Using devices to upregulate nonnutritive swallowing in typically developing infants

Abstract

The role of various sensory stimuli for stimulating swallowing in infants may be of importance for assisting infants to develop oral feeding. We evaluated the swallowing mechanism response to two devices for increasing the rate of nonnutritive swallowing in two typically developing infant age groups, ages 2-4 mo and 7-9 mo. One device was a pacifier familiar to the infant; the other was a small vibrator placed on the skin overlying the thyroid cartilage. The rate of nonnutritive swallowing while infants were awake was compared in three 10-min conditions: at rest without stimulation (spontaneous); during nonnutritive sucking with a pacifier; and over 10 min containing 18 epochs of vibratory stimulation for 10 s each. To assess whether vibration on the throat over the laryngeal area altered respiration, the mean cycle length was compared between 10-min intervals either containing vibratory stimulation or without stimulation at rest. Both the pacifier and laryngeal vibration stimulation doubled the rate of swallowing in the infants with a mean age of 3 mo 16 days and infants with a mean age of 8 mo 8 days. No differences occurred in the mean respiratory cycle length between intervals with and without vibration in either age group. Results suggest that nonnutritive sucking, vibration, or both might be beneficial in enhancing swallowing in young infants. Because vibration on the neck would not interfere with oral transfer of liquid, it might provide additional stimulation for swallowing during oral feeding. Both stimulation types should be evaluated for enhancing swallowing in infants with immature swallowing skills.

Dysphagia Management in the Schools: Past, Present, and Future

“…18 Although there are recent studies emerging in stimulation and upregulation of swallowing, most products and protocols remain in the research development phases. 19,20 Presently, there are few management pathways that have adequate empirical evidence to inform practitioners serving children. 21 For these reasons, employing approved state or district guidelines for swallowing and feeding services in the schools is advised.…”

Vibration over the larynx increases swallowing and cortical activation for swallowing

“…However, this approach requires an apparatus in the mouth for air puff stimulation, which can interfere with oral intake for feeding. A recent study indicated that surface vibration to the neck significantly increased the rate of swallowing in healthy infants without significant alterations in respiration (Hegyi Szynkiewicz et al 2016). This method of noninvasive vibratory stimulation on the neck would not interfere with oral intake and thus may be suitable for dysphagia management.…”