What is High Risk Baby?

A condition where the baby is born with complications during:

• Fetal development in the womb
• The health of mother during pregnancy, or
• Problems that occur during the birth process

This can result in babies that are born to frequently fall sick and has a high risk of death.

Who are High Risk Infants?

Babies or neonates that will be discussed in this article refer to infants between the ages of 0 – 12 months.

Importance of Communication

Parents are generally able to predict and respond to the baby’s action. This is one of the functions of communication. The types of infant communication forms include:

• Vocalization (sounds that are similar to vowels)
• Facial expressions (crying, laughing)
• Body gestures (lifting both hands asking to be carried)

Risk Factors of Communication Problem

Development of communication can be delayed if the overall development of a child is affected. The following are the factors that could pose risks to the communication problem:

1. Factors before Pregnancy

   • The mother gets pregnant before 16 years old or above 40 years old
   • Pregnant mother who suffers from health problems such as diabetes or high blood pressure.
   • Pregnant mother who drinks alcohol excessively. This condition can affect the growth of the baby in the womb.
   • Pregnant mother who is exposed to toxins (example: lead and mercury).
   • Pregnant mother who is infected with a virus or a parasite (example: rubella, cytomegalovirus)

2. Factors for Premature Baby

   • Long term use of ventilator, breathing tube and tracheostomy
     • Hinders the overall development of language and speech
   • Babies in Neonatal Intensive Care Unit (NICU) has a risk of:
     • Sensory neural or conductive hearing loss. This is caused by the consumption of ototoxic medications and exposure to loud noise from the incubator
     • Damage or trauma to the laryngeal tissues when undergoing the intubation or suction procedures
     • The NICU environment does not encourage the development of the infant communication
       • Parents cannot communicate with the infant for a longer period. This is because the infants needs a thorough care and treatment in the hospital.
       • Parents assumed that premature babies are weak and sick. This leads to lesser desire of the parents to hold, touch and play with their baby.

3. Birth Factors

   • Lack of oxygen during the process of delivery can interrupt the development of speech and language. The kind of cases that usually occurs during the delivery process are:
     • Breech delivery
     • Meconium aspiration (the baby ingests the feces in the womb)
     • Umbilical cord gets entangled at the neck
   • Forceps delivery can cause injuries to the head.

4. Genetic and Congenital Problem

   • Metabolic disorder
     • Hurler Syndrome
     • Hunter’s Syndrome
     • Morquio’s Syndrome
   • Craniofacial anomalies
     • It causes hearing impairment and results in inability to hear sound information
   • Abnormal chromosomes
     • Down syndrome (trisomy 21; 3rd chromosome at chromosomes number 21)
     • Cri-du-chat syndrome (5p-missing half of the 5th chromosome)
   • Chromosomal sex disorder
     • Klinefelter syndrome (XXY chromosomes for males)
     • Turner syndrome (XO chromosomes)
     • Fragile X syndrome

5. Environmental Factors

   • Socio-economic
     • Malnutrition
     • Limited access to health care
     • Unsafe living environment
     • Limited education opportunities
   • Abandoned and neglected children

6. Other factors

   • Problems that cannot be detected after birth
     • Delay in the development of communication, physical ability, cognitive skills, etc. The problems can be identified through the parental report or medical references.
   • Poor awareness on the development of the baby/ child
     • Children with Autism, mental retardation or learning difficulties can only be identified at the early stages of language development.
   • Lack of neonatal hearing screening services in some hospitals
     • Hearing problems are not being detected after birth. It is only being identified after a certain period of time

Role of Speech-Language Therapist (SLT)

Speech-Language Therapist (SLT) can play an important role during the period that the baby is in the NICU. According to American Speech-Language Hearing Association, ASHA (2004) guideline.

Among the roles of the SLT includes:

• Providing information to the parents on normal language development.
• Conduct formal and informal assessments, plan a suitable therapy, and monitor the progress as well as the effectiveness of the given therapy.
• Drive and guide parents to get involved actively in listening activities and speaking during a therapy session
• Drive and guide parents to help the children hear and use language in their everyday life.
• Monitor and guide parents in group activity

Source : jppp.hukm

Referrals

Children who were high risk babies should undergo follow ups to monitor their progress. This is because they are more likely to suffer developmental problems in the first year of life.

Therefore, ensure that your child gets a thorough assessment from the various disciplines such as:

• Pediatrician
• Ophthalmologist
• Speech-Language Therapist
• Occupational Therapist
• Physiotherapist
• Dietitian
• Pharmacist
• Social worker

References

1. American Speech-Language-Hearing Association (ASHA), (2004). Roles of Speech-Language Pathologists in the Neonatal Intensive Care Unit: Technical Report. ASHA, 1-30.
2. McInroy. A. (2007). Communication Development of High-Risk Neonates from Admission to Discharge from a Kangaroo Mother Care Unit. Retrieved from Master Communication Pathology Dissertations.
3. Ministry of Health Malaysia (2009). Guidelines for High Risk Neonatal Hearing Screening. [PDF Document]. Retrieved from MOH Guidelines Online Website: http://www.moh.gov.my/images/gallery/Garispanduan/Buku_NHS_Edition_internet.pdf
4. Paul, R. 2004. Language Disorders from Infancy Through Adolescence: Assessment & Intervention. 3rd ed. Mosby.

Image resource

1. Jabatan Perkhidmatan Pemulihan Perubatan Terapi Pertuturan (2009). Retrieved September 4, 2012, from http://www.jppp.hukm.my

Website

1. Bayi Pramatang. MyHEALTH Kementerian Kesihatan Malaysia. Retrieved July 4, 2013
2. Sindrom Down. MyHEALTH Kementerian Kesihatan Malaysia. Retrieved July 3, 2013
3. Autisme. MyHEALTH Kementerian Kesihatan Malaysia. Retrieved July 4, 2013