When to refer for Speech-Language Therapy Assessment

1. When to refer for Speech-Language Therapy Assessment SPEECH-LANGUAGE THERAPY CONTACTS FOR WARD 23b: Terry Wackrow: 021 2407017 Lena Williams: 021 2416268

2. Criteria for an effective feeding plan: SAFETY - the feeding plan should support and maintain the baby’s health OPTIMAL NUTRITION - this is essential as the feeding process is high energy output FARSIGHTED - the implications of current treatment on future feeding and oral functions must be considered

3. Indicators for concern: • Poor or absent sucking reflexes • Difficulty establishing sucking • Problems maintaining latch • Poor or absent milk transfer • Pacing difficulties • Poor state regulation • Frequent gagging and choking • Difficulty maintaining a seal / vacuum • Aspiration • Bites or chews when nipple offered • Strong preferences for particular positions, angles, pacifier shape

4. Refer for speech-language therapy: • If there is ongoing difficulty with SSB synchrony • Loss of co-ordination during a feed • If a baby persistently exhibits stress signs during feeding • Noisy, “wet” upper airway sounds after individual swallows • Persistent desaturations associated with sucking feeds • Coughing or choking during swallowing • Multiple swallows to clear a bolus • History of respiratory infections

5. Disorganised Sucking Disorganization = lack of sucking rhythm • lack of response to nipple insertion at mealtime • poor Suck/Swallow/Breathe co-ordination • sucking bursts of varying length • irregular, jerky jaw excursion • rapid deterioration of normal sucking pattern • flaring of the nares / head bobbing • worried facial expression • extraneous movement, head turning • significant anterior fluid loss

6. Dysfunctional Sucking Oro-motor patterns that disrupt feeding • poor rate change between Non-Nutritive Sucking and Nutritive Sucking • excessively wide jaw excursions • restricted ROM at temporal mandibular joint resulting in jaw clenching / biting down • flaccid or retracted tongue with absence of central grooving • significant anterior fluid loss

7. Always refer to the speech-language therapist • If there is ongoing difficulty with SSB synchrony • If a baby persistently exhibits stress signs during feeding • Noisy, “wet” upper airway sounds after individual swallows • Loss of co-ordination occurs during a feed • Persistent desaturations associated with sucking feeds • Coughing or choking during swallowing • Multiple swallows to clear a bolus • History of respiratory infections