Louisiana State University LSU Digital Commons LSU Doctoral Dissertations Graduate School 10-20-2018 Evaluation of Oral Function Before and After Frenectomy in Breastfed Infants Diagnosed with Tethered Oral Tissue Cindy L. Parr Louisiana State University and Agricultural and Mechanical College, [email protected] Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_dissertations Part of the Speech Pathology and Audiology Commons Recommended Citation Parr, Cindy L., "Evaluation of Oral Function Before and After Frenectomy in Breastfed Infants Diagnosed with Tethered Oral Tissue" (2018). LSU Doctoral Dissertations. 4734. https://digitalcommons.lsu.edu/gradschool_dissertations/4734 This Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Doctoral Dissertations by an authorized graduate school editor of LSU Digital Commons. For more information, please [email protected]. EVALUATION OF ORAL FUNCTION BEFORE AND AFTER FRENECTOMY IN BREASTFED INFANTS DIAGNOSED WITH TETHERED ORAL TISSUE A Dissertation Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College In partial fulfillment of the Requirements for the degree of Doctor of Philosophy in The Department of Communication Disorders by Cindy Lane Parr B.A., Florida Atlantic University, Boca Raton, 2010 M.A., Louisiana State University, Baton Rouge, 2014 December 2018 This work is dedicated to my husband, Scott ‘Skip’ Parr. Without his love, support, patience, and insight, this journey would not have been possible. In loving memory of my sister, Patricia Jenne Lane. You would be so proud. 1991-2018 ii ACKNOWLEDGEMENTS I would like to thank my major professor and mentor, Dr. Jan Norris, for believing in me since the very beginning. You took a chance on a girl with no background in the field of speech- language pathology and helped mold me into the woman, teacher, researcher, and clinician I am today. It is difficult to put into words the impact you and this program have had, and will continue to have, on my education, career, and personal growth. You have always supported me and never let me quit, even when I really wanted to. You are the kindest soul I have ever had the pleasure of knowing and I admire your thirst for knowledge. Thank you for all of your wisdom and guidance throughout this journey. Thank you to my committee members Dr. Paul Hoffman, Dr. Daphne Hartzheim, and Dr. Jacqueline Bach. Dr. Hoffman, thank you for your theoretical and statistical insight throughout my Ph.D. Your wisdom and sense of humor made even the toughest days better. Dr. Hartzheim, thank you for your guidance and compassion so that I could see this endeavor through the end. You have made me a better researcher and critical thinker. Thank you Dr. Bach for being a wonderful addition to my committee as the Dean’s representative. I am honored you were able to give your time and watch me grow as a researcher. To Courtney Gonsoulin, thank you for all of your support as my mentor, clinical supervisor, instructor, colleague, friend, and “Louisiana mama.” You have always treated me like family and you have always been there when I needed you the most. Your character and strength speak volumes, which I aim to emulate on a daily basis. You are truly a blessing and I would not have developed a passion for pediatric feeding and swallowing if it had not been for you. Also, your family has had a tremendous impact on my life. Papa Kent, Jack, Lee, Claire, iii and Kate (my favorite), thank you for the laughs, love, encouragement, hugs, and all the home- cooked meals along the way. I am forever grateful for you. Thank you Dr. Michael Juban for being a great mentor, colleague, and friend. I appreciate your generosity and support throughout this journey. I will always respect your determination to go above and beyond in everything you do. Let me know when work slows down so we can start publishing together. Without you and your amazing employees at Juban Dental, data collection for this study would not have been possible. A special thank you to Erin Collins for being so dependable and organized throughout the data collection process. You are an amazing speech-language pathologist and you possess a genuinely remarkable talent for helping others. I could not have done this without you and I cannot thank you enough. To my colleagues and friends (who sometimes feel more like family), especially Simone Laroussini, Emily Johnston, Ashley Larson, Melissa Lalande, Wendy Jumonville, Megan Musso, Teresa Miller, Denise Thompson, and Jamie Findley, thank you for imparting your knowledge and expertise so that we can work together to help families and to grow our professions. You have all helped me become a better clinician and, in turn, a better researcher. I admire each of you for many reasons and I am so thankful to have worked alongside you. A special thanks to Jeanne Pichoff, Ashley Waguespack, Megan Dewberry, Crystal Sewell, and a number of lactation consultants in the state of Louisiana for your talents and support throughout this study. Thank you to my fellow doctoral students who have persevered alongside me throughout this program. You truly understand what it’s like on the inside and can attest to the blood, sweat, and tears it takes to get to the finish line. Thank you, especially, Dr. Laura Delrose (my forever officemate), Dr. Rebecca Parker, Dr. Chantelle Varnado, Dr. Cara Tyson, Dr. Ashley Meaux, Dr. Crystal Randolph, Dr. Jan Bradshaw, Dr. Andy Rivière, Dr. Lindsey Turner, Dr. Kyomi iv Gregory, Dr. Christy Seidel, Dr. Christina Tausch, and Dr. Christy Moland for showing that it can be done. To Matthew Vansant and Lindsey Parker, who are on their way to the finish line as well, thank you for your unending support and encouragement. To the student volunteers in the Language Intervention Lab at Louisiana State University, thank you for your hard work and dedication throughout the years. It has been an honor being your lab manager and mentor. I have had the pleasure of knowing many enthusiastic and devoted students throughout this doctoral program and it has been extremely rewarding working with you all. Thank you to the mothers and infants who participated in this study. Being a mother is tough, but being the mother of an infant who has difficulty feeding and swallowing is especially challenging. The time and commitment it took to complete the evaluations, undergo treatment, and pursue follow-up care are appreciated beyond belief and are what made this study possible. And last, but certainly not least, thank you to my family. Mom, thank you for always encouraging me to “do whatever makes you happy” and to pursue my dreams. Dad, thank you for your unwavering support and for always believing in me. I am so thankful for you and my wonderful stepmother, Debra, and your words of wisdom. To my sisters, Julie and Katie, thank you for always loving me and being my biggest cheerleaders in life. You are the greatest support system. I am blessed to have married a man who also gave me a family full of endless love and support. Also, to my grandparents, aunts, uncles, cousins, thank you all. I am one lucky girl. v TABLE OF CONTENTS ACKNOWLEDGEMENTS ........................................................................................................... iii LIST OF TABLES ....................................................................................................................... viii LIST OF FIGURES ........................................................................................................................ x ABSTRACT ................................................................................................................................... xi INTRODUCTION .......................................................................................................................... 1 LITERATURE REVIEW ............................................................................................................... 3 METHODS .................................................................................................................................. 39 RESULTS .................................................................................................................................... 60 DISCUSSION ............................................................................................................................. 108 REFERENCES ........................................................................................................................... 117 APPENDIX A: IRB INFORMATION ...................................................................................... 122 APPENDIX B: SLP TRAINING CHECKLIST ........................................................................ 127 APPENDIX C: LATCH TOOL ................................................................................................. 129 APPENDIX D: ASSESSMENT TOOL FOR LINGUAL FRENULUM FUNCTION (ATLFF) ..................................................................................................................................................... 130 APPENDIX E: LINGUAL FRENULUM PROTOCOL WITH SCORES FOR INFANTS ..... 132 APPENDIX F: SYMPTOM/COMPLAINT CHECKLIST ........................................................ 136 APPENDIX G: PRE-FRENECTOMY QUESTIONNAIRE ...................................................... 138 APPENDIX H: POST-FRENECTOMY QUESTIONNAIRE