Question:

I did infant feeding many, many years ago. Just got a referral for a 4-month-old, NG tube, congenital heart disease, some bottle feeding. What CE courses would get me up to date ASAP? Most of my feeding work in the past 10 years has been food avoidance and oral motor/chewing related difficulties in toddlers.

Catherine’s response:

It reflects your thoughtfulness that you reached out, as I suspect your instincts are telling you to think this through. Because our cardiac infants are some of our most fragile feeders. Given that her history and co-morbidities are likely complex, she will require some high-level problem-solving to keep her safe and to sort out all the pieces. Even after many years of complex infant feeding, I still have to pause and really think through these complex little ones. She is likely at high risk to invade her airway. Balancing the VFSS results, and her arduous course with family before you can be quite challenging for all of us. Before you accept referrals for infants with feeding problems, take the time to fully understand the underpinnings specific to congenital heart disease and its impacts on feeding and swallowing (and WOB and state regulation and postural control and neurodevelopment), as they will all need to be a part of your differential and plan. The infant-guided interventions for safe swallowing in infants, s/s that suggest a different plan, won’t be available to you right now. So, perhaps think about first building your guided/mentored experience with feeding/swallowing with more complex toddlers, then older more stable infants in EI and then increasing the complexity to younger and more complex infants. Taking courses under the gun isn’t the path to the critical thinking that is required with each population we serve, especially one so fragile. It would be no different if tomorrow I were asked to work in adult ICU at the very large medical center in which I work as a senior neonatal/pediatric swallowing specialist. I could technically treat adults in ICU because it is in our scope of practice as SLPs, but it would be ill-advised, unfair to the patient and family and likely place me in a potentially litigious situation should something adverse happen based on my recommendations or lack of insight, and clearly noted by an attorney or an expert witness from my limited preparation for that population. The risks all around would not be a good situation. If this (infant feeding/swallowing) is a direction you are passionate about, make a “long-term” (not “stop-gap”) plan (perhaps over 6 months rather intense and then an ongoing commitment) to read, read, read the research, take some highly recommended courses about infant feeding, find a mentor whom you can observe and learn along with. The things in life that we become successful at are rarely if ever easily attained. Allow yourself the time and support required.