breastfeeding management and the speech-language...
TRANSCRIPT
Breastfeeding Knowledge
and Clinical Management
among Speech-Language
Pathologists ADARA N. BLAKE, MS, CF-SLP, IBCLC
CARA MCCOMISH, PHD, CCC-SLP
ELIZABETH CRAIS, PHD, CCC-SLP
SUZANNE THOYRE, PHD, RN
Disclosure Statement
I have no relevant financial or nonfinancial relationships to
disclose.
Why Should SLPs Care About
Breastfeeding?
“The American Speech-Language-Hearing Association
(ASHA) has long accepted the prevention of
communication disorders as one of the profession's
primary responsibilities.”
GI, Respiratory, Otitis media (Ip et al., 2007), IQ* (Belfort et al., 2013)
“Developmentally supportive” care
“…support the infant's physiological stability, self-regulation,
behavioral organization, and developmental progressions…”
Babies are more stable at the breast (Bier et al., 1993; Chen et al., 2000;
Goldfield et al., 2006)
Why Should SLPs Care About
Breastfeeding?
ASHA Practice Recommendations
Clinicians providing pediatric dysphagia services should have
knowledge and skills to assess and treat breastfeeding as well as
bottle feeding.
Objectives
Describe the breastfeeding knowledge and skills of
speech-language pathologists (SLPs) who provide
pediatric swallowing and/or feeding services
Describe the quality of collaboration between SLPs
and other professionals regarding breastfeeding
management
In particular, lactation consultants
Describe the current state of professional
development
Background
Breastfeeding rates
continue to rise
(CDC, 1995, 2013)
Feeding disorders are
prevalent (Manikam & Perman, 2000; Burklow et al.,
1998; Arvedson, 2008)
Literature Review
Knowledgeable professionals are important for
breastfeeding success (Renfrew et al., 2012)
Danger of conflicting information (Dykes and
Williams, 1999)
Professional confidence = initiation of support (Burglehaus et al., 1997)
Role of professional organizations (McFadden et al.,
2006)
Literature Review
ASHA’s role in the promotion of breastfeeding
competence
Little mention in practice policy documents
ASHA Leader
“The SLP and the IBCLC bring both overlapping and unique
skills to the table when assessing and treating infant feeding
difficulties. An awareness and respect for each other’s roles as
well as forming a partnership will only improve the quality of
care provided” (Fletcher & Ash, 2005)
No available continuing education resources
Method
Qualtrics survey
Quantitative and qualitative data
Recruitment via ASHA forums and email contact
with 21 feeding programs
Inclusion criteria: provision of pediatric feeding
and/or swallowing services
97 total responses
86 included in results
Results
Breastfeeding Knowledge
Areas of relative strength
Physiologic stability at the breast
Non-nutritive sucking at the breast
Positioning
Areas to be targeted in education
Latch basics
Methods of supplementation
Infants with special needs
… I was seldom called to work with
breastfed babies (or their moms). That is
because the primary strategy I use for
improving swallow function is slowing the
flow rate, and there is really no way to do
that with breastfeeding. Instead, we would
encourage mom to pump, and the baby
was fed via bottle, at least until feeding
issues were resolved. Then, hopefully, the
mom could go back to breastfeeding.”
Results
Results
Current Breastfeeding Management
Self-rated competence in breastfeeding management
Sources of this knowledge were largely
personal interest/self-directed education
and collaboration with other knowledgeable
professionals.
Strong perceived benefit of increased
knowledge and skills
Little to no
clinical
knowledge
2%
Some clinical
knowledge,
but would
refer
concerns to
another
professional
41%
Sufficient
clinical
knowledge to
address
concerns that
come up in
my practice
Advanced
knowledge,
skills, and
experience
Figure 2: Self-Described Breastfeeding Competence
Results
44% of respondents encountered breastfeeding issues
“once per month or less,” but 24% reported a frequency
of “more than once per week.”
Hospital-based SLP’s
Wide variety of issues encountered, including poor
weight gain, medically fragile infants, latch, and suck
issues
Areas targeted during evaluation and intervention
included feeding readiness, coordination, positioning,
and latch
Results
Frequency of collaboration with other professionals
65% reported wanting increased collaboration
with other professionals
Most frequently collaborated with LC’s, but
also pediatricians, neonatologists, RN’s,
dieticians, other SLP’s, OT’s, PT’s, GI, ENT
No interaction
with other
professionals
15%
Referrals only;
no
collaboration
8%
Occasional
collaboration
33%
Frequent
collaboration
28%
Work on a
team
16%
Figure 4: Frequency of Collaboration with other Professionals
Results
“While [collaboration] can at
times be a bit challenging
because we come at problems
from different perspectives, it’s
also been very informative for
both the lactation specialists and
myself. I have learned a lot about
the mother’s side of the equation
from the lac [sic] specialist.”
Results
“…as an SLP, I thought I myself
was knowledgeable enough to
nurse my infant daughter, but
had to seek the help of a
lactation consultant… As a
profession we should put more
focus on teaming with
pediatricians and lactation
consultants to support all mothers
in nursing.”
Results
“At our center – a large
pediatric hospital, ALL
assessments by an SLP of
breastfeeding dyad [sic]
are done in conjunction
with an IBCLC.”
Discussion
Implications for education
Responses indicate a need for and potential benefit of increased breastfeeding education
Multiple sources of education needed
ASHA’s role in the promotion of breastfeeding competence
Serving the mission statement:
advancing science
setting standards
fostering excellence in professional practice, and
advocating for members and those they serve
Discussion
Implications for Practice
Increasing collaborative service delivery
Educational preparation for teaming
Implications for Further Research
Case studies
Differentiation of SLP and LC roles
Effects of implementing breastfeeding education
Limitations
Sample selection
Buy-in from other professionals?
Terminology
Resources
Talk to an IBCLC!
International Lactation Consultant Association – “Find a
Lactation Consultant”
http://www.ilca.org/i4a/pages/index.cfm?pageid=3337
KellyMom.com
Dr. Newman
The Ultimate Book of Breastfeeding Answers
http://www.breastfeedinginc.ca/content.php?pagename=inform
ation
http://www.breastfeedinginc.ca/content.php?pagename=videos
Photographs used with permission from Grainne Evans
http://birthingandbreastfeeding.wordpress.com/2013/08/10/breastfeeding-tracheostomies-
tears-and-triumphs-part-one/
Even Tessa can breastfeed!
References Arvedson, J.C. (2008). Assessment of pediatric dysphagia and feeding disorders:
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Belfort MB, Rifas-Shiman SL, Kleinman KP, et al. Infant feeding and childhood cognition at ages 3 and 7 years: effects of breastfeeding duration and exclusivity [published online July 29, 2013]. JAMA Pediatr. doi:10.1001/jamapediatrics.2013.455.
Bier, J.B., Ferguson, A., Anderson, L., Solomon, E., Voltas, C., Oh, W., & Vohr, B.R. (1993). Breast-feeding of very low birth weight infants. Journal of Pediatrics, 123, 773-778. Retrieved from http://ac.els-cdn.com/S0022347605808583/1-s2.0-S0022347605808583-main.pdf?_tid=5e0ff2a6-606d-11e3-9273 00000aab0f02&acdnat=1386551039_b8094b34166164d2367b205306ce8bcf
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Centers for Disease Control and Prevention. (1995). National survey of family growth: cycle 5. Retrieved from http://www.cdc.gov/nchs/data/hus/2010/014.pdf
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References Fletcher, K. & Ash, B. (2005, February 08). The speech-language pathologist and
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