Do Early Sucking/Feeding Difficulties Impact Speech Sound Development?
Jean Ashland, PhD
MGH Speech Language and Swallowing Disorders Department
Mary Riotte, MA & Gregory L. Lof, PhD
MGH Institute of Health Professions
BOSTON, MASSACHUSETTS
Background
Moore and Ruark (1996) determined that mandibular coordination in 15-month old children’s single
word productions was different than that observed during their chewing and sucking. They
concluded that the development of speech coordination does not come from earlier appearing oral
motor behaviors of sucking/feeding.
Others believe that there is a causal relationship between the motor control used for
sucking/feeding and that used for speech production. For example, Evan-Morris (1998) stated that
when a child experiences difficulty with oral control in feeding, there will be similar oral control
difficulties in their speech sound productions.
Medical
History
Purpose
The purpose of this retrospective study was to determine if there is a relationship between early
sucking/feeding problems in infancy and later speech/articulation difficulties in preschool-age
children.
Methods
PARTICIPANTS
Inclusion criteria were: (a) current age 3-5 years; (b) gestational age minimum 32 weeks to fullterm; (c) feeding evaluation must have taken place within the first month of life (corrected age)
while an inpatient at MGHfC; (d) must have had a referral for a feeding evaluation from a physician
or nurse practitioner. Newborn feeding evaluations were completed by the primary investigator.
Exclusion criteria were: (a) cleft lip/palate; (b) any syndromes with mental retardation or
craniofacial anomalies; (c) moderate to severe abnormal muscle tone determined by neurology
exam; (d) moderate to severe micrognathia; (e) hydrocephaly/shunt; (f) brain anomalies identified
by MRI; (g) sensorineural hearing loss; (h) tracheostomy that could be associated with or cause
speech deficits.
PROCEDURES
• 3 phases: Review of medical records from newborn period; Parent phone interview; Evaluation
• TESTING: Case history, oral motor examination, speech/articulation assessment, language
assessment, and hearing screening
• Oral Cavity Assessment Form (Bliele, 2004)
• Goldman-Fristoe Test of Articulation-2 (GFTA)
• Peabody Picture Vocabulary Test III/B
• Hearing screening for the frequencies 500, 1K, 2K, 4K and 8K Hz.
Child 2
Child 3
Male
Gestational Age
33 weeks
36 weeks
41 weeks
39 weeks
Age for NICU Feeding Exam
4 weeks
1 week
4 weeks
1 week
Apgar Scores
9 @ 1 min
Respiratory History
RDS (Respiratory Distress Syndrome)
Neurological History
Mild PVL (Periventricular Leukomalacia)
Gastroenterology History
Reflux; Duodenal atresia; Gastrostomy tube;
Esophageal dysmotility
In the NICU
Coordinated suck; Choking with feeds
1st Year of Life
At Time of Testing
9 @ 5 min
Male
9 @ 1 min
9 @ 5 min
4 @ 1 min
8 @ 5 min
Female
Child 4
8 @ 1 min
8 @ 5 min
Stridor; Laryngomalacia
No concerns
Hypotonia; Facial dysmorphism; Reduced gag
No concerns
Reflux
No Concerns
Severe reflux
Choking; Dusky episodes
Weak tongue; Pooling secretions; Oxygen
desaturation
Coordinated suck; Color changes; Fussy;
Oxygen desaturation
Reflux first 6th months
Brief nasogastric feeds; Poor suck
Brief nasogastric feeds; Good suck
Overstuffing solids until age 3;5 years
“Picky” eater; Occasional cough with liquids;
Overstuffing mouth
Pocketing food; Overstuffing; Good weight gain
No concerns
Good weight gain; No concerns
Speech
“Late talker”
Parent concern with speech clarity
No concerns
Distortions /s,z/
Motor
Mild leg spasticity
Age appropriate
Hypotonia
No concerns
1st Year of Life
Reflux
Reflux resolved
Reflux resolved
Hospitalized for croup; One ear infection
Current
Monoplegia
No concerns
Good weight gain
Mood regulation problems
Therapy
Received
OT/PT
Birth to present
None
PT first 3 years of life
None
Speech
Language: 18 months - 3 years old
Speech Sounds: 2 - 3 years old
None
Pragmatics: 18 months - present
Age at Testing
3;0 years
3;8 years
4;6 years
4;5 years
Test
Findings
Hearing Screening
Pass
Pass
Pass
Pass
Oral Motor (Bliele)
Pass
Pass: Clipped frenulum, minor jaw protrusion
Not Pass: Face asymmetry, weak lip
movement, mild retrognathia, mild hypernasal
Pass: Large tonsils, mouth breathing
Speech Sounds (GFTA)
High average score
Average score
Above average score
Above average score
Language (PPVT 3)
High average score
High average score
High average score
High average score
Feeding
Developmental
Health
Summary
Tachypnea; Apnea; Bradycadia
Female
Meconium aspiration; Intubated
Conflicting views between researchers and practicing clinicians regarding the relationship between
these two systems also impacts the provision of patient care.
To date, there is little research regarding the possible role of early sucking/feeding difficulties in
infants and the later development of speech sounds.
Child 1
Gender
Implications
• This is a preliminary study with a small sample size. The strict inclusion criteria eliminated many potential
participants.
• It appears that these children who were referred for a feeding evaluation in the NICU setting did not have
later speech problems if they had sucking problems.
• All children had respiratory issues in early infancy; 2 children had mild neurological issues in early infancy;
3 children had reflux in infancy; 1 child had reported sucking difficulties. 3 children had sensory-based
feeding difficulties as toddlers; 1 child had later speech therapy (that focused on articulation); no children had
feeding therapy; 1 child did not pass oral motor testing (hypotonia).
• One child received speech sound therapy but did not have early sucking problems.
• All children had average to high average speech-language test scores.
• It is unknown the effect of early intervention services (OT/PT) on the speech development of two children.
• Further research (including longitudinal and prospective studies) is warranted to further examine the
relationship between early sucking/feeding performance and later speech sound development.