Unique Relationship Between Feeding & Respiration in Infants
Most adults can eat a meal without needing to focus on breathing at the same time. Synchronized eating and breathing involves a coordinated effort that most people master at a young age. Some infants present different circumstances because they drink from a bottle and are still developing this coordination. This is known as suck-swallow-breathe, and is a skill that may take time to learn for some babies.
According to GI Motility Online, some types of infants are at higher risk of problems with coordinated eating and breathing. These include premature infants, babies with failure to thrive syndrome, infants with heart disease and babies with cerebral palsy. All of these conditions delay an infant’s ability to learn how to breastfeed or bottle-feed while maintaining respiratory patterns.
Infants display two different types of sucking patterns, as stated by Dr. Maria-Gisela Mercado-Deane. Non-nutritive sucking occurs when the infant is able to breathe through his nose at the same time and is frequently seen when a baby sucks on a pacifier. Nutritive sucking occurs when an infant eats from a bottle. The baby takes in food and his tongue pushes it to the back of the mouth to facilitate swallowing. This process can be repeated numerous times on one breath before the baby remembers to pause from eating to take another breath.
Infant muscles used for respiration work easily without the infant consciously thinking about how to breathe. Alternatively, eating requires coordination of muscles, sucking reflexes and the physical ability to swallow milk. The process of sucking begins in the fetus and according to GI Motility Online's Joan C. Arvedson, PhD., sucking can be seen in a fetus between 18 and 24 weeks gestation. The ability to suck and swallow develops by approximately 34 weeks gestation.
Because the sucking reflex progresses during the fetal stage, infants born prematurely may have difficulty with eating from a bottle until coordination develops. Depending on facility protocol, some institutions do not allow an infant to attempt bottle or breastfeeding until at least 32 weeks corrected gestational age, as attempting to eat without coordination skills can cause physical complications. Infants born before this time are typically fed breast milk or formula through a feeding tube, which bypasses the sucking reflex.
Infants that do not understand how to breathe and eat at the same time risk developing complications. Milk aspiration into the lungs occurs when an infant breathes in at the incorrect time during feeding, inhaling the milk instead of sending it to the stomach. Milk aspiration can cause infection and ultimately pneumonia if left unmanaged. Other complications of uncoordinated feeding and breathing include apnea, which occurs when an infant temporarily stops breathing; bradycardia, which happens when the heart beats at a slower rate than normal and fatigue.
- Neonatal Intensive Care: A Model of Feeding Readiness for Preterm Infants
- GI Motility Online: Swallowing and Feeding in Infants and Young Children
- “Newborn Intensive Care: What Every Parent Needs to Know”; Jeanette Zaichkin; 2002