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Effects of nonnutritive sucking on behavioral organization and feeding performance in preterm infants.

The purpose of this study was to examine the effects of nonnutritive sucking (NNS) on behavioral organization and feeding performance in preterm infants. Thirteen preterm infants were observed at four bottle-feedings, two of which involved treatment with prefeeding NNS. NNS had a positive effect on oxygen saturation and behavior state, as well as on the initiation and duration of the first nutritive suck burst.

Bottle Feeding↗

Nonnutritive sucking modulates behavioral state for preterm infants before feeding.

Forty-two pre-term infants were studied to determine the effect of nonnutritive sucking pre-feeding on behavioral state. Infants were randomly assigned to pacifier or rest groups. Pacifiers or rest were given for 5 minutes following routine caregiving and before each of the first 16 bottle feedings. A 12-category scale was used to measure state immediately before the 5-minutes and after. Frequencies of states that precede optimal feedings changed for infants given pacifiers versus rest: alert inactivity (+6 vs. -2), quiet awake (+19 vs. -6), and active awake (-24 vs. +12); infants given pacifiers had more sleep and fewer restless states. Group differences were non-significant before nonnutritive sucking (p = 0.16) but significant after (p = 0.00001). When self-regulatory feeding policies based on early hunger cues are not allowed, nonnutritive sucking for 5 minutes pre-feeding is simple, brief, and appropriate for busy intensive care units. These findings confirm those from earlier less conclusive research and indicate that nonnutritive sucking modulates behavioral state.

Feeding Behavior↗

Energy intake, not energy output, is a determinant of body size in infants.

BACKGROUND: It has been proposed that the primary determinants of body weight at 1 y of age are genetic background, as represented by parental obesity, and low total energy expenditure. OBJECTIVE: The objective was to determine the relative contributions of genetic background and energy intake and expenditure as determinants of body weight at 1 y of age. DESIGN: Forty infants of obese and 38 infants of lean mothers, half boys and half girls, were assessed at 3 mo of age for 10 risk factors for obesity: sex, risk group (obese or nonobese mothers), maternal and paternal body mass index, body weight, feeding mode (breast, bottle, or both), 3-d energy intake, nutritive sucking behavior during a test meal, total energy expenditure, sleeping energy expenditure, and interactions among them. RESULTS: The only difference between risk groups at baseline was that the high-risk group sucked more vigorously during the test meal. Four measures accounted for 62% of the variability in weight at 12 mo: 3-mo weight (41%, P = 0.0001), nutritive sucking behavior (9%, P = 0.0002), 3-d food intake (8%, P = 0.0002), and male sex (3%, P = 0.05). Food intake and sucking behavior at 3 mo accounted for similar amounts of variability in weight-for-length, body fat, fat-free mass, and skinfold thickness at 12 mo. Contrary to expectations, neither total nor sleeping energy expenditure at 3 mo nor maternal obesity contributed to measures of body size at 12 mo. CONCLUSIONS: Energy intake contributes significantly to measures of body weight and composition at 1 y of age; parental obesity and energy expenditure do not.

Adult↗

Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition.

PURPOSE: Little is known about the extent to which nonnutritive sucking habits contribute to malocclusion in the mixed dentition. The purpose of this study was to report on the relationship between certain occlusal traits in the mixed dentition and longitudinal sucking behaviors. METHODS: Dental examinations were conducted on 630 children in the mixed dentition who participated in a large, ongoing longitudinal study. Five hundred eighty consented to impressions, and 524 adequate study models were obtained. Of these, 444 also had adequate longitudinal nonnutritive sucking data obtained via mailed questionnaires to parents at 3- to 6-month intervals from birth to 8 years. Sucking behaviors were grouped by predominant type and duration. Study models were hand articulated using wax bites to evaluate the occlusion for the presence of open bite, crossbite, molar relationship, and excessive overjet. Bivariate statistical analyses related presence of these malocclusions to sucking duration and type. RESULTS: Fifty-five percent of the children had malocclusions (anterior open bite, posterior crossbite, bilateral Class II molar relationship, or overjet >4 mm). Class II molar relationship was most common (30%). Overall, anterior open bite and posterior crossbite was associated with habits of 36 months or more. Sustained pacifier habits, including those of 24 to 47 months, were associated with anterior open bite and Class II molar relationships, while digit habits were associated with anterior open bite when sustained for 60 months or longer. CONCLUSIONS: Malocclusions are quite prevalent in the mixed dentition, and anterior open bite and posterior crossbite may be preventable by modifying nonnutritive sucking behaviors.

Chi-Square Distribution↗

Predictors of body size in the first 2 y of life: a high-risk study of human obesity.

OBJECTIVE: To ascertain the predictors of body size at 2 y of age. DESIGN: : Prospective, longitudinal study of risk factors for weight gain of infants at high or low risk of obesity by virtue of their mothers' obesity or leanness. SUBJECTS: A total of 40 infants of obese mothers and 38 infants of lean mothers, equally divided among boys and girls. METHODS: Measurement of dependent variables: weight, length and skinfold thicknesses at 3, 6, 9, 12, 18 and 24 months and percent body fat at 3, 12 and 24 months. Measurement of independent variables: average daily caloric consumption at 3, 6, 9, 12, 18 and 24 months; and, at 3 months, nutritive sucking behavior during a test meal, total energy expenditure (TEE), sleeping energy expenditure (SEE), estimation of nonsleeping energy expenditure (TEE-SEE) and socioeconomic status. Parental weights and heights were obtained by self-report at the time of recruitment. Partial correlation and mixed effects linear regression analyses were performed. RESULTS: Measures of body size (weight, length, skinfold thicknesses) and percent of body fat were almost identical between high- and low-risk groups at all times. Energy intake during six occasions over the 2 y, sucking behavior, family income and TEE predicted weight gain, controlling for body length. Parental body mass index was not associated with the child's body size during the first 2 y. During the first year, there were strong lagged correlations between energy intake and body weight and smaller correlations between protein intake and body weight. CONCLUSION: Energy intake, and not energy expenditure, was the determinant of body size in these infants at 2 y of age, as it had been at 1 y. Sucking behavior and TEE (positively) and family income (negatively) also contributed to body weight at 2 y. The novel finding of a lagged correlation between energy intake and body weight early in life suggests that energy intake is programmed for future growth and development.

Body Constitution↗

A new method for delivering a taste without fluids to preterm and term infants.

A new method for administering a taste to preterm and term infants has been developed that does not necessitate the delivery of rapid solutions. Sucrose, a sugar that in solution was shown to potentiate sucking behavior, was embedded in gelatin-based nipples that continuously release sweet taste when mouthed or sucked. The gelatin nipples and comparable latex nipples were adapted to measure sucking behavior and were tested in a within-subject design. The gelatin nipples potentiated sucking in preterm and term infants by increasing the frequency and strength of the responses. Few sucking measures varied significantly for preterm and term infants. Those that did vary might be attributable to differences in physical stamina, rather than to orosensory or hedonic factors. It was concluded that the flavored gelatin nipple provides an effective method for studying taste in infants and offers the possibility of routine chemosensory stimulation for research and clinical applications.

Discrimination Learning↗

Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life.

INTRODUCTION: The purposes of the study were to determine prospectively the duration of nonnutritive sucking behaviors of children between 1 and 8 years of age and the effect of persistent habits on selected occlusal characteristics in the late deciduous dentition. METHODS: Sucking behavior data were initially collected from 797 children who were followed longitudinally from birth; the data came from periodic questionnaires completed by the parents. In addition, study models were obtained for 372 children at 4 to 5 years of age and assessed for posterior crossbite, anterior open bite, and overjet. The subjects were grouped according to the duration and type of habit (pacifier or digit, for less than 12 months or more than 48 months). Children with nonnutritive sucking of less than 12 months were further grouped according to the duration of breast-feeding. The McNemar nonparametric test was used to compare the changes in the incidence and effect of the habits with time. RESULTS: There was a significant (P = .001) decrease in the incidence of pacifier habits between 1 and 5 years of age, from 40% to 1%. There was a significant (P = .01) decrease in the incidence of digit habits between 1 and 4 years of age, from 31% to 12%. Between 4 and 7 years of age, the decrease in the incidence reached a plateau--ie, the decrease continued but at a slower rate. Between 7 and 8 years of age, there was an additional significant (P = .008) decrease in the incidence of digit habits, but 4% of the children were, to various extents, still sucking fingers. Children who had pacifier or digit habits lasting less than 12 months did not have significantly different occlusal characteristics than children who were breast-fed for 6 to 12 months. Prolonged pacifier and digit habits caused significant changes in the occlusal characteristics in the late deciduous dentition, and the effects of pacifier habits were different from those of digit sucking. CONCLUSIONS: To intercept the development of crossbites and functional shifts, the developing occlusion should be observed in the deciduous dentition in children with prolonged digit or pacifier habits. The transverse occlusal relationship, particularly in pacifier-sucking children, should be evaluated between 2 and 3 years of age. If there are interfering contacts of the deciduous canines, the parents should be instructed to reduce pacifier-sucking time, and appropriate treatment should be rendered, if required.

Chi-Square Distribution↗

Early developmental change in bitter taste responses in human infants.

Human newborns (birth-6 days) and older infants (14-180 days) were allowed to ingest both urea (0.12-0.24 M) in a mildly sweet diluent and the diluent alone, and multiple measures of responsivity were obtained (relative intake, sucking behavior, and hedonic ratings based on facial expressions and body movements). For newborns, there was no indication of rejection of urea relative to the diluent in measures of intake or sucking behavior; rather, their responses were predominantly controlled by the order of presentation of the two tastes. In contrast, older infants tended to reject all concentrations of urea according to these measures. Hedonic ratings provided an indication of limited rejection of the bitter taste by newborns, but older infants were still found to respond more consistently. These data suggest there is an early developmental change in bitter taste perception.

Facial Expression↗

A preliminary study of the associations among preterm infant behaviors.

The purpose of this study was to examine whether relationships exist among various preterm infant behaviors. The study used an exploratory method design. Twenty infants were bathed and a total of 120 baths were video recorded and observed to measure preterm infant behaviors based on the frequency that behaviors occurred. The frequency was measured by using the preterm infant behavioral coding scheme developed for the study. Pearson Correlation Coefficients were used to analyze the behavioral data and examine whether the relationships among these behaviors were significant. The interrater reliability of the behavioral variables ranged from .82 to .99. There were highly positive correlations between the stress behaviors. There was, however, negative correlation between the stress behaviors and the stable behavior (sucking). The occurrences of the stress behaviors were associated with the state of " eyes open " and "fuss or crying". Knowing the associations may enhance NICU nurses ' abilities to identify preterm infant behaviors. While interacting with preterm infants, nurses can sensitively and actively sense preterm infant signals, prevent or ameliorate the early threats to an infant ' s life, and adjust care to support the infant ' s growth and development.

Baths↗

Oral motor function in the neonate.

The information in this article illustrates the importance of evaluating oral motor function of the infant, not only as function of his or her own ability but also of external and maternal assistance. The proper development of maternal behavior as a contribution toward the development of sucking behavior may not be readily evident; however, awareness is growing that a close mother-infant interaction can positively affect the infant's ability to feed, as well as his or her psychosomatic development. As a consequence, it becomes essential that the integrity of the nursing dyad be protected. More often than not, caretakers have seen the latter break down when mother or infant becomes too involved. Studies focusing on maternal and neonatal non-nutritional attributes stress the importance of acquiring a better appreciation of the psychosomatic benefits that can be generated by the nursing dyad. With such understanding, interventions may be developed to enhance the expression of these factors to help safeguard mother-infant relationship during difficult times.

Bottle Feeding↗

Night-time non-nutritive sucking in infants aged 1 to 5 months: relationship with infant state, breastfeeding, and bed-sharing versus room-sharing.

AIM: Epidemiological studies suggest that pacifier use may be protective against SIDS but little is known of the relationship between pacifier use and other forms of non-nutritive sucking (NNS) in infancy, or of patterns of NNS during the night, when most SIDS deaths occur. We report the first longitudinal study of NNS by direct overnight observations in healthy infants in a sleep laboratory. METHODS: Healthy, breast fed term infants (n = 10) were enrolled at birth, and sequential overnight polygraphic and infrared video recordings of infants with their mothers performed at monthly intervals from 1 to 5 months. Each month, mother baby pairs were randomized to 1 night bed-sharing (BN) then 1 room-sharing (RN), or vice versa. 'Episodes' of pacifier, own digit and mother's digit sucking (> 1 min) were identified and compared with state-matched control periods without sucking or feeding before and after each such episode. RESULTS: 329 episodes of NNS were identified in 749 h of video recording. The prevalence of pacifier sucking decreased with age, whilst digit sucking increased. Routine pacifier users rarely sucked their digits. There were temporal differences throughout the night in the distribution of different types of sucking and in infant state during and around sucking episodes. Sleeping in the 'non-routine' location was associated with a larger percentage of nights with sucking episodes and increased sleep latency. Bed sharing (routinely or on a given night) was associated with less sucking behavior and more breastfeeding. Non-nutritive sucking was not, however, associated with decreased total time breastfeeding per night or number of feeds per night. CONCLUSION: Patterns of NNS during the night change with age and are affected by maternal proximity. Digit sucking has state modulating effects, and may be suppressed by pacifier use. Thus any benefits of pacifier use must be set against the potential loss of a self-directed ability to modulate state during the night, and possible shortening of breastfeeding duration.

Beds↗

Development of preterm infants: feeding behaviors and brazelton neonatal behavioral assessment scale at 40 and 44 weeks' postconceptional age.

The purpose of this study was twofold: (1) to explore potential changes in the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) from 40 to 44 weeks postconceptional age (PCA) and (2) to determine the relationship between the BNBAS scores and feeding behaviors in preterm infants at 40 and 44 weeks PCA. The BNBAS and sucking behavior measurements were completed on 104 preterm infants at 40 and 44 weeks PCA. The Orientation (p = .001), Motor (p = .001), Range of State (p = .001), Autonomic Regulation (p = .01), and Reflexes (p = .00) clusters were significantly more mature at 44 weeks PCA than at 40 weeks. Infants that were extremely early born (n = 24) had a significantly larger change in BNBAS scores over time as compared to the more mature preterm infants (n = 77), largely catching up with their more mature preterm counterparts. At 40 and 44 weeks PCA, the BNBAS cluster scores for orientation (p = .02), motor (p = .048), range of state (p = .048), and regulation of state (p < .001) were significantly related to the average maximum pressure, adjusted for gestational age and weeks PCA. Significant neurobehavioral maturation takes place between 40 and 44 weeks PCA in preterm infants, with the greatest changes occurring in the most preterm infants. These findings highlight the relationship between neurobehavioral maturation and feeding behaviors.

Child Development↗

Effects of auditory stimulation upon non-nutritive sucking by premature infants.

Changes in non-nutritive sucking contingent upon presentation of an auditory stimulus previously found capable of eliciting heart-rate acceleration was investigated in a sample of 24 premature infants. Across 30 10-sec. presentations of the stimulus, only transient changes in sucking rate during the first 6 trials were observed, and these effects obtained primarily for those infants showing few abnormalities in their non-nutritive sucking behavior. These results were discussed as reflecting possible differences in infants' attention associated with sucking pathology and the dependence of psychological assessment upon the specific response index used.

Attention↗

Neonatal nutritive sucking: effects of taste stimulation upon sucking rhythm and heart rate.

The sucking behavior and heart rate of 22 full-term newborns were recorded. Half of the infants sucked for 9 minutes in 3 blocks of 3 minutes, first receiving a 0.02-ml drop of 5% sucrose for each criterion suck, then no fluid contingent upon such sucks, and finally a 0.02-ml drop of 15% sucrose for each suck. The other half received these conditions in reverse order. Regardless of the order in which the 2 nutrient conditions were administered, intersuck intervals were longer under the sweeter condition, but heart rate was also higher. Possible interpretations include a hedonic explanation suggesting that sucking rate is modulated to facilitate savoring of the sweeter fluid.

Heart Rate↗

The actifier: a device for neurophysiological studies of orofacial control in human infants.

A new device for the stimulation of intraoral tissues in human neonates is described. This instrument, known as an actifier, features a wide frequency range for mechanical stimulation, integrated multichannel electomyographic electrode pairs, and the capacity for transducing law compression during non-nutritive sucking behavior. The stimulus/recording interface consists of a modified pacifier. The actifier has been used to investigate the responsiveness of the sucking central pattern generator in human infants to mechanical perturbation.

Electromyography↗

The effect of music-reinforced nonnutritive sucking on feeding rate of premature infants.

Premature infants are fed by gavage tube before 34 weeks adjusted gestational age and when nipple feeding results in detrimental changes in respiration and heart rate. Nipple feeding skill must be developed and correlates with length of hospitalization and neurobehavioral development. This study provided music reinforcement for nonnutritive sucking and assessed nipple feeding rates pre- and posttreatment for 32 infants referred as poor feeders. A pacifier fitted with a pressure transducer activated 10 seconds of recorded music in a one-trial, 15-minute intervention given to experimental infants (n = 16) 30 to 60 minutes before the late afternoon bottle feeding. Feeding rates were collected for bottle feedings pre- and postintervention and for a similar interval for a no-contact control group (n = 16). Results showed that the intervention significantly increased feeding rates. Music functioned as reinforcement and the sucking behavior transferred from a nonnutritive to a nutritive event.

Feeding Behavior↗

The stability and interrelationships of newborn sucking and heart rate.

The sucking behavior of 44 newborns was recorded along with heart rate (HR) and respiration. These 3 systems showed stability over a 24-hr period. Sucking parameters varied markedly depending upon whether the infant was sucking for sucrose or under a no-fluid condition. Moreover, HR was strikingly affected by sweetness. The direction of HR change was toward increasing rates when sucking for sweet, even though sucking for sweet substances occurs more slowly than for no fluid.

Female↗

Suckling in the rat: evidence for patterned behavior during sleep.

Electrophysiological recordings showed that 2-wk-old rats are actually asleep 66% of the time while suckling on the dam. The pups are no more likely to be awake while on the nipple than between nursing bouts. Sucking behavior, recorded electromyographically, occurred during sleep as well as during wakefulness. Pups were found to be asleep just prior to the dam's periodic milk ejections (ME) in 100% of 33 recorded instances and were briefly awakened by the ME, but 60% were asleep again within 30 s. These studies demonstrate the embedding of a vital early behavior pattern in the states of sleep.

Animal Population Groups↗