parent education and support as much as direct work with neonate
Should often be coordinated with other professionals in what is known as "cluster care," in which therapies/treatments are given close together to allow a longer period for the baby to rest in between
