AAP 2023 Neonatal Care Standards: Recognizing the Value of Rehab

NICU Nurse Decal by AdriansVinyl on Etsy

The American Academy of Pediatrics has just issued new neonatal care standards that now recognize the expertise of SLPs for supporting feeding, swallowing and neurodevelopment, as part of an interdisciplinary NICU team alongside OT and PT. Minimum standards for Level II, III, and IV are specified, with a goal to “improve neonatal outcomes by ensuring that every infant receives care in a facility with the personnel and resources appropriate for the newborn’s needs and condition.”

Both Level III and Level IV NICU Requirements support consistent presence of SLPs in the NICU and ensure that NICU patients and their families receive the services they need to thrive in the NICU and after discharge. This includes onsite access to an SLP with neonatal expertise, preferably certified in neonatal therapy, who is skilled in the evaluation and management of neonatal feeding and swallowing concerns.

How the NICU rehab “workload” is shared depends on each NICU team’s interprofessional practice, and the unique expertise of rehab team members. That working relationship, no matter what way it is designed in each particular NICU, is the key to meeting the needs of the infants, their families and staff. Together, the rehab team addresses six core practice domains (environment, family and psychosocial support, sensory system, neurobehavioral system, neuromotor and musculoskeletal systems, and oral feeding and swallowing) in order to provide appropriate care for the neonatal population.

Stark, A. R., Pursley, D. M., Papile, L. A., Eichenwald, E. C., Hankins, C. T., Buck, R. K., … & Faster, N. E. (2023). Standards for Levels of Neonatal Care: II, III, and IV. Pediatrics151(6), e2023061957. See attached via open access on Google Scholar



Lifelong Learners Join Catherine in Houston

My final seminars for 2022 held at Texas Childrens Hospital in Houston brought together SLPs and OTs from across the US and Canada, including Stephanie, pictured with me above. From new graduates to seasoned therapists, we shared complex patients, and problem-solved the “bigger picture” as our framework for interventions. Such a great opportunity to learn along with each other, and to have the time to grow our critical thinking skills that underpin swallowing and feeding practice, from infants through adolescents. Our conversations and discussions helped each of us realize that the challenges we each face are not unique, and we are all in this together. I can’t wait to continue the conversation in 2023!

State-of-the-Art NICU Practice: Catherine Shaker and Suzanne Thoyre

Just returned from Houston after presenting with my colleague, Dr. Suzanne Thoyre, a gifted and remarkable researcher and neonatal nurse. The attendees came from across the US to share our common passion for infant-guided co-regulated feeding in the NICU and after discharge.

Our Early Feeding Skills Assessment Tool was the framework for advancing cue-based feeding, problem-solving challenges in the NICU and beyond, getting everyone “on the same page” through a common language, and supporting parents in building a relationship with their infant through feeding. We all left renewed and empowered to be the change … and with a solid path forward.

Catherine Shaker Seminars: “Formula One” Style in Austin!

     The flagman waves the chequered flag as Red Bull's Dutch driver Max Verstappen crosses the finish of the Austrian Formula One Grand Prix in...

Formula One, part of the US Grand Prix, came to Austin in October and so did I!

The Feeding and Swallowing Team at Dell Children’s were amazing hosts! Speech-Language Pathologists and Occupational Therapists joined us from across the US and Canada to learn interactively along with each other, focusing on a wide variety of practice settings. In the Cue Based seminar, Dr Thoyre and I guided the group in higher level conversations about complex feeding challenges in the NICU and after discharge, watching and scoring videos of neonates feeding and problem-solving next steps. In the Pediatric Swallow Studies seminar, we discussed unique components of the swallow pathway across the pediatric age span, and then peeling apart the pathophysiology and its implications.  In the Advanced Dysphagia seminar, we looked at critical thinking for decision-making, problem-solving and interventions for our neonatal through school aged patients.  It was also a great opportunity to share ways of navigating the practice challenges that each of us faces on a daily basis. It reminded us that we are not alone. One attendee commented: “I feel rejuvenated and validated in my practice, and our conversations reinforced my values as a clinician. ” We all walked away feeling renewed.

Practicing at the Top of Your Profession in Feeding/Swallowing

An SLP asked recently, “What resources, articles, courses, etc. did you find helpful when you were first learning infant feeding? I’m looking for something to give me what I really need.”

“My seminars” I told her, “are designed to do just that. When I created them, and as I update them, I always think ‘What do I wish I had known, both research and clinical information, to practice in peds dysphagia when I started out? What is essential to work toward practicing at the top of our professions?’  My NICU and Pediatric as well as Advanced seminars, my Peds/ Neonatal Video Swallow Studies and Cue Based seminars are filled with everything I want to pass along. As I learn from colleagues and attendees at my courses, I weave that in as well. Sometimes I almost run out of time!

I will always offer you a welcoming environment that fosters interaction and learning along with each other.