1. When to refer for Speech- Language Therapy Assessment SPEECH-LANGUAGE THERAPY CONTACTS FOR WARD 23b: Terry Wackrow: 021 2407017 Lena Williams: 021 2416268

2. Criteria for an effective feeding plan: SAFETY - the feeding plan should support and maintain the baby’s health OPTIMAL NUTRITION - this is essential as the feeding process is high energy output FARSIGHTED - the implications of current treatment on future feeding and oral functions must be considered

3. Indicators for concern: Poor or absent sucking reflexes Difficulty establishing sucking Problems maintaining latch Poor or absent milk transfer Pacing difficulties Poor state regulation Frequent gagging and choking Difficulty maintaining a seal / vacuum Aspiration Bites or chews when nipple offered Strong preferences for particular positions, angles, pacifier shape

4. Refer for speech-language therapy: If there is ongoing difficulty with SSB synchrony Loss of co-ordination during a feed If a baby persistently exhibits stress signs during feeding Noisy, “wet” upper airway sounds after individual swallows Persistent desaturations associated with sucking feeds Coughing or choking during swallowing Multiple swallows to clear a bolus History of respiratory infections

5. lack of response to nipple insertion at mealtime poor Suck/Swallow/Breathe co-ordination sucking bursts of varying length irregular, jerky jaw excursion rapid deterioration of normal sucking pattern flaring of the nares / head bobbing worried facial expression extraneous movement, head turning significant anterior fluid loss Disorganised Sucking Disorganization = lack of sucking rhythm

6. poor rate change between Non-Nutritive Sucking and Nutritive Sucking excessively wide jaw excursions restricted ROM at temporal mandibular joint resulting in jaw clenching / biting down flaccid or retracted tongue with absence of central grooving significant anterior fluid loss Dysfunctional Sucking Oro-motor patterns that disrupt feeding

7. Always refer to the speech- language therapist If there is ongoing difficulty with SSB synchrony If a baby persistently exhibits stress signs during feeding Noisy, “wet” upper airway sounds after individual swallows Loss of co-ordination occurs during a feed Persistent desaturations associated with sucking feeds Coughing or choking during swallowing Multiple swallows to clear a bolus History of respiratory infections