The relationship between early feeding and communication development in preterm and term infants : birth to 12 months

Abstract

The relationship between feeding development and early speech production has received increasing interest over the past 30 years. If a relationship between the motor control systems for feeding and communication is present, it could have implications for the early identification of communication deficits in children. Theoretical support exists for a relationship between the feeding and speech motor systems based on evolutionary theory (Blanchard, 1963), and anatomical similarities in oral motor function (Morris, 1985, 1990, 1991, 1998). However, the existence of a causal relationship between early feeding and communication development remains uncertain due to a lack of empirical research. A model proposed by Carpendale and Lewis (2004) encompasses the triadic interaction between the environment, maternal factors, and infant factors, which can influence both feeding and communication development. Clinical feeding assessments typically employed by clinicians and researchers are most often carried out with observational checklists. Data reflecting the theoretical foundation, validity, and reliability for these tools are limited. Observation tools assess specific aspects of feeding and oral motor control from a modular perspective, without regard for the infant’s total feeding system. Rogers and Arvedson (2005) highlighted the need for a single standardised assessment tool to assess infant feeding descriptively and objectively. The primary aim of the project was to determine whether the same motor control mechanisms are utilised for oral feeding and communication. The first stage of the study involved the development of a theoretically informed assessment protocols to document systematically the development of feeding skills from birth, the Feeding Assessment Observation (FAO) and the Feeding Assessment Questionnaire (FAQ).The assessment protocol was piloted on 10 term and 10 preterm infants at 1 to 2 weeks, 4, 8 and 12 months corrected age (CA) for preterm infants and chronological age for term infants. The second stage of the project examined the progression of feeding and communication development in a group of term and preterm infants over a 12 month period. The progression of 8 preterm and 7 term infants was observed at 1-2 weeks, 4, 8 and 12 months CA and chronological age for term infants. The mean gestational age for preterm infants was 30 weeks, 6 days (SD = 6.8 days), and term infants was 39 weeks, 5 days (SD = 9.4 days). Assessment of the infants’ feeding and communication skills, environmental and maternal influences was conducted using the initial questionnaire, Feeding Assessment Observation (FAO), Feeding Assessment Questionnaire (FAQ), Home Screening Questionnaire (HSQ), Receptive Expressive Emergent Language Scale, second edition (REEL-2), and the infant-toddler checklist of the Communication and Symbolic Behavior Scales Developmental Profile (CSBS-DP), to determine the nature and impact of environmental and social factors on feeding and/or communication development. Preliminary reliability testing of the FAO was conducted. Sixty seven percent (10/15) of observation items achieved greater than 90% inter-observer agreement. There was no significant difference in feeding and communication development between term and preterm infants. The negative linear trend for the development of feeding efficiency on liquids for infants was opposed to the positive linear trend for communication development. Infant feeding efficiency on solids showed parallel positive linear developmental trends with communication development.Comprehensive data were collected on influencing factors from infant, maternal and environmental domains during the initial assessment, and the 4, 8 and 12 month CA developmental reviews. The data revealed significant differences between the term and preterm groups for infant and environmental factors, but no significant differences were found for maternal influences. The study provided some support for the hypothesis of integrative motor control and co-development of feeding and communication. The prediction that infant, maternal, and environmental factors would significantly influence feeding and communication development was not supported. In addition, there was no difference in the impact of influencing factors for the term and preterm groups. The feeding and communication skills of preterm infants developed at corrected age levels, and were not significantly slower than term infants. Furthermore, predicted delays in feeding development were not associated with concomitant delays in communication development for term and preterm infants. Further investigation of the subsequent communication development of infants with definitive feeding difficulties and with a larger sample is suggested.