Title: The effect of different feeding methods and non-nutritive sucking behaviours on child speech development
Funder: Health Education England

Abstract: Background Children with speech sound disorders (SSD) constitute the largest population of referrals to SLT services (Broomfield & Dodd, 2004). This study aims to identify potential early risk factors for SSD at the critical ages of 2-5 years by investigating the relationship between different infant feeding regimes (exclusive breastfeeding, bottle and mixed feeding), NNS and motor development of speech in early childhood. If a relationship is identified, this will support parents to make informed care choices from birth onwards, as well as reinforcing national public health messages and maximising positive long-term health and social outcomes for children. Furthermore liaison with industry partners will aim to develop guidelines for dummy and bottle teats which provide optimal support for development of speech. Aim To establish whether there is a link between infant feeding methods, NNS and speech development in order to identify risk factors for potential SSD in pre-school children. Objectives To describe the mechanisms of feeding and NNS and their impact on early speech development. To identify potential clinical indicators of SSD to inform SLT speech assessment for this population. To make recommendations based on the findings of this study for health professionals on supporting children at risk of developing SSD. To make recommendations for further study based on the findings of this work. To develop industry guidelines for optimising teat/dummy design to minimise any observed detrimental impact on speech development. Research Questions Is there a relationship between feeding regime and speech development in the first five years of life?Is there a relationship between NNS and speech development in the first 5 years of life? Within a population of children diagnosed with SSD, are different patterns of speech disorder observed in children with different histories of infant feeding regime and NNS? What are the potential indicators of SSD with regard to feeding and NNS? Plan of Investigation This study contains 3 independent but related strands. Strand 1 will use data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to investigate the relationship between feeding, NNS and speech development at ages 2 and 5 in a longitudinal cohort study. Strand 2 will collect data as part of the ALSPAC Generation 2 (ALSPAC G2) to look at feeding, NNS and speech development in 2-4 year-olds.Strand 3 will use NHS SLT clinical caseload data to investigate the feeding histories of children diagnosed with SSD and determine whether a greater proportion were exposed to one particular type of feeding regime and/or NNS than would occur in the general population. Children participating in strands 2 and 3 will complete detailed standardised speech assessments. Data on potential confounding variables for speech will be collected and included in the analysis. Speech articulation skills and phonetic inventory will be described in detail and statistical analysis undertaken to identify differences between groups of children fed by different methods and with different NNS behaviours. Relationships between variables, and specifically the role that feeding and NNS plays in the speech development of children with and without SSD, will be explored. Potential Benefits to Patients and the NHS Understanding the role that different feeding and NNS patterns play in the speech development of children with and without SSD, may identify early risk factors for SSD. This will provide HCPs with increased capability to identify early signs of SSD and facilitate targeted support, assessment and intervention. This could improve longer-term outcomes for this population and result in more effective and efficient use of NHS SLT resources. Furthermore collaboration with baby bottle/dummy industry partners could develop guidelines for teat designs that optimise speech development.

Lay abstract: The effect of different feeding methods and sucking behaviours on speech sound development in children aged 2-5 years.Background: In the UK every year around 48,000 children aged 2-5 years are referred to NHS Speech & Language Therapy (SLT) services with difficulties using the right sounds in their talking. This is known as speech sound disorders (SSD). This is the largest population seen by Speech and Language Therapists and costs the NHS about 24 million per year. Children with SSD are more at risk of mental health problems and difficulties making relationships with those around them. They are also more likely to struggle with learning at school and be involved with the criminal justice system at some point in their early lives. When a baby is born parents make different choices about feeding their baby. Some breastfeed, some bottle-feed and some use a mixture of both. Some babies also like to have a dummy, while others suck their hand and some don't suck anything. Some studies have found that breastfeeding is linked to better language and learning in later childhood, while others have found that dummy sucking has the opposite effect. However, the effect that different types of feeding have on speech development has not been looked at in as much detail.Aim: This study will look at whether there is a relationship between how babies are fed, whether they suck a dummy/hand and how they develop speech. Objectives: To describe the relationship between feeding, sucking and speech development.To describe the different effects that breast and bottle-feeding have on speech development. To support healthcare professionals to identify young children who might be at risk of SSD. To make recommendations for further research into using different types of assessment and therapy for breast and bottle-fed children. To work with dummy and baby bottle industries to support the development of teats that reduce any impact on speech development. Design & Methods: This study has three independent but related strands to look at the relationship between feeding, sucking and speech development. Strand 1 will use data from the Avon Longitudinal Study of Parents and Children (ALSPAC) which was carried out in the 1990s and collected information on over 14000 pregnant mothers, their partners and their babies. This strand will use existing questionnaire and speech assessment data to look at feeding, sucking and speech development in children aged 2 and 5 years. Strand 2 will use data from a new study (ALSPAC Generation 2) which is collecting information from the children who are now being born to the children from the original ALSPAC study. This strand will involve collecting new data to look at the relationship between feeding, sucking and speech development in children aged 2-4 years. Strand 3 will look at children aged 2-5 years who are on SLT clinical caseloads and have a diagnosis of SSD. It will use parent questionnaires to gather information on feeding and sucking history as well as information about the parents. A Speech and Language Therapist will carry out a speech assessment to collect information on the types of speech errors the child makes. This information will then be used to look at the relationship between feeding, sucking and SSD.Patient & Public Involvement: A Parent Group of children under age 5 with SSD has been formed to advise the researchers on how to go about inviting families to participate in the study, as well as carrying out assessments. The group will also help to design the information sheet that will be given to families to explain the study. This Parent Group will continue to guide and influence the research throughout the life of the study to ensure that the research and findings are relevant and applicable to the people it aims to benefit. Dissemination: The findings of this study will be shared and discussed with the national group of Speech & Language Therapists specialising in working with children with SSD, as well as other health professionals (e.g. Health Visitors, midwives). This will be done through conferences, meetings and publications. This will be particularly important if there are recommendations to be made regarding changes in practice and providing new advice and information to parents and families. The findings will also be shared with patient/parent representative groups, including national charities and organisations (e.g. The Communication Trust) who support children with SSD. The researchers will also work with dummy and baby bottle companies to develop guidelines for designing teats that minimise any negative effect on speech development.

Research activity codes: 6.7 PHYSICAL
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;MENTAL HEALTH