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!

Questions?

Comments?

adaranblake@gmail.com

References Arvedson, J.C. (2008). Assessment of pediatric dysphagia and feeding disorders:

Clinical and instrumental approaches. Developmental Disabilities Research Reviews, 14(2), 118-127. Retrieved from http://eds.b.ebscohost.com.libproxy.lib.unc.edu/ehost/pdfviewer/pdfviewer?sid=7bfc34cf-8fbe-40f1-b4e8-29364dbb659a@sessionmgr114&vid=4&hid=102

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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