Speech-Language Pathologists and Clinical Management of Breastfeeding by Adara Blake, BS, IBCL

During the first year of my graduate program in speech-language pathology, I was very fortunate to be able to pursue my interest in breastfeeding support by completing an intensive lactation consultant certification program. As a student of both disciplines, I have observed the relationship between these professionals with great interest. In some ways, SLPs and IBCLCs are very much at odds with each other – lactation consultants are experts in breastfeeding but typically receive little training in swallowing physiology, while speech-language pathologists have a scope of practice that includes dysphagia management and little to no background in even the basic mechanics of breastfeeding.

Despite this inherent tension, the relationship between SLPs and IBCLCs is also ripe for collaboration. As breastfeeding outcomes continue to improve, it stands to reason that there will be a greater number of breastfeeding difficulties. For many of these families, exclusive bottle feeding will not be an acceptable outcome. With the appropriate education speech-language pathologists should be able to translate their knowledge, which has traditionally been based on bottle feeding, to the management of infants demonstrating disordered feeding and swallowing at the breast.

To investigate this further, I completed a master’s thesis that aimed to describe the current state of knowledge and clinical management of breastfeeding concerns among speech-language pathologists who provide pediatric swallowing and feeding services.

 

While many participants described themselves as having sufficient clinical knowledge to address the breastfeeding concerns in their practice (47%), almost as many indicated that they had some clinical knowledge, but would refer breastfeeding concerns to another professional (40%).

 

Variable competence was also reflected in responses to knowledge questions intended to determine understanding of breastfeeding topics that could conceivably come up in a SLPs practice. While the target responses were generally selected more often, incorrect responses were also frequently chosen. For example, more than a third of participants thought that widely flanged lips, often considered to be a classic characteristic of a good latch onto the breast, were actually a sign of a poor latch.

Most participants (91%) reported interest in increasing their knowledge and skills in breastfeeding, and 87% felt that this increased knowledge would benefit their practice. Despite this interest, 72% of participants felt there were not enough resources for increasing their breastfeeding knowledge and skills. This mismatch in reported interest, perceived benefit, and availability of resources reveals a gap in pre-service and continuing education for speech-language pathologists.

The inclusion of basic breastfeeding information in graduate level dysphagia coursework would be a huge step toward remediating this gap in knowledge. For those SLPs who routinely address pediatric dysphagia and are already working, continuing education could help them become more skilled in a topic area. This information could be valuable as, according to the participants of this survey, some SLPs (24%) experience these issues as frequently as several times per week.

Another salient result of this survey was the reported importance of collaboration with other professionals. When asked where their breastfeeding knowledge came from, 79% of participants indicated that it came from collaboration with other knowledgeable professionals. Sixty-five percent of those who took the survey wanted increased collaboration with others. The participants in this survey seemed to value and benefit from these professional interactions.

There is a need and a desire for more resources to be developed in the interest of furthering the breastfeeding knowledge of speech-language pathologists. But how do we encourage the production of these resources? In the USA, the primary professional organization for speech-language pathologists is the American Speech-Language-Hearing Association (ASHA) which sets the professional standards for the field. While most participants of the current survey (90%) felt that ASHA does not adequately promote or facilitate breastfeeding competency at this time, the organization is constantly revising and expanding its views and policies. Breastfeeding basics can be included in the Knowledge and Skills Acquisition standards, as part of swallowing competence. The inclusion of these standards would indicate to graduate programs that they need to add breastfeeding topics to their curriculum, would encourage the creation of continuing education in this area, and would suggest to practicing SLPs that they might pursue that continuing education if breastfeeding knowledge and skills are not in their repertoire.

As I embark on my career in speech-language pathology, I look forward to synthesizing my lactation background with my dysphagia knowledge. Through clinical experience and collaboration with other professionals, I hope to continue to investigate and refine the role of the speech-language pathologist in the management of disordered breastfeeding, and make that knowledge available to other SLPs.

Breast feeding tips for the feeding therapist :

• Signs of a good latch include a wide open mouth with widely flanged (like a fish) lips, tongue down, an asymmetrical latch where more of the bottom of the areola is in the mouth than the top, and baby’s chin is pushing into the breast more than the nose. The nipple should be everted and round after feeding (not creased, blanched/white, or lipstick shaped).

• Always consider baby’s latch and efficiency when there is a suspicion of low milk supply – the breast must be emptied in order to make more milk, and even a copious supply won’t benefit a baby who can’t adequately express.

• Flow rate can be slowed by asking mom to pump or hand express before a feeding, or using upright (football hold) or prone (mom is reclined) positioning.

• Asking mom to compress her breast throughout the feeding can increase flow and the fat content of the milk, and providing cheek or jaw support may improve expression.

• While swaddling encourages flexion and is a common intervention, placing baby skin to skin with mom can be very organizing and lead to increased readiness cues.

• Babies are typically more physiologically stable at the breast than they are with bottle feeding (better heart rate, respiratory rate, and oxygen saturation); a baby who is disorganized with bottle feeding may demonstrate improved coordination at the breast.

• Suspect a tongue tie? Remember that the type of latch required for efficient expression from the breast is different from that for a bottle – just because a baby can express from a bottle does not mean the tongue tie is insignificant. The Hazelbaker Assessment for Lingual Frenulum Function scores baby’s tongue on both appearance and function, and can provide useful information when referring to an ENT.

• www.kellymom.com is dedicated to providing evidence-based breastfeeding information – this is a fantastic resource for any questions you might have.

• If you’re not familiar with the IBCLCs in your area, you can find one using the International Lactation Consultant Association’s directory.