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Assisting The Breastfeeding Dyad: A Guide For Speech-Language Pathologists
Assisting The Breastfeeding Dyad: A Guide For Speech-Language Pathologists
SIG 13, Vol. 3(Part 1), 2018, Copyright © 2018 American Speech-Language-Hearing Association
More than 80% of U.S. mothers plan to breastfeed. The provision of competent support
to breastfeeding dyads is a key element in improving public health outcomes and reducing health
care costs (Bartick et al., 2017; see Table 1 for additional details), because care providers who
lack formal training in breastfeeding support tend to fall back on personal experiences, clinical
intuition, and extrapolation from bottle-feeding (cf. Radzyminski & Callister, 2015). Although the
speech-language pathologist’s (SLP’s) scope of practice includes assessment and treatment of
pediatric feeding problems, breastfeeding knowledge is not a direct focus of the SLP training
process (Council on Academic Accreditation, 2017). The limited research available on practicing
SLPs’ breastfeeding knowledge indicates that their proficiency in this domain is variable (Blake,
2014; Fishbein, Flock, & Benton, 2013).
Table 1. Human milk is associated with favorable differences in outcomes related to health and
neurodevelopment for both infants and mothers.
Child outcomes
Autism (Schultz et al., 2006)
Bed-wetting (Barone et al., 2006)
Celiac disease
Cognition (Kramer et al., 2008)
Gastrointestinal illness
Language development (Dee et al., 2007; Gibson-Davis et al., 2006; Oddy et al., 2010)
Leukemia
(continued)
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Note. Unless noted otherwise, pediatric outcomes are drawn from Eidelman et al. (2012). Maternal
outcomes are drawn from Chowdhury et al. (2015).
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Another example of an easily adapted strategy is buccal support. Many babies on SLPs’
caseloads have some degree of hypotonia and may benefit from manual support of the cheeks
during feeding (Hwang, Lin, Coster, Bigsby, & Vergara, 2010). This strategy can be especially
effective for assisting preterm babies who do not have the well-developed sucking pads typically
seen in full-term infants. A breastfeeding mother can use the dancer hand position to provide
simultaneous support to her breast and the baby’s jaw and cheeks (see Figure 4; Walker, 2008).
Use of this strategy may require attention to resulting increases in flow rate, as discussed further
in the following paragraph.
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A third example of a strategy that can be adapted is adjustment of the flow rate (see Wolf
& Glass, 2017), which may need to be either faster or slower. Problem solving for SLPs working
with breastfeeding dyads will often involve assessment of optimal flow rate. For many infants,
semiprone or prone positioning with mild head extension improves their ability to coordinate
swallowing and breathing. Mothers can press on the breast to block some ducts to slow milk flow
if the baby is struggling. For infants who are easily overwhelmed, mothers can express some milk
to slow milk flow; milk flows more slowly from a less full breast. Short, frequent feedings will also
reduce fatigue, which can in turn reduce the risk of aspiration for some babies. It is also possible
to increase the rate of milk flow so that feedings are more efficient, an approach that is especially
helpful for a baby who tires easily but who has good suck–swallow–breathe sequencing. Mothers
can be taught to use breast compression to assist milk transfer (Morton et al., 2009), thus
facilitating more efficient breastfeeding sessions. Selected at-breast supplementers can also be
used to provide an achievable challenge, gradually increasing the pressure needed to remove milk
from the device until it matches that needed to transfer milk from the breast. Further information
can be found on Catherine Watson Genna’s website (n.d.).
Begin With the End in Mind: Work Toward the Family’s Goals. If a mother’s priority
is direct breastfeeding, optimal SLP intervention strategies will support her in reaching that goal.
If mothers who had hoped to breastfeed participate in interventions that focus on bottle-feeding,
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Conclusion
This article has emphasized the importance of providing competent assistance to mothers
who wish to breastfeed. Premature weaning has significant costs, in terms of both health care
dollars and avoidable suffering (Eidelman et al., 2012); it is not unusual for mothers to describe
intense feelings about breastfeeding, for many years after their children have left infancy behind
(Promislow, Gladen, & Sandler, 2005). When mothers need help to breastfeed their babies, skilled
SLPs can make a critical difference.
References
Barone, J. G., Ramasamy, R., Farkas, A., Lerner, E., Creenan, E., Salmon, D., . . . Schneider, D. (2006).
Breastfeeding during infancy may protect against bed-wetting during childhood. Pediatrics, 118(1), 254–259.
Bartick, M. C., Schwarz, E. B., Green, B. D., Jegier, B. J., Reinhold, A. G., Colaizy, T. T., . . . Stuebe, A. M.
(2017). Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs.
Maternal & Child Nutrition, 13(1), e12366.
Blake, A. N. (2014). Breastfeeding knowledge and clinical management among speech-language pathologists
(Master’s thesis). Retrieved from ProQuest Dissertations and Theses database (UMI No. 1557076).
Bystrova, K., Widstrom, A. M., Matthiesen, A. S., Ransjö-Arvidson, A. B., Welles-Nyström, B., Vorontsov, I.,
& Uvnäs-Moberg, K. (2007). Early lactation performance in primiparous and multiparous women in relation
to different maternity home practices. A randomised trial in St. Petersburg. International Breastfeeding
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Catherine Watson Genna. (n.d.). Helping mom work “Smarter, not harder”. Retrieved from http://www.
cwgenna.com/smartnothard.html
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Chowdhury, R., Sinha, B., Sankar, M. J., Taneja, S., Bhandari, N., Rollins, N., . . . Martines, J. (2015).
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Collins, C. T., Ryan, P., Crowther, C. A., McPhee, A. J., Paterson, S., & Hiller, J. E. (2004). Effects of bottles,
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Colson, S. (2010). What happens to breastfeeding when mothers lie back. Clinical Lactation, 1, 9–12.
Council on Academic Accreditation. (2017). Standards for accreditation of graduate education programs
in audiology and speech-language pathology. Retrieved from https://caa.asha.org/wp-content/uploads/
Accreditation-Standards-for-Graduate-Programs.pdf
Dee, D. L., Li, R., Lee, L., & Grummer-Strawn, L. M. (2007). Associations between breastfeeding practices
and young children’s language and motor development. Pediatrics, 119(Suppl. 1), S92–S98.
Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012).
Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841.
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History:
Received November 09, 2017
Revised January 19, 2018
Accepted January 23, 2018
https://doi.org/10.1044/persp3.SIG13.47
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