Roles of Speech-Language Pathologists in the Neonatal Intensive Care Unit: Position Statement

Ad Hoc Committee on Speech-Language Pathology Practice in the Neonatal Intensive Care Unit (NICU)

It is the position of the American Speech-Language-Hearing Association (ASHA) that speech-language pathologists play a significant role in the assessment and intervention of stable preterm and medically compromised preterm and term infants as well as infants with anatomic, physiologic, and neurologic disorders. Given the increasing survival of infants born prematurely and/or with other life threatening conditions, and the resulting increased prevalence of neurodevelopmental sequelae, appropriate management of communication, cognition, feeding/swallowing problems and self-regulation in these infants is critical. In addition, culturally appropriate education and support to families and other caregivers are essential for facilitating the desired medical and developmental outcomes. The impact of intensive care on the developmental outcomes of infants and on quality of life and caregiver burden is significant. In addition, there is significant cost to the health care and educational systems.

Speech-language pathologists who acquire specific education and experience to provide care in the Neonatal Intensive Care Unit (NICU) are knowledgeable about embryologic, prenatal, and postnatal development, anatomy, physiology, and neurophysiology in the developing infant with regard to acquisition of skills and behaviors related to communication, cognition, and feeding/swallowing. Their educational and experiential background prepares speech-language pathologists to assume a variety of roles for providing team-based, family centered, culturally appropriate, and developmentally supportive care for infants and their caregivers from culturally and linguistically diverse backgrounds.

Appropriate roles for speech-language pathologists as members of the NICU team, include, but are not limited to:

1. Communication evaluation and intervention, in the context of developmentally supportive and family focused care

   • Perform developmentally appropriate assessments of prelinguistic and sociocommunication interactions, including neurodevelopmental assessments.

   • Identify additional disorders that impact communication and make referrals to other professionals as appropriate.

   • Enhance the infant's developmental outcomes and prevent secondary sequelae by providing specific interventions to facilitate social, interactive communication.

   • Intervene to enhance communication directly with infants and indirectly through culturally appropriate family and other caregiver education.

2. Feeding and swallowing evaluation and intervention, to include prefeeding, assessment and promotion of readiness for oral feeding, evaluation of breast and bottle feeding ability, and completion of instrumental swallowing evaluations

   • Perform developmentally appropriate clinical assessments of feeding and swallowing behavior.

   • Perform instrumental assessments that delineate structures and dynamic functions of suckling/swallowing and cardiopulmonary correlates.

   • Diagnose suckling/swallowing disorders and determine the abnormal anatomy and physiology associated with these disorders.

   • Identify additional disorders that impact feeding and swallowing and make referrals to other professionals as appropriate.

   • Enhance the infant's developmental outcomes and prevent secondary sequelae by providing specific interventions to facilitate safe feeding and swallowing.

   • Intervene to facilitate feeding and swallowing skills, and adequate skills for safe hydration and nutrition directly with infants, and indirectly through culturally appropriate education and counseling for the family and other caregivers.

3. Parent/caregiver education and counseling, staff (team) education and collaboration, which includes information regarding developmental expectations, communication interaction patterns, and feeding and swallowing behaviors

   • Contribute to the NICU team's developmental care plan with a focus on communication, cognition, and feeding/swallowing.

   • Contribute to a supportive and nurturing environment in the NICU to enhance development.

   • Provide culturally appropriate educational and counseling opportunities to families, team members, and others involved in care of the infant focusing on communication and feeding/swallowing.

4. Other roles SLPs assume in the NICU include:

   • Quality control/risk management

     Maintain quality control/risk management program.

   • Discharge/transition planning and follow-up care

     Participate in discharge planning and contribute to a smooth, seamless transition to other levels of care, to home, and to community.

   • Professional education and supervision

     Educate and supervise speech-language pathologists, including clinical fellows and students-in-training.

   • Public education and advocacy

     Provide public education and advocacy for serving infants and families in the NICU.

     Advocate for infants and their families to get services that may assist in reaching neurodevelopmental potential.

   • Research

     Participate in basic scientific and clinical research to advance the body of knowledge relevant to communication development and feeding and swallowing for infants in the NICU.

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