Talk With Me Baby: Georgia's Language Nutrition Strategy

Purpose: An early environment that includes language-rich, adult-child interactions, or language nutrition, is critical for a child’s brain development and subsequent educational achievement. Research demonstrates that the strongest predictor of a child’s academic success is the quality and quantity of words spoken to a child in the first three years of life, which is directly related to third grade literacy. Children from low-income families hear thirty million words less than peers from more affluent families and currently, only 21% of fourth-grade children from low-income families in Georgia can read at grade level. Talk With Me Baby (TWMB) is a cross-sector coalition focused on bridging the word gap in Georgia by building the capacity of parents to provide early language nutrition to their babies. TWMBseeks to create statewide systemic change by establishing a wide-reaching public health, clinical, and early childhood education workforce that can coach parents to talk with their babies by demonstrating dynamic language exchanges and encouraging language-rich home and educational environments. The purpose of this study will be to assess the extent to which nurse-led maternal “language nutrition” training of mothers influences language enrichment and development among a sample of neonates in a NICU setting

Methods: TWMB has already started to train nurses and incorporate education about language nutrition into the Georgia Women, Infants, and Children (WIC) nutrition program. TWMB has the potential to help close the nation’s educational achievement gap, leverage dramatic results for children’s literary success, and holds promise for children of future generations.  This study uses very novel interventions and assessment methods.  Although the concept of language enrichment is hardly novel, TWMB’s approach is truly unique.  One of the most unique features of TWMB is that is nursing based maternal and child intervention that is sustainable and accessible to those in most need of such a service. Additionally, this study is using a very novel approach to assessing early language environment and outcomes among neonates and toddlers. Measuring developmental characteristics of neonates and toddlers is obviously difficult because there are few if any good psychometric methods. The Language Environment Analysis (LENA) technology that will be used in this study provides an innovative but empirically validated approach to measure subclinical variation in a child’s early language skills. It also characterizes an infant’s acoustic environment to provide researchers with a more granular perspective on parent/child linguistic interactions. We will are conducting randomized control trial (RCT) to determine the extent to which nurse-led maternal “language nutrition” training influences language enrichment and development among a sample of newborns in two hospitals in order to:

Aim 1: Determine the extent to which language nutrition training (LNT) improves a mother’sability to communicate with her neonate effectively;

Aim 2:Characterize maternal-infant linguistic interactions (e.g., adult words spoken, conversational turns, and child vocalizations) among the intervention and control groups at 2 months of age.

Aim 3: Compare infant receptive and expressive language development between the intervention and control groups.

Data will be analyzed using both descriptive and inferential test statistics. We will build multivariable statistical models to examine the relationship between language nutrition training (LNT) and maternal-infant linguistic interactions. The main predictor variables for the analyses include: group assignment (intervention versus control) and maternal mastery of language nutrition concepts and skills (performance-based assessment score). The main criterion variables for the analyses include: adult words spoken, conversational turns, and child vocalizations. These variables will largely be operationalized as mean length of utterance (MLU), or the average number of words per unit of speech.

Results: The study is currently underway in Phase I with expected outcome data in March 2015. The outcomes of testing and will shift maternal and child research and neonatal/pediatric clinical practice in a twofold manner. First, this study will examine how maternal and infant linguistic interactions at birth influence the early cognitive and linguistic trajectory of infants during a critical period of development. Second, we are evaluating the extent to which maternal/child health nurses can provide clinical services that may help prevent language deficits among children who are at higher risk of such deficits. This represents a clear clinical paradigm shift in clinical practices. While high risk neonates (e.g., very low birthweight, congenital anomalies, and prematurity) typically receive services at developmental clinic post discharge, clinicians in the NICU often do not provide services or support to help prevent developmental deficits among lower risk neonates (e.g., late preterm) such as those being examined by this study.

 Conclusion:  The lack of evidenced-based neonatal and early childhood interventions represents a critical barrier to reducing language deficits among children who are highest risk. This study will improve our understanding of the neonate’s linguistic environment and will evaluate a clinical intervention for improving the neonate’s linguistic interaction with the mother. First, few studies have examined the early linguistic environment on infants’ early language development. We will be able to characterize maternal-infant linguistic interactions shortly after birth in relatively controlled environment. This will provide a great deal of information about how mothers of infants in the NICU communicate with their offspring and concomitant language development. Second, the findings from this study will provide preliminary evidence concerning the effectiveness of the TWMB intervention. Such evidence is critical to developing a clinicallybased intervention to prevent language deficits.