Coordination of breathing and swallowing in human infants

Wilson, Stephen; Thach, Bradley T.; Brouillette, Robert T.; Abu-Osba, Yousef K.

doi:10.1152/jappl.1981.50.4.851

Cited by 139 publications

(97 citation statements)

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“…A recent study on eight term and five preterm infants (2-7 wk postnatal) found that sucking during bottle feeds could occur in inspiration or expiration (1). In continuous sucking, there was a fairly During the first 15 s, swallows occur at end-inspiration ( 7 ) , mid-expiration ( 9 ) , and end-inspiration followed by a pause (4). The onset of regular breathing (u) corresponds to the start of a period of stable coordination between swallows and breaths.…”

Section: Discussionmentioning

confidence: 99%

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The Relationship between Rhythmic Swallowing and Breathing during Suckle Feeding in Term Neonates

1992

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ABSTRACT. Little is known of the development of efficient coordination between suckle feeding and breathing in human infants. To establish baseline data, we recorded breathing and swallowing activity during bottle feeds in 23 infants at 14-48 h postnatal age. Most swallows (overall mean 68%) were organized into runs, with intervals starting at 0.6-0.8 s and slowing to 1-1.3 s after 30-40 s. The proportion of run swallows to total swallows increased significantly with age. Swallow intervals were regular (coefficient of variation = 18-38%) compared with breathing (coefficient of variation = 50%). Both breathing rate and tidal volume were significantly reduced by the onset of suckle feeding, and the pattern of respiratory airflow became markedly irregular. Mild transient desaturation was common, but was not accompanied by changes in heart rate. Swallows could occur in all phases of breathing. Overall, equal numbers of swallows were preceded by expiration and inspiration, but twice as many were followed by expiration compared with inspiration. Swallows were classified by the respiratory phases both preceding and following the swallow. Swallows occurred in all possible classifications in each of the infants studied. The incidence of the most frequent classification (inspiration-swallowexpiration), was 24% overall (individual range 5-50%). The phase relation between swallows and breaths changed frequently but showed occasional short periods of stability during which the breathing became regular and tidal volume increased. We conclude that at <48 h the normal infant has little coordination between swallowing and breathing rhythms and maintains rhythmic swallowing at the expense of eupnea. (Pediatr Res 31: 619-624,1992)

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Section: Discussionmentioning

confidence: 99%

“…The swallow recording methods were based on those of Wilson et a/. (9) and Pierantoni et al (10). Respiratory recording used standard polysomnography techniques.…”

Section: Methodsmentioning

confidence: 99%

The Relationship between Rhythmic Swallowing and Breathing during Suckle Feeding in Term Neonates

1992

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“…55,56 They often respond to fluid in the oropharynx with prolonged apnea, an exaggerated protective response. 57,58 The size of the fluid bolus, the speed with which it travels through the oropharynx, the number of swallows needed to clear the bolus, and the postconceptional age of the infant all affect changes in the respiratory pattern to accommodate swallowing.…”

Section: Ability To Coordinate Swallowing and Breathingmentioning

confidence: 99%

“…19,38,59 Preterm infants often suck in excess of their capacity to swallow, which places a large bolus of fluid in the mouth, requiring several swallows to clear and obstructing the airway for a prolonged period. 55,56 Hanlon and colleagues found that apnea time during swallowing and the incidence of multiple swallows decreased as healthy preterm infants matured. Preterm infants continued to have longer swallowing apneic events at term than full-term infants do, however.…”

Section: Ability To Coordinate Swallowing and Breathingmentioning

confidence: 99%

The Early Feeding Skills Assessment for Preterm Infants

Thoyre

Shaker²,

Pridham³

2005

Neonatal Network

212

143

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Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oralmotor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers-notably nurses and parents-need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant's developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.Neonatal clinicians, clinicians who work with families during the early postdischarge period, and parents of preterm infants are in an important position to observe and support the development of an emergent motor skill: oral feeding. Oral feeding skills have commonly been conceptualized by health care providers as an infant's ability to organize and coordinate oralmotor functions to efficiently consume enough calories for growth. Early feeding skills are much more complex than this, however. They also involve the infant's ability to (1) engage and remain engaged in a physiologically and behaviorally challenging task, (2) organize oralmotor movements so as to have long-term functional benefits, (3) coordinate breathing with swallowing to avoid prolonged apnea or aspiration of fluids, and (4) regulate the depth and frequency of breathing to maintain physiologic stability.Motor skill development corresponds to changes in an infant's brain, body, and experience. 1 According to research, two factors affect progression in ability to feed orally: the infant's state of health 2-6 and oral feeding experience. [7][8][9][10][11] According to other research, neuromaturation of the following contributes to an individual infant's skill in feeding: the ability to regulate oxygen, 11,12 development of alertness, 13-15 and development of sucking strength and organization of the sucking pattern. 16,17 External influences can also change the nature of the task. These include the size and speed of flow of the fluid bolus, 18-20 the impact of nasogastric tubes in place during feeding, 21 and the type of feeding support provided by the caregiver. [22][23][24][25][26] During its emergent phase, motor skill expression varies considerably. 27 Early feeding skills can vary from feeding to feeding and even across a given feeding. Some infants adapt and improve in skill as the feeding pro...

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“…This reflexively induced inspiratory activity has been observed in felines (Gestreau, Milano, Bianchi, & Grelot, 1996;Hukuhara & Okada, 1956) and humans (Hardemark Cedborg et al, 2009;Wilson, Thach, Brouillette, & Abu-Osba, 1981). Schluckatmung activity can be distinguished from gradual onset and offset of the eupneic rhythmic breathing, which is 9 normal breathing pattern.…”

Section: Thoracic Diaphragmmentioning

confidence: 72%

Swallow and breathing coordination following suprahyoid muscle injury.

Kimbel¹

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DEDICATIONTo my wife, Kate, for all her support and patience. iv ACKNOWLEDGMENTS First, I would like to thank my thesis advisor at the University of Louisville. She provided invaluable input into the thesis process. Her knowledge base related to the scope of this paper was instrumental in its publication. Further, she was patient and forthright in her feedback. Under her tutelage, I fostered a newly found passion for research. Swallowing motility disorders (dysphagia) are a major complication following radiation treatment for head and neck cancer, affecting ~50% of those treated. One reason for this is that radiation causes muscle damage, provoking sensorimotor pathologies.Previous work has suggested that injury may cause discoordination between breathing and swallowing behaviors. We sought to determine if muscle injury provokes changes in this behavior. We hypothesized that acute suprahyoid muscle damage would alter crossbehavior excitability, causing destabilization of the respiratory-swallow pattern.Swallowing was evoked in anesthetized spontaneously breathing cats via injection of a 3cc bolus of water into the oropharyngeal cavity. A suprahyoid injury was induced unilaterally by applying a ~2mm cryoprobe to the belly of the mylohyoid muscle.Electromyography (EMG) activity (duration, amplitude) was measured concurrently in thyrohyoid, mylohyoid, thyropharyngeal, and diaphragm muscles. Swallow-breathing coordination (SBC) was measured by determining inspiration/expiration phase during the onset and offset of a swallowing event, based off the mylohyoid initiation and thyropharyngeal termination bursts, respectively. Results showed an injury-related effect in the mylohyoid muscle, as indicated by a significant decrease in the mean amplitude vi post-injury compared to pre-injury. During swallowing, the expiratory phase was found to predominate the respiratory cycle in both pre-and post-injury. No significant changes to the swallow-breathing coordination were found following injury. Results demonstrate that mylohyoid muscle injury does not appear to interfere with short-term changes in the respiratory-swallow pattern. Although deficits in muscle function were found immediately following injury, an extended time or more severe injury may be needed to adversely inhibit these behaviors. Thus, disrupting the stable coupling between respirations and swallowing, which has been found clinically, may not be apparent immediately after injury and require long-term changes in function.

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Coordination of breathing and swallowing in human infants

Cited by 139 publications

References 0 publications

The Relationship between Rhythmic Swallowing and Breathing during Suckle Feeding in Term Neonates

The Relationship between Rhythmic Swallowing and Breathing during Suckle Feeding in Term Neonates

The Early Feeding Skills Assessment for Preterm Infants

Swallow and breathing coordination following suprahyoid muscle injury.

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