Infant Swallow Physiology
Infant Swallow Physiology
Swallowing begins in utero as early as 11 weeks (Miller, Sonies, & Macedonia, 2003). Early suckle patterns are observed as early as 18 weeks and well established by 34 weeks in utero. By 38 weeks gestation (at time of birth), healthy, term infants swallow at least half their amniotic fluid per day (approximately 400ml) (De Vries, Visser, & Prechtl, 1982). (See Box 1.32 for a YouTube video of an in-utero infant sucking as recorded from ultrasound.) This bodes well, as it provides the sucking and swallow practice needed for a newborn infant who will swallow about that same amount per day during the first couple weeks of life.
Box 1.32 External Link
Feeding is essential for adequate growth, especially in the newborn. Growth can be monitored by the use of growth charts. Standardized growth charts have been developed by the Centers for Disease Control and Prevention (CDC) and are available for download (Box 1.33). Feeding is considered “functional” if weight gain is consistently sufficient as noted by charting and monitoring the growth curve.
Box 1.33 External Link
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Growth charts have been developed by the CDC as well as WHO. Read this for an overview of these two growth chart sets.
Clinical Note
A feeding therapist may monitor growth using growth curves. Particular concern with appropriate referral should be considered if an infant drops from one growth curve to another. E.g., from 20th percentile to 10th percentile.
Over the first two years of development, as depicted in Box 1.34, successful feeding correlates with (1) the infant’s medical health and stability yielding appropriate developmental milestones, (2) intact neurophysiology, (3) the ability to regulate state regardless of environmental stresses, and (4) the ability to coordinate breathing into the suck-swallow skill that was practiced in-utero. Further, successful feeding is based on communication between the feeder and the infant. The feeder must learn to observe and respect cues from the infant regarding feeding readiness. (The video in Box 1.35 displays an example of feeding readiness in a healthy 3 month old infant.) The infant should be awake, quiet, and content during feeding. However, the infant may exhibit fussiness or crying just prior to feeding that is extinguished with the onset of feeding.
Examples Box 1.34: Feeding readiness in a healthy infant
Box 1.35 Video: Feeding readiness in a healthy infant
Once feeding is initiated, infants may cue the feeder that they need a break or that they are finished with their meal. For example, if an infant looks away during feeding they may be cueing the feeder that they have completed their feeding. Careful consideration must be given to the infant who pauses during feeding, yet retains eye contact. They may need a break, but may not have completed their feeding. When signs of stress are observed the feeder must be prepared to respond accordingly to the cues. Common stress cues