Newborns and the NICU; What you need to know

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Newborns and the NICU; What you need to know

By Christina M. Freise-Schlotfeldt, M.S., CCC-SLP

It can be quite frightening if your newborn must be admitted to a specialized unit of the hospital, the Neonatal Intensive Care Unit (NICU). Upon entry it can seem like a scary place, but being familiar with basic terms in regards to swallowing and understanding what happens in the NICU can assuage your fears.  Within the contents below, is information regarding some questions you might have along with a glossary of terms that will be helpful.

Why does my newborn need a speech therapist in the NICU?

A neonatologist, a medical doctor with extensive training in newborn intensive care, may order a Bedside Swallow Evaluation if he or she suspects your infant may have difficulty swallowing.   If your baby was born prematurely, or there were complications during delivery, there may be problems in the baby’s ability to successfully feed by mouth.  In most hospitals, a speech-language pathologist will carry out a Bedside Swallow Evaluation to effectively assess your baby’s swallow function and determine most appropriate means to deliver nutrients.

What does a Bedside Swallow Evaluation in the NICU entail? 

A Bedside Swallow Evaluation is a subjective, yet comprehensive analysis of your newborn’s ability to orally consume nutrients. A speech-language pathologist begins with a thorough review of your baby’s medical history and will discuss your infant’s current means of nutrition/hydration and overall status with the nurse and/or doctor prior to the evaluation. She will (optimally) schedule her evaluation during a deemed “feeding” time with the RN to facilitate the baby’s wish to feed. The SLP will evaluate the structures and functioning of the oral cavity.  To examine the structures and evaluate them appropriately, the speech-language pathologist will perform an exam called an oromotor exam.  The exam looks at the lips, gums, hard palate, soft palate, and tongue. She may administer small amounts of feeding (formula or breast milk) via bottle, observing the baby’s suck/swallow response.  The suck/swallow response is observed during the oropharyngeal phases of the swallow.  During the evaluation, the SLP is looking for any changes in vital signs during the feeding experience.

What are the possible recommendations subsequent to a NICU evaluation? 

The speech-pathologist will gather her observations to formulate of variety of recommendations for the neonatologist. She may recommend the baby receive oral feedings via bottle in a specific position or via a specialized nipple. Or, she may recommend the baby is currently not safe to eat orally. In this case, the MD may place a small, temporary feeding tube (a nasogastric or NG tube) to deliver needed nutrients to your baby. This tube is placed in the stomach via the nose. There are many cases in which infants in the NICU are receiving a combination of tube feedings and oral feedings; thus the infant receives some feeding from the bottle and the remainder through the feeding tube.

If a swallowing disorder is suspected, the MD should provide you a referral to a speech-language pathologist upon discharge home. This SLP will conduct a thorough evaluation in your home; she will pay particular attention to environment, positioning while feeding, and your interaction with your infant. If warranted, the SLP will recommend a treatment program to target deficits she noted during her evaluation.

The NICU experience can be extremely overwhelming. However, armed with basic knowledge of swallowing terms, you can feel more confident in your ability to discuss your infant’s status with the medical team.  Enjoy watching your little one’s progress!

Glossary of terms:

Bedside Swallow Exam: subjective yet comprehensive analysis of one’s ability to orally consume nutrients

Nasal cannula: a clear plastic tube which is placed under the nose to administer supplemental oxygen

Neonatal Intensive Care Unit: abbreviated NICU, also known as intensive care nursery in some facilities, unit in which newborns requiring specialized care are admitted

Neonatal nurse practitioner: a registered nurse (RN) with Masters Degree and specialized training in neonatology. He/she is under the supervision of the neonatologist

Neonatologist: medical doctor with extensive training in newborn intensive care

NPO: nothing to be administered by mouth

Oromotor exam: assesses the structure and function of the oral cavity (lips, gums, hard palate, soft palate, tongue)

Nasogastric tube: abbreviated NG tube, a small, temporary feeding tube placed in the stomach via the nose

Resident: medical doctor in training under supervision of a fully licensed physician. A pediatric medical residency is three years in length. First year residents are often known as interns, while third year residents are often known as seniors.  

Total Parenteral Nutrition: abbreviated TPN, nutrients such as proteins, sugars, salts and sometimes fats administered via vein if the baby cannot tolerate oral feeding or NGT placement


Christina M. Freise-Schlotfeldt MS CCC-SLP

Focus of practice: Swallowing disorders across the lifespan

Christina M. Freise MS CCC-SLP is a speech-language pathologist with experience serving both pediatrics and adults with communication, cognition and swallowing impairments in the acute care environment.
She is an affiliate of the American Speech Language Hearing Association Special Interest Group 13, Swallowing and Swallowing Disorders. She is an MBS-ImP certified clinician

05 April 2013 09:32
by Christina M. Freise-Schlotfeldt, M.S., CCC-SLP