Problem Solving: NICU therapy services

Question: There are several different hospitals with NICU’s in my general area and many of our nurses float between hospitals. Periodically one will question the differences in speech services in the different NICU’s. In particular one NICU has a plethora of SLP’s who work there full time (contracted in) and typically feed a majority of the babies every day (or so I am told). Comparatively, our NICU has one SLP (me) where I typically feed the babies on my list once every 1-2 weeks  – with a tx focus more on sensory stim, tongue thrust reversal, NNS and oral reflex stim. I am wondering what other NICU’s are doing around the country? How often do you see each baby and is feeding part of your tx at each visit? Thank you in advance,

Roles of the SLP in the NICU vary depending on the particular NICU, and, of course, on the SLPs perspective, expertise and passion, as well as logistics of budget, staffing and training.
Some NICUs are much farther along in the transformation from volume-driven to infant-driven feeding. As such, they can more readily benefit from a more consultative model similar to what you describe you describe. Even so, typically, our presence on a regular basis is critical and builds the relationships necessary to give us value in the NICU as a resource for research, the latest information about swallowing/feeding and outcomes, guiding parents, providing in-services, and having “casual” conversations with staff (both MDs and RNs) as colleagues, which provide a basis for mutual respect and problem-solving together both in the present and the future. This provides the basis for “belonging” to the team. It does not happen overnight but it is a journey every NICU therapist, I believe, mustembrace.

Due to the positive influence of maturation, as well as the adverse effects of changes in medical status (i.e., decline,weaning of supports, fluctuations in the influence of current and new-onset co-morbidities etc.), a frequency of every 1-2 weeks would be very limiting. It doesn’t typically allow for the collaboration from day to day with RNs/Neonatologists, problem-solving, parent teaching and guided participation, updating of suggestions, as well as actual therapy to improve function, be it for feeding readiness or safe and efficient swallowing/feeding. Preterms and often sick newborns in NICU change daily; our input is critical regarding resulting changes in  recommendations/suggestions, progression to PO, and for advocating for neuro-protection for the developing preterm, for whom the “work” of feeding may present new and perhaps more concerning safety issues over time. Nothing in NICU is static. Each day, each session, each interaction with caregivers/staff brings a new perspective and perhaps a different level of support needed from day to day.

I hope this is helpful.

Catherine S. Shaker, MS/CCC-SLP, BRS-S
Board Recognized Specialist – Swallowing and Swallowing Disorders

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