Speech therapy in the NICU: Key to babies' survival

Tanner and Kirah Crane

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Lee Ann Damian, speech therapist, help Tanner Crane with his feeding skills.

One thing neither Chris nor Crystal Crane expected when their newborn twins were transported to Dayton Children’s Regional Level III B Newborn Intensive Care Unit (NICU) was the involvement of a speech therapist in the twins’ care.

At first it may seem strange—after all, newborn babies can’t talk. But, speech therapists also help infants and children with feeding issues, and those issues are critical when you are caring for fragile, critically ill newborns.

Hear from the Crane family and other NICU families and staff


At Dayton Children’s, Lee Ann Damian, one of the hospital’s speech therapists, evaluates every premature baby admitted to determine if there are feeding challenges.

“The baby’s ability to feed and gain weight is not only a survival issue, but is one of the main factors in determining how quickly that baby can go home,” Lee Ann explains. “The sooner we can get the baby happy and comfortable with feeding, the better it will be for the entire family.”

With Lee Ann’s help and the Cranes’ involvement, the twins are now feeding and gaining weight.

“Once Lee Ann started working with the twins, we could see the difference,” Chris says. “We’ve been very impressed with Lee Ann’s skill and watching the twins’ progress.” Chris jokes that Tanner is known around the NICU as the “bottle killer” because of his ability to finish his small bottle in record time. Kirah, his twin, is quickly catching up.

Lee Ann points out that all premature babies are at risk for feeding issues, since it’s not until 38-40 weeks that all the muscles and reflexes needed to feed fully develop. “They use their time in the womb to practice sucking, tasting, smelling and swallowing. When that time is cut short, we need to provide that stimulus outside the womb,” she explains.

Helping babies learn to feed

One of Lee Ann’s primary goals is to help babies develop pleasurable experiences around feeding. “In the NICU, babies may not be able to feed right away, and if we don’t make an effort to create pleasant oral experiences, they may not feed well when they are ready,” she explains.

Lee Ann typically starts working with the parents and their babies at around 30 weeks gestational age. “We start by watching and waiting, looking for signs that baby is ready to feed. This may be when the baby starts staying awake longer, sucking on a finger placed in his or her mouth, or bringing a hand up to the face. These are all signs they may be ready to feed,” she explains.

To help parents create these experiences, Lee Ann demonstrates how she uses a cotton swab dipped in breast milk or formula and applies that to the baby’s lips and around his or her nose. “This helps them get familiar with the taste and feel of these foods.” Depending on the baby, she might also use a pacifier—the NICU stocks three different sizes—also dipped in formula or breast milk to use with premature and sick newborns. If the babies are not allowed to ingest anything—even if it’s just a drop of breast milk—Lee Ann will rub a small amount of flavored Chapstick on the baby’s mouth to create a pleasing oral experience.

Lee Ann explains that premature babies may have trouble feeding because all the body’s systems—digestive, muscular, respiratory, neurological, cardiovascular, etc—are all involved in successful feeding. Because these systems aren’t fully developed, premature babies often face challenges in feeding and gaining weight. “Fortunately, specialists in all these areas are onsite at Dayton Children’s, so we can call on them at anytime for advice on feeding and other issues,” she says.

Lee Ann’s services have been well received by both parents and staff in the NICU. Some comments from a recent survey include the following:
 

  • “Very friendly, knowledgeable and gentle. Allows us to get involved.” – From a parent
  • “Very helpful. Explained things and the reasons well. Very nice.” – From a parent
  • “Very valuable member of the team. Great addition to patient care services.”  - From a staff member
  • “I have seen a quicker improvement in our babies with their feedings thanks to Lee Ann being here to do the feedings or helping us (the staff) and families do the feedings.” – From a staff member

Feeding successfully is a complex, coordinated process, and even a smile—something most of us take for granted—results from the astounding interplay of 26 muscles and six cranial nerves.

And, there are plenty of smiles in the NICU as the result of Lee Ann’s expertise, specialized techniques and rapport with parents, families and staff that help ensure our tiniest patients get to go home sooner.

Speech therapist in the NICU helps babies learn to feed.

 

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