Today we will be discussing the role of the different therapists you might come across in Early Intervention. Speech-Language Pathologists (SLP) can help with Expressive -Receptive language delays as well as feeding and oral-motor challenges. http://www.asha.org/slp/clinical/EarlyIntervention/
How our transplant babies and toddlers can benefit from speech therapy
Pre- or post-transplant kids can present some unique challenges related to feeding or expressive and receptive language. Before an infant or toddler is listed for transplant, they may need to be on heavy medication, or even inpatient on a ventilator, where they cannot speak. When small infants and toddlers are on ventilators, they are usually sedated for their own comfort. During this time, this is usually when a child would be spending time learning how sounds and words are formed. http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/language-development/art-20045163
By the end of 6 months old, your baby may start to babble and use a variety of different sounds to mean different things. If this is at a time when your baby has been sedated to wait for their transplant, they wouldn‘t have developed these vital skills. They may have missed learning receptive language skills.
Receptive language is the understanding of language. This could mean understanding of gestures and signs as well as understanding the way others use words. Receptive language skills are typically developed before expressive language skills.
Expressive language is the way we get our wants and needs met. This can be through signs, gestures or using verbal language. http://nspt4kids.com/parenting/expressive-vs-receptive-language/ When a child is on a ventilator, he may be able to hear you speaking to him, but he is not able to see your facial expressions and gestures, which help him take in meaning of your words. There is also not that back and forth babble that parents do with their children to help them learn that first baby jargon that leads to speech.
How a Speech therapist can help
This is where the speech therapist can help. When your child is able to come off of the ventilator and is stable, a speech therapist will be able to assist you in helping your child gain skills, or regain skills lost, to form those first sounds and words to express their wants and needs. They can assess if there is any oral-motor delay’s that are causing the child to not be able to use verbal communication at that time, and if necessary find other ways to communicate to bridge the gap until the child is able to form words verbally. This can be anything from sign language to a communication system like Picture Exchange Communication System (PECS) https://www.speechandlanguagekids.com/picture-exchange-communication-system-pecs-non-verbal-children/ This is usually used as a bridge to verbal communication.
While your Speech Language Pathologist or SLP is using sign language, they will be saying the word as well and having the child look at their face to try to imitate the word they are saying.
The other thing SLP’s can work on is feeding therapy. A child who has been on a ventilator, or even a Nasogastric (NG) tube for feeding, will need some help learning how to eat again. An SLP is able to assess any oral-motor difficulties a child is having and if they have low-tone in their mouth or if there is any tongue protrusion that is causing feeding difficulties, or a swallowing disorder. They may also request a swallow study to be performed to make sure there is no aspiration occurring. Aspiration is where food or liquid enters the airway. Your therapist will be able to determine the safest and most effective means of feeding therapy with this information. http://www.asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders-in-Children/
Once they have made these assessments they can work on the source of difficulty for your child. This may look like the therapist working with you at dinner time and helping you to help your child eat safely. Or she may assist you help your child to learn to nurse or bottle feed again safely (in the case of nursing, this may be done in consultation with a Board-Certified Lactation Consultant). It is always done with your child’s safety in mind, so if your child is still on an NG tube, it will be about getting them used to textures again first and making sure they are able to acquire all calories orally before having a consultation with the medical team about removing the NG tube. You may also work on getting your child used to different textures since up until then she may not have been taking in any solids and thus will have to acquire tastes for all of the different textures she will need to take in. Whatever your concern, speak up to your therapist so that they are able to address it quickly. When you are working on feeding therapy, you want to keep your child as safe as you can and your want your child to have fun.
As you can see, SLP’s can have many roles. They are able to work on feeding, oral motor delays and swallowing disorders, they also work on Expressive and receptive language delays. If you have a concern in any of these areas, please reach out to your nearest Child and Family Connections and have your child assessed. The earlier you have your child treated, the better!
-Written by Stacy Hillenburg (parent of transplant recipient and Early Intervention Specialist)