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PubMed2005

Assessment of infant oral sensorimotor and swallowing function.

The development of feeding and swallowing is the result of a complex interface between the developing nervous system, various physiological systems, and the environment. The purpose of this article is to review the neurobiology, development, and assessment of feeding and swallowing during early infancy. In recent years, there have been exciting advances in our understanding of the physiology and neurological control of feeding and swallowing. These advances may prove useful in furthering our understanding of the pathophysiology of dysphagia in infancy. Progress in developing standardized, reliable, and valid measures of oral sensorimotor and swallowing function in infancy has been slow. However, there have been significant advances in the instrumental analysis of feeding and swallowing disorders in infancy, including manometric analyses of sucking and swallowing, measures of respiration during feeding, videofluoroscopic swallow evaluations, ultrasonography, and flexible endoscopic examination of swallowing. Further efforts are needed to develop clinical evaluative measures of dysphagia in infancy.

Deglutition↗
PubMed1982

Development of sucking in term infants from birth to four hours postbirth.

The development of sucking response was investigated in 30 clinically normal infants from 1 or 5 minutes postbirth until their first feeding 4 hours later. Maximum sucking pressures were measured with a research nipple attached to a portable electronic suckometer. Mean suction (negative pressure) began at 5 Torr at birth, peaked at 103 Torr at 90 minutes, and decreased thereafter to 65 Torr at 4 hours. Expression (positive pressure) began at 12 Torr, rose to 29, and decreased to 25. Mean expression pressures correlated with feeding scale scores, r = +.44(24); p less than .025, but suction pressures did not, r = +.26(24); p less than .1. Normative data were gathered on 10 additional stabilized newborns who had been fed twice successfully. Suction pressures were 96 Torr on Day 1, and 103 Torr on Day 2; expression pressures were 25 and 24 Torr, respectively. These pressures approximate those recorded in newborns between 1 and 2 hours postbirth.

Biomechanical Phenomena↗
PubMed1988

Respiratory control during nipple feeding in preterm infants.

The present study was designed to investigate the development of respiratory control during feeding in premature infants. Cardiorespiratory disturbances during feeding were evaluated with polygraphic monitoring in 24 premature infants within 1 week of beginning nipple feeds. During the initial study, 15 infants exhibited one or more episodes of short apnea (greater than or equal to 10 sec) and three infants exhibited prolonged apnea (greater than or equal to 20 sec). Bradycardia developed in seven infants; apnea and decreases in oxygen saturation invariably preceded the development of bradycardia. In contrast, short apnea occurred during sleep in five infants and associated bradycardia developed in four infants. Occurrence of apnea during sleep was significantly lower than that observed during feeding (P less than 0.05). Subsequently, 18 of these infants were reevaluated 7-10 days later. Seven infants developed one or more episodes of short apnea, five developed prolonged apnea, and four developed bradycardia. These occurrences were not significantly different from those observed during the initial study (P greater than 0.05). Short apnea persisted during sleep in four infants during reevaluation. Most of the apneic episodes in both studies were mixed apnea. The high frequency of cardiorespiratory disturbances during the first 2 weeks of nipple feeding indicates that in most preterm infants respiratory control during feeding is still immature at the postconceptional age of 35-36 weeks.

Apnea↗
PubMed1986

Suckling deficits in rat pups exposed to alcohol in utero.

With the aid of a pair-feeding procedure, two groups of pregnant Long-Evans rats were fed a liquid diet containing 35% or 0% ethanol-derived calories during days 6-20 of gestation. A third group was allowed free access to standard lab chow and water throughout pregnancy. At 6-7 or 9-10 days of age, suckling performance by male and female offspring representing the three prenatal treatment groups was examined. The test stimulus was a 6-10-day postparturient, anesthetized dam in which milk letdown was prevented. Compared to both pair-fed and lab chow controls, alcohol-exposed animals exerted a lower maximum suckling pressure, spent less time suckling during the test session, and displayed an altered suckling pattern. These data are consistent with existing clinical and experimental evidence documenting sucking deficits following prenatal alcohol exposure and are discussed in terms of prenatal alcohol-induced CNS impairment.

Age Factors↗
PubMed2005

Repeatability of the sonographic assessment of fetal sucking and swallowing movements.

OBJECTIVE: To test the repeatability of sonography in the assessment of fetal sucking and swallowing movements. METHODS: Eighty normal fetuses of pregnant women with no systemic abnormalities were examined sonographically at 30-38 weeks of gestation. Sucking and swallowing movements were observed for 15 min and the face was visualized in frontal and lateral views. The examinations were recorded for later analysis by two independent observers and the 95% limits of agreement (Bland and Altman) method was used for inter- and intraobserver comparison. RESULTS: The mean +/- SD number of swallowing movements, sucking bursts and total sucking movements recorded by Observer 1 were 8.3 +/- 4.7, 9.9 +/- 9.3 and 35.8 +/- 48.0 and the equivalent values for Observer 2 were 8.2 +/- 4.8, 9.8 +/- 9.3 and 36.4 +/- 49.0, respectively. The mean (95% limits of agreement) interobserver difference was 0.1 (-1.4; 1.6), 0.1 (-2.2; 2.3) and -0.6 (-9.0; 7.9), and the mean (95% limits of agreement) intraobserver difference was 0.4 (-3.1; 3.9), 0.1 (-2.0; 2.2) and 1.0 (-10.7; 12.7) for swallowing movements, sucking bursts and total sucking movements, respectively. CONCLUSIONS: The high degree of intra- and interobserver repeatability disclosed in the sonographic analysis of fetal sucking and swallowing movements supports the applicability of sonographic assessment in normal fetuses.

Cross-Sectional Studies↗
PubMed1997

High-amplitude sucking and newborns: the quest for underlying mechanisms.

This study seeks to determine whether newborns are sensitive to an operant-conditioning task involving an unprepared relation between a response and a stimulus. The High-Amplitude Sucking procedure, which is based on such a relation by reinforcing nonnutritive sucking with auditory stimulation, was used. In order to verify that newborns learn the contingency between sucks and sounds in the HAS paradigm, three experiments were carried out. In Experiment 1, the effect of contingent versus noncontingent presentation of speech sounds on newborns' sucking activity was investigated during the minutes following a silent baseline. In contrast to what has been reported with 2-month-old infants in HAS, contingently stimulated newborns did not differ significantly from a nonstimulated control group. Experiment 2 showed that an increase in sucking rates could be obtained after a stimulus change, when sounds were presented contingently, but not when sounds were presented noncontingently. Experiment 3 demonstrated that newborns' sucking responses were reinforced by variation in the presented speech sounds. The results of these three experiments support the hypothesis that newborns tested under the HAS procedure are involved in an operant-learning situation. Implications for learning in neonates and possible differences with older infants are discussed.

Child, Preschool↗
PubMed2002

Begging for milk: evolution of teat massaging in suckling pigs.

We present a model that simulates the evolution of teat massaging (begging) by suckling piglets (Sus scrofa) and milk distribution among teats (provisioning) by their mothers. Contrary to previous begging models, this one incorporates an ontogenetic dimension in that the inherited begging and provisioning rules are repeatedly allowed to interact, and their consequences for milk intake, growth and death probability are assessed, during each nursing. We test the model under three selection regimes differing in the relative importance of the between-litter selection component. We show that the selection regime with the strongest between-litter selection component leads to lowest begging levels and most effective milk utilization, thus supporting the hypothesis that selection based on whole litters may attenuate sibling competition.

Animals↗
PubMed2002

Efficacy and effectiveness of LAM.

Two major protocols of non-randomized clinical trials of the efficacy of the Lactational Amenorrhea Method of contraception (LAM) were performed in the 1990s that suggested LAM to be a highly effective albeit temporary method of contraception. Data from a longitudinal study of over 4000 breastfeeding women performed by the World Health Organization provide supporting information as to the efficacy of LAM. Effectiveness data are scarce, as is information on the use of LAM in industrialized countries. Issues surrounding LAM efficacy and effectiveness are reviewed, and the existing information from industrialized countries is highlighted.

Adult↗
PubMed1984

Participation of the hippocampus in the facilitatory effect of an exteroceptive stimulus on milk ejection.

The auditory exteroceptive stimulus emanating from a lactating rat and the litter while suckling was used to facilitate milk ejection in another "induced" mother suckled by her own litter. Sectioning of the tractus corticohypothalamicus medialis (TCM) or the columns of the fornix, prevented the facilitatory effect of the exteroceptive stimulus on milk ejection. Sham operated induced mothers gave significantly more milk than noninduced rats. Electrolytic lesioning of the stria terminalis did not affect normal milk ejection nor the response to the exteroceptive stimulus. It is proposed that the hippocampus through the TCM may facilitate the suckling-induced milk ejection when an appropiate exteroceptive stimulus is applied. Neither the lesion of the stria terminalis nor the section of the fornix or the TCM seems to alter the normal suckling-induced milk ejection. A general modulatory role of the limbic system is described.

Animals↗
PubMed1984

Relationship between swallow rate and salivary flow.

Recent studies indicate that swallow-induced, primary peristalsis is a major determinant of normal esophageal acid clearance. However, factors that regulate the rate of spontaneous swallowing in normal subjects are incompletely understood. We postulated that the rate of salivary flow influences the rate of spontaneous swallows. To test this hypothesis, we did a total of 60 studies measuring salivary flow or the rate of spontaneous swallowing in 10 healthy volunteers, age 10-30 years. Saliva was collected by expectoration. Swallow rate was recorded by a small, transnasal catheter stationed in the pharynx and also, in some circumstances, by cervical electrodes. On separate sessions, we evaluated the effect of five test manipulations on salivary flow and swallowing rate, respectively. The test manipulations consisted of: (1) pharyngeal intubation, (2) sucking of a dummy lozenge, (3) sucking of a peppermint lozenge, (4) bethanechol injection (5 mg subcutaneously), and atropine administration (12 micrograms/kg intravenously). Pharyngeal intubation caused a small, but significant increase in the rate of salivation and spontaneous swallows. Sucking of a peppermint lozenge caused a sixfold increase in salivary flow while nearly doubling the swallowing rate whereas the dummy lozenge caused only a modest increase in salivary flow and swallowing. Cholinergic stimulation by bethanechol elicited a substantial increase in salivary flow and swallowing rate. In contrast, atropine caused a significant decrease in both salivary flow and swallowing. We conclude that in awake, normal subjects the rate of spontaneous swallows is influenced directly by salivary flow. Because oral lozenges substantially increase both swallowing rate and salivary flow, such agents merit investigation as a potentially useful ancillary treatment for the relief of heartburn.

Adolescent↗
PubMed1985

Special swallowing problems in children.

As the swallowing process evolves from infantile suckle feeding through transitional feeding to mature function, the process can go awry at many points. Understanding the changes in structure and function of the mouth and pharynx that occur with growth and development is of basic importance. When a child is referred because of unsuccessful feeding or suspicion of aspiration, dynamic imaging of the swallowing mechanism and scrutiny of radiographic abnormalities described in this article can lead to greater understanding of the underlying cause and to more effective treatment.

Adult↗