Challenges with Breastfeeding: Pain, Nipple Trauma, and Perceived Insufficient Milk Supply.

BACKGROUND AND SIGNIFICANCE: Breastfeeding problems are common; however, health care providers vary widely in their ability to address them effectively. PURPOSE: The purpose of this study was to identify the relative frequencies of common breastfeeding challenges and their associations with maternal well-being. STUDY DESIGN AND METHODS: Women completed an online survey in which they described breastfeeding problems. Factor analysis was used to identify problems that co-occurred frequently, as well as the problems most strongly associated with maternal distress, maternal perceptions of greater severity, and postpartum depression or postpartum anxiety. RESULTS: There were 535 responses to the online survey; of these, 457 answered the question about the nature of their breastfeeding difficulties. Pain with breastfeeding was the most common breastfeeding problem. Difficulties with milk supply and milk intake were most strongly associated with heightened maternal distress and perceptions of severity. CLINICAL IMPLICATIONS: Coordinated care for breastfeeding dyads, in which providers acknowledge the complex and reciprocal nature of many breastfeeding problems, has the potential to improve maternal satisfaction with breastfeeding as well as breastfeeding metrics.

Caregivers' Experiences of Infant Feeding Problems: The Role of Self-Compassion and Stress Management.

Introduction Infant feeding problems are strongly associated with caregiver stress, which in turn is linked to poorer outcomes for children. Self-compassion is a modifiable trait strongly associated with improved mental health and greater resilience. The purpose of this study was to investigate the relationships among self-compassion, stress management practices, and caregiver stress in a sample of parents who identified feeding problems in their infants. Method Parents who identified feeding problems in their infants completed an online survey. They described the feeding problems, completed the Self-Compassion Scale and the Perceived Stress Scale, and detailed their stress management practices. Results Higher self-compassion was strongly associated with lower overall stress and more modestly associated with lower feeding-related distress. More severe feeding problems were significantly more stressful for caregivers. Participants reported a wide variety of stress management approaches. Discussion These findings indicate that higher self-compassion is associated with lower caregiver stress for parents whose infants experience feeding problems. Implications for service providers are reviewed. Supplemental Material https://doi.org/10.23641/asha.14831028.

Children Born Prematurely May Demonstrate Catch-Up Growth in Pre-Adolescence.

Introduction Children born prematurely often score lower on standardized tests of language in early childhood. Less is known about longer term outcomes. This investigation considered language outcomes in pre-adolescent children born very preterm/very low birthweight, as assessed by both standardized test scores and language sample measures, and explored attention abilities as a possible moderating factor. Method The present investigation provided a longitudinal follow-up to Mahurin Smith et al. (2014) by examining the language outcomes of 84 children at the 11-year time point (39 with a history of prematurity and 45 born at full term) and a total of 82 at the 12-year time point (37 with a history of prematurity, 45 born at full term). Assessments included subtests of the Clinical Evaluation of Language Fundamentals- Fourth Edition, productive language measures taken from narrative tasks, and parent and examiner ratings of attention. Results Gestational age significantly predicted standardized language scores at age 11 years, but this effect was no longer statistically significant at age 12 years. When parent ratings of attention were considered as additional variables, gestational age was no longer a significant predictor. Gestational age did not serve as a significant predictor for the productive language measures at either time point. Discussion Results indicate that catch-up growth in language may take place in pre-adolescence for many children born prematurely. Clinical implications focus on the need to utilize multiple forms of language assessment and to directly consider the potential role of attention on standard test results.

Rare Vocabulary Production in School-Age Narrators From Low-Income Communities.

Purpose This study was designed to assess the utility of a tool for automated analysis of rare vocabulary use in the spoken narratives of a group of school-age children from low-income communities. Method We evaluated personal and fictional narratives from 76 school-age children from low-income communities (M age = 9;3 [years;months]). We analyzed children's use of rare vocabulary in their narratives, with the goal of evaluating relationships among rare vocabulary use, performance on standardized language tests, language sample measures, sex, and use of African American English. Results Use of rare vocabulary in school-age children is robustly correlated with established language sample measures. Male sex was also significantly associated with more frequent rare vocabulary use. There was no association between rare vocabulary use and use of African American English. Discussion Evaluation of rare vocabulary use in school-age children may be a culturally fair assessment strategy that aligns well with existing language sample measures.

Changes in Speech-Language Pathology Students' Attitudes Toward Breastfeeding During a Pediatric Dysphagia Course.

BACKGROUND: Speech-language pathologists provide infant feeding assessment and intervention; their training in breastfeeding management is highly variable. Research aim: The purpose of this study was to evaluate student attitudes toward breastfeeding and self-identified factors in attitude change. METHODS: Before and after their course in pediatric dysphagia, two cohorts of graduate students in speech-language pathology ( N = 36) completed an assignment designed to capture qualitative and quantitative data on changes in their attitudes toward breastfeeding. Students rated their reactions to two hypothetical breastfeeding scenarios before and after the class, which included multiple sources of information on the importance of human milk and on breastfeeding management. Additionally, they completed a postclass reflection describing the nature of any changes in their attitudes toward breastfeeding and their ideas about the factors that were responsible for these changes. Nonparametric statistical tests were used to assess quantitative results; the qualitative data were evaluated via content analysis to identify themes. RESULTS: Significant positive changes in student attitudes were measured at the completion of the course. Students identified parents' stories as a particularly compelling component of their increased openness to breastfeeding. CONCLUSION: Attitudes toward breastfeeding may improve significantly over a relatively short period of time following a targeted intervention. Implications for lactation consultants and continuing education providers are discussed.

Longitudinal Associations Across Prematurity, Attention, and Language in School-Age Children.

Purpose: This research note explores the potential role of attention in mediating previously reported associations between language outcomes and prematurity. Method: As a follow-up investigation to Mahurin Smith, DeThorne, Logan, Channell, and Petrill (2014), we employed multilevel modeling to analyze longitudinal data on language and attention collected when children were, on average, ages of 7, 8, and 10 years. The sample of 114 children taken from the Western Reserve Reading and Math Project was selected to oversample children with a history of prematurity while also controlling for differences in confounding influences such as age, gender, parental education, and race. Results: As predicted, attention differentially predicted language outcomes based on form of measurement. Specifically, parent and examiner ratings of attention were significantly associated with standardized test performance at all 3 time points (R2 = 15.2%-20%). Associations between attention and language sample measures were less consistent across home visits and tended to be smaller in effect size. Conclusion: Attention abilities are associated with children's language performance even in the absence of an attention-deficit/hyperactivity disorder diagnosis. Clinical implications, particularly as related to assessment, are discussed.

Does Rare Vocabulary Use Distinguish Giftedness From Typical Development? A Study of School-Age African American Narrators.

PURPOSE: The purpose of this study was to examine rare vocabulary produced in the spoken narratives of school-age African American children. METHOD: Forty-three children from general and gifted classrooms produced 2 narratives: a personal story and a fictional story that was based on the wordless book Frog, Where Are You? (Mayer, 1969). The Wordlist for Expressive Rare Vocabulary Evaluation (Mahurin-Smith, DeThorne, & Petrill, 2015) was used to tally number and type of uncommon words produced in these narratives. The authors used t tests and logistic regressions to explore classroom- and narrative-type differences in rare vocabulary production. Correlational analysis determined the relationship between dialect variation and rare vocabulary production. RESULTS: Findings indicated that tallies of rare-word types were higher in fictional narratives, whereas rare-word density-a measure that controls for narrative length-was greater in personal narratives. Rare-word density distinguished children in general classrooms from those in gifted classrooms. There was no correlation between dialect variation and rare-word density. CONCLUSION: Examining school-age African American children's facility with rare vocabulary production appears to be a dialect-neutral way to measure their narrative language and to distinguish gifted children from typically developing children.

Breastfeeding may protect against persistent stuttering.

PURPOSE: This study investigated the hypothesis that breastfeeding in infancy might protect against persistent stuttering in children. METHOD: We collected new data from the mothers of current and past participants in the Illinois Stuttering Research Program on their children's feeding history during infancy. We obtained 47 usable responses, for 17 children with persistent stuttering and 30 children who recovered naturally after a period of stuttering. RESULTS: A chi-squared test for linear trend revealed a significant relationship between breastfeeding duration and the likelihood of natural recovery for the boys in the sample. Mothers of children in the persistent group were no more likely to report early feeding difficulties which might have suggested an underlying oral motor deficit in children predisposed toward persistent stuttering. CONCLUSIONS: Our results offer preliminary support for the idea that breastfeeding may confer a measure of protection against persistent stuttering. The fatty acid profile of human milk, with its potential to affect both gene expression and the composition of neural tissue, may explain this association. Further research is called for. LEARNING OUTCOMES: The reader will be able to discuss at least one reason why human milk may make a difference in neurodevelopment generally and with regard to stuttering outcomes specifically. Additionally, the reader will be able to describe the relationship between breastfeeding duration and stuttering recovery observed in this sample.

Volubility as a mediator in the associations between conversational language measures and child temperament.

BACKGROUND: Despite support for the use of conversational language measures, concerns remain regarding the extent to which they may be confounded with aspects of child temperament, extraversion in particular. AIMS: This study of 161 twins from the Western Reserve Reading Project (WRRP) examined the associations between children's conversational language use and three key aspects of child temperament: Surgency (i.e., introversion/extraversion), Effortful Control (i.e., attention and task persistence) and Negative Affectivity (e.g., fear, anger, sadness). Child biological sex was considered as a possible moderating factor. METHODS & PROCEDURES: Correlational analyses were conducted between aspects of temperament during early school-age years (i.e., 7-8 years), as measured by the Children's Behavior Questionnaire-Short Form (CBQ), and six different measures of children's conversational language use: total number of complete and intelligible utterances (TCICU), number of total words (NTW), mean length of utterance (MLU), total number of conjunctions (TNC), number of different words (NDW) and measure D (i.e., a measure of lexical diversity). Values for NTW, TNC and NDW were derived both on the entire sample and on the first 100 C-units. Correlations between language and temperament were compared between girls and boys using the Fisher r-to-z transformation to examine the significance of potential moderating effects. OUTCOMES & RESULTS: Children's reported variability in Effortful Control did not correlate significantly with any of the child language measures. In contrast, children's Negative Affectivity and Surgency tended to demonstrate positive, albeit modest, correlations with those conversational language measures that were derived from the sample as a whole, rather than from a standardized number of utterances. MLU, as well as measures of NDW and NTW derived from standardized sample lengths of 100 C-units, did not correlate with any measure of child temperament. TNC demonstrated an unexpected negative correlation with child Surgency when it was derived from a standardized number of C-units, but not when derived from the entire sample length. Child biological sex did not moderate the significant associations between language and temperament measures. CONCLUSIONS & IMPLICATIONS: Overall, measures that control for volubility did not correlate significantly with child temperament; however, measures that reflected volubility tended to correlate weakly with some aspects of temperament, particularly Surgency. Results provide a degree of discriminant evidence for the validity of MLU and measures of type (i.e., NDW) and token use (i.e., NTW) when derived from a standardized number of utterances.

When "Simon says" doesn't work: alternatives to imitation for facilitating early speech development.

PURPOSE: To provide clinicians with evidence-based strategies to facilitate early speech development in young children who are not readily imitating sounds. Relevant populations may include, but are not limited to, children with autism spectrum disorders, childhood apraxia of speech, and late-talking toddlers. METHOD: Through multifaceted search procedures, we found experimental support for 6 treatment strategies that have been used to facilitate speech development in young children with developmental disabilities. Each strategy is highlighted within this article through a summary of the underlying rationale(s), empirical support, and specific examples of how it could be applied within intervention. CONCLUSIONS: Given the relatively sparse experimental data focused on facilitating speech in children who do not readily imitate, theoretical support emerges as particularly key and underscores the need for clinicians to consider why they are doing what they are doing. In addition, this review emphasizes the need for the research community to bridge the gap between pressing clinical needs and the limited evidence base that is currently available.