Karen Davies

Improving narrative skills in young children with delayed language development

A substantial number of 5–7 year old children experience delayed language development which threatens their progress in school, although they have not been placed on speech and language therapy caseloads. Children with delayed language development typically have a limited ability to understand and tell stories. Intervention to develop the oral narratives of these children can significantly improve their ability to understand and tell stories. This development improves their ability to participate in, and benefit from, mainstream classroom activities. We report on a style of intervention which aims to achieve these objectives. The intervention applies a story grammar approach through a collaboration between teachers, learning support assistants and speech and language therapists. The intervention took place in UK schools with a high proportion of children from families with low socio‐economic status and this article reports significant improvements in the quality of these childrens story‐telling.

Parental experience of sleep disordered breathing in infants with cleft palate: comparing parental and clinical priorities

Objective: To identify outcomes relating to sleep-disordered breathing (SDB) that are relevant to parents, during the early weeks of caring for infants with cleft palate (CP), and compare these with clinical outcomes identified in a systematic search of research literature. Design: A qualitative study using telephone/face-to-face interviews with parents explored their understanding of breathing and respiratory effort in infants with CP. Setting: Care provided by 3 specialist cleft centers in the United Kingdom, with study conducted in parents’ homes. Participants: Criteria for participation were parents of infants with isolated CP aged 12 to 16 weeks. Thirty-one parents of infants with CP (over 12 weeks) were invited to participate in the interview. Interviews were completed with 27 parents; 4 parents could not be contacted after completing the sleep monitoring. Results: Parents’ description of infants’ sleep suggests that breathing is not considered as a separate priority from their principal concerns of feeding and sleeping. They observe indicators of infants’ breathing, but these are not perceived as signs of SDB. Parents’ decision to use lateral or supine sleep positioning reflects their response to advice from specialists, observation of their infants’ comfort, ease of breathing, and personal experience. Outcomes, identified in published research of SDB, coincide with parents’ concerns but are expressed in medical language and fit into distinct domains of “snoring,” “sleep,” “gas exchange,” and “apnea.” Conclusions: Parents’ description of sleeping and respiration in infants with CP reflect their everyday experience, offering insight into their understanding, priorities, and language used to describe respiration. Understanding parents’ individual priorities and how these are expressed could be fundamental to selecting meaningful outcomes for future studies of airway interventions.

Safe sleeping positions: practice and policy for babies with cleft palate

AbstractGuidance recommends ‘back to sleep’ positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate. A qualitative descriptive study used data from a national survey with clinical nurse specialists from 12 regional cleft centres in the UK to investigate current practice. Data were collected using semi-structured telephone interviews and analysed using content analysis. Over half the regional centres used lateral sleep positioning based on clinical judgement of the infants’ respiratory effort and upper airway obstruction. Assessment relied upon clinical judgement augmented by a range of clinical indicators, such as measures of oxygen saturation, heart rate and respiration. Conclusion: Specialist practitioners face a clinical dilemma between adhering to standard ‘back to sleep’ guidance and responding to clinical assessment of respiratory effort for infants with cleft palate. In the absence of clear evidence, specialist centres rely on clinical judgement regarding respiratory problems to identify what they believe is the most appropriate sleeping position for infants with cleft palate. Further research is needed to determine the best sleep position for an infant with cleft palate.Whatis Known• Supine sleep positioning reduces the risk of sudden infant death in new born infants.• There is uncertainty about the benefits or risks of lateral sleep positioning for infants with upper airway restrictions arising from cleft palate.What is New• Variability exists in the information/advice provided to parents of infants with cleft palate regarding sleep positioning.• Over half the national specialist centres for cleft palate in the UK advise positioning infants with CP in the lateral position as a routine measure to reduce difficulties with respiration.

Co-working: parents' conception of roles in supporting their children's speech and language development

Speech and language therapists’ (SLTs) roles include enabling parents to provide intervention. We know little about how parents understand their role during speech and language intervention or whether these change during involvement with SLTs. The theory of conceptual change, applied to parents as adult learners, is used as a framework for understanding changes in parents’ conception of roles during intervention. The aims of the study were (1) to investigate parents’ conception of their own and SLT roles during speech and language therapy intervention and (2) to explore changes in parents’ conception of their role as they work with SLTs. A qualitative study was conducted using semi-structured interviews with 14 parents of pre-school children with speech and language needs referred to speech and language therapy in the UK. A subset of 8 parents participated in a longitudinal study over nine months to track any changes in conception of roles during intervention. Interviews were analysed using Thematic Network Analysis to identify basic, organizing and global themes. Framework Analysis was used to compare participants over time and identify any changes reported by parents. Parents had a firm conception of their role as advocates but did not express a clear notion of their role as intervener before involvement with the SLT. During intervention, some described changing their conception of role including adopting roles as ‘implementer’ and ‘adaptor’ of intervention. In some cases, parents described changes in their approach to parenting which they associated with adopting more active roles as interveners. Policy statements about parental choice and co-working typically present parents’ conception of roles as fixed. This research shows that parents may change their conception of role as they work with SLTs and become increasingly involved as interveners. Implications for practice include negotiating roles in the partnership before intervention begins and enabling parents to adopt an intervener role.