Development of sucking behavior in infants with Down's syndrome

The aim of this study was to gain a better understanding of the development of sucking behavior in infants with Down's syndrome. The sucking behavior of 14 infants with Down's syndrome was consecutively studied at 1, 4, 8 and 12 mo of age. They were free from complications that may cause sucking difficulty. The sucking pressure, expression pressure, frequency and duration were measured. In addition, an ultrasound study during sucking was performed in sagittal planes. Although levels of the sucking pressure and duration were in the normal range, significant development occurred with time. Ultrasonographic images showed deficiency in the smooth peristaltic tongue movement.

Conclusion: The sucking deficiency in Down's syndrome may result from not only hypotonicity of the perioral muscles, lips and masticatory muscles, but also deficiency in the smooth tongue movement. This approach using the sucking pressure waveform and ultrasonography can help in the examination of the development of sucking behavior, intraoral movement and therapeutic effects.     

Real-time 3D ultrasound imaging of infant tongue movements during breast-feeding

Background

Whether infants use suction or peristaltic tongue movements or a combination to extract milk during breast-feeding is controversial. The aims of this pilot study were 1] to evaluate the feasibility of using 3D ultrasound scanning to visualise infant tongue movements; and 2] to ascertain whether peristaltic tongue movements could be demonstrated during breast-feeding.

Methods

15 healthy term infants, aged 2 weeks to 4 months were scanned during breast-feeding, using a real-time 3D ultrasound system, with a 7 MHz transducer placed sub-mentally.

Results

1] The method proved feasible, with 72% of bi-plane datasets and 56% of real-time 3D datasets providing adequate coverage [> 75%] of the infant tongue. 2] Peristaltic tongue movement was observed in 13 of 15 infants [83%] from real-time or reformatted truly mid-sagittal views under 3D guidance.

Conclusions

This is the first study to demonstrate the feasibility of using 3D ultrasound to visualise infant tongue movements during breast-feeding. Peristaltic infant tongue movement was present in the majority of infants when the image plane was truly mid-sagittal but was not apparent if the image was slightly off the mid-sagittal plane. This should be considered in studies investigating the relative importance of vacuum and peristalsis for milk transfer.     

Tongue movement and intra-oral vacuum in breastfeeding infants

OBJECTIVE: The mechanism by which the breastfeeding infant removes milk from the breast is still controversial. It is unclear whether the infant uses predominantly intra-oral vacuum or a peristaltic action of the tongue to remove milk from the breast. The aim of this study was to use ultrasound to observe movements of the tongue during breastfeeding and relate these movements to both milk flow and simultaneous measurements of intra-oral vacuum. METHODS: Submental ultrasound scans of the oral cavity of 20 breastfed infants (3-24 weeks old) were performed during a breastfeed. Intra-oral vacuums were measured simultaneously via a milk-filled supply line (SNS) connected to a pressure transducer. RESULTS: Vacuum increased during the downward motion of the posterior tongue and at the same time milk flow and milk ducts in the nipple was observed. Peak vacuum (-145+/-58 mmHg) occurred when the tongue was in the lowest position. CONCLUSIONS: Ultrasound imaging demonstrated that milk flow from the nipple into the infant's oral cavity coincided with both the lowering of the infants tongue and peak vacuum. Therefore vacuum is likely to play a major role in milk removal from the breast.     

A Pilot Study of Oral-Motor Dysfunction in “At-Risk” Infants

The purposes of this pilot study were to devise a neonatal oral-motor assessment scale (NOMAS), and to correlate oral-motor function with feeding histories, perinatal-neonatal complications, neurologic status, and polygraphic recording of sucking. The methods used to study the at-risk infants were polygraphic amplification and recording of intra-oral pressure waves; scoring of sucking behavior with the NOMAS occurred concurrently with instrumental measurement. Both non-nutritive (NNS) and nutritive sucking (NS) modes were tested. Oral-motor performance tended to be disorganized or dysfunctional in infants with intraventricular hemorrhage (IVH) and asphyxia neonatorum. Those infants with brain insults (IVH, hydrancephaly) showed slower sucking rates in NNS, and the degree of slowing of the rate when switched to NS was less in these higher-risk infants. The polygraphic data did not, however, distinguish those same infants who had abnormal NOMAS scores. Oral-motor dysfunction was identified only from 40 weeks corrected age (C.A.) and correlated with generalized hypotonia on neurological examination. Polygraphic data further substantiated that oral-motor dysfunction may be the result of deviant jaw movement. Deviant motor patterns observed between 35 and 37 weeks C.A. were not easily identifiable as oral-motor dysfunction and probably represented incoordination or disorganization because, although differences in oral-motor function were noted, normal movements of both the tongue and jaw were present. Further study is needed to determine if oral-motor disorganization noted between 35 and 37 weeks can be attributed to immaturity or whether oral-motor function deteriorates with loss of normal movement, so that by term age dysfunction is subsequently noted.     

Effect of suckling on the peripheral sensitivity of full-term newborn infants

BACKGROUND: Sucking may reduce the manifestations of pain in newborn infants. OBJECTIVE: To examine the effect of suckling on the threshold for peripheral somatosensory responses. Subjects and methods: Graded Von Frey filaments were applied to the heel to initiate peripheral somatosensory responses (withdrawal reflex and gross body movements) in term infants. RESULTS: Dummy sucking increases the somatosensory threshold, but breast feeding had a more marked effect, increasing the threshold of the flexion withdrawal reflex (p相似文献   

Interventions to improve the oral feeding performance of preterm infants

Aim: Preterm infants have difficulty oral feeding. We hypothesized that a specific sucking and swallowing exercises vs. no intervention accelerate the attainment of independent oral feeding through a faster maturation of infants’ oral feeding skills (OFS). Methods: Very low birthweight infants were randomized to a control, sucking and swallowing groups. Sucking consisted of active sucking on a pacifier, and swallowing of placing a milk bolus (0.05–0.2 mL) on the tongue where the bolus rests prior to entering the pharynx. Primary outcome was days from start to independent oral feeding (SOF‐IOF). Secondary outcomes included overall transfer (OT, % volume taken/volume prescribed), proficiency (PRO, % volume taken at 5 min/volume prescribed), rate of transfer (RT, mL/min) over the entire feeding and infants’ OFS levels. OFS levels were defined by PRO and RT. Results: Days from SOF to IOF vs controls (21 ± 2) were similar for the sucking group (19 ± 2) and shorter for the swallowing group (15 ± 2; p = 0.019). Only the latter infants demonstrated more mature OFS levels than controls. Conclusion: The swallowing exercise is an efficacious intervention in facilitating the attainment of independent oral feeding, but not the sucking exercise. We speculate that the swallowing benefit resulted from an accelerated maturation of infants’ OFS levels.     

Analysis of feeding behavior with direct linear transformation

AIM: The sucking pattern of term infants is composed of a rhythmic alteration of expression and suction movements. The aim is to evaluate if direct linear transformation (DLT) method could be used for the assessment of infant feeding. SUBJECT AND METHODS: A total of 10 gnormalh infants and two infants with neurological disorders were studied using DLT procedures and expression/suction pressure recordings. Feeding pattern of seven gnormalh infants were evaluated simultaneously recording DLT and pressures. The other infants were tested non-simultaneously. We placed markers on the lateral angle of the eye, tip of the jaw, and throat. The faces of infants while sucking were recorded in profile. The jaw and throat movements were calculated using the DLT procedure. Regression analysis was implemented to investigate the relationship between suction and expression pressures and eye-jaw and eye-throat movement. All regression analyses investigated univariate relationships and adjusted for other covariates. RESULTS: Ten gnormalh infants demonstrated higher suction pressure than expression pressure, and their throat movements were larger than jaw movements. Two infants with neurological problems did not generate suction pressure and demonstrated larger movements in their jaw than throat. The simultaneous measurement (n=7) showed a significant correlation, not only between eye-jaw distance and the expression pressure, but also between eye-throat distance and suction pressure. The change in the eye-jaw distance was smaller than the changes in the eye-throat distance in gnormalh infants (p<0.001). CONCLUSIONS: The DLT method can be used to evaluate feeding performance without any special device.     

Effects of maternal pethidine on infants' developing breast feeding behaviour

The aim of this quasi-experimental study was to examine the effects of maternal pethidine during labour on the developing breast feeding behaviour in infants in the first 2 h after birth compared with infants not exposed to pethidine. Forty-four healthy infants were observed immediately after birth. They were placed skin-to-skin on their mothers' chests. The development of mouth and sucking movements as well as rooting behaviour and state of sleep/wakefulness were noted. The observer was blind as to the pain relief the mother had received during labour. Of the 44 mothers 18 had received pethidine. The main findings were that infants exposed to pethidine had delayed and depressed sucking and rooting behaviour. In addition, a smaller proportion of infants exposed to pethidine started to suckle the breast. Rooting movements which are expected to be vigorous at 30 min after birth were affected both by administration of pethidine and a longer second stage of labour. It is suggested that the differences found in sucking behaviour may be a central effect of pethidine. Depression of rooting movements in the pethidine group may be caused by exhaustion due to a longer second stage of labour and administration of pethidine. It is recommended that pethidine-exposed mother-infant couples stay together after birth long enough to enable the infant to make the choice to attach or not to attach to the nipple without the forceful helping hand of the health staff.     

Movement disorder of premature infants with severe bronchopulmonary dysplasia: a new syndrome

A previously unrecognized, striking movement disorder has been observed in 10 premature infants with severe bronchopulmonary dysplasia. Chronic hypoxemia, hypercarbia, bronchospasm, and inadequate nutrition were present in all. The movement disorder developed from approximately the third postnatal month. The dominant movements involve the limbs, neck, trunk, and oral-buccal-lingual structures. The limb movements were most prominent distally and consisted of rapid, random, jerky movements (similar to chorea) and "restless" movements (similar to akathisia). Similar movements of the neck and face were observed; tongue movements had a "darting" quality. The oral-buccal-lingual movements were similar to the dyskinesia of older patients. Movements were exacerbated during episodes of respiratory failure and attenuated during sleep. All infants exhibited feeding disorders, largely due to tongue movements. In 3 infants treated with clonazepam, there was striking improvement in motor function, including feeding. The natural history was partial or complete resolution or a static course. Thus, of the 7 surviving infants, the movements were absent (without therapy) at 15, 18, and 30 months of age. In the remaining 4 infants (3 of whom receive clonazepam), the movements, though attenuated, persisted at 6, 12, 15 and 21 months of age, respectively. Neuropathologically, 1 infant showed neuronal loss with astrocytosis in caudate, putamen, globus pallidus, and thalamus. These data defined a previously unrecognized extrapyramidal movement disorder of infants with severe bronchopulmonary dysplasia; pathogenesis may be related to chronic hypoxemia.     

Ultrasonographic analysis of sucking behavior of newborn infants: the driving force of sucking pressure

The sucking behaviors of 15 low-risk full-term newborns were observed with ultrasonography and a special device directly measuring sucking pressure. In this study, the sequential changes in the movement of a tongue and other intra-oral structures and the sequential changes of the sucking pressure were successfully examined simultaneously. It was indicated that sucking pressure could be generated by sequential changes of an intra-oral volume caused by a peristalsis of the tongue in the sucking behavior.     

Feeding behaviour of infants with cleft lip and palate

AIM: To determine whether the feeding behaviour of infants with cleft lip and palate is improved with a type-P teat, which is widely used in Japan by such infants, compared with a standard teat. The difference in intra-oral movements between the type-P teat, modified for the evaluation of feeding behaviour, and an unmodified type-P teat was also compared using ultrasonography. METHODS: In part 1 of the study, 15 infants aged 2 to 3 mo and 7 infants aged 2 wk were evaluated for sucking pressure, expression pressure, frequency and duration of sucking. All the infants had a complete unilateral cleft lip and palate without any other abnormalities. In part 2, an ultrasonographic analysis of intra-oral movement was done for 5 infants enrolled in part 1 of the study. RESULTS: Sucking pressure did not occur in all infants. It was found that feeding efficiency improved with the type-P teat compared with the standard teat. The expression pressure with the type-P teat was significantly higher than that with the standard teat, and the feeding frequency with the type-P teat was lower than that with the standard teat. CONCLUSION: A type-P teat is suitable for infants with cleft lip and palate who have sucking difficulties. However, a type-P nipple with a squeezable bottle does not fully solve the feeding problems of infants with cleft lip and palate. New artificial teats that allow a higher expression pressure are desirable, and the measurement of the expression pressure may be helpful in the evaluation of artificial nipples.     

The position of the tongue during rooting reflexes elicited in newborn infants before the first suckle

A common breast-feeding problem is when the infant "places its tongue in its palate" and has difficulties in attaching to its mother's nipple. The aim of this study was to document the position of the tongue in the mouth cavity during rooting reflexes elicited in newborn infants before the first suckle. Eleven healthy, full-term infants were videotaped 101 ± 31 min after birth during an evoked distinct rooting reflex before the first suckle. The videotaped rooting reflex was analyzed in detail concerning the degree of turning of the head, mouth opening and position of the tongue, in pictures that were "frozen" at specific intervals. "Licking movements" preceded and followed the rooting reflex in the alert infants. In 10 of the 11 infants the tongue was placed in the bottom of the mouth cavity during a distinct rooting reflex ( p = < 0.05). It is suggested that forcing the infant to the breast might abolish the rooting reflex and disturb placement of the tongue. A healthy infant should have the opportunity of showing hunger and optimal reflexes, and attach to its mother's nipple by itself.     

The Effect of Non-Nutritive Sucking on Plasma Insulin, Gastrin, and Somatostatin Levels in Infants

ABSTRACT. The aim of the present investigation was to study the effect of non-nutritive sucking on plasma levels of insulin, gastrin, and somatostatin in infants. These hormones were measured with radioimmunoassay in plasma collected from fullterm and preterm infants sucking a pacifier. In fullterm infants, sucking caused a significant increase of insulin levels from 13 ± 10 μU/ml to 40 ± 36 μU/ml and 21 ± 17 μU/ml after 45 sec and 5 min respectively, from when the infants started sucking. A similar pattern was seen in preterm infants. In contrast, gastrin and somatostatin levels were not significantly affected. We suggest that sucking causes an activation of the vagal nerve, which results in the release of insulin. We also suggest that in infants, oral feeding is superior to bolus feeding, since in the latter case no vagal activation and consequently no release of hormones with anabolic properties occurs.     

The pharyngeal effect of partial nasal obstruction.

The case histroy and cinematoradiographic findings of a baby with partial nasal obstruction are presented. This infant's restriction to air entry at the nose led to severe airway obstruction during inspiration by a forward movement of the posterior pharyngeal wall and backward movement of the tongue and lower jaw. At the height of inspiration, there was total airway occlusion in the pharynx. These events can be explained by the pressure drop that takes place behind a restriction if air is sucked through it forcibly from an area of atmospheric pressure. Studies of postpalatal pressures in adults and infants demonstrate such a drop in pressure during nasal breathing if the nose is partly obstructed. If the adult or infant is able to respond to the diminished nasal airway by mouth breathing, there is no postpalatal pressure drop. It is suggested that partial nasal obstruction in a sleeping obligatory nasal-breathing infant could result in a sucking back of the tongue over the larynx in this "cafe coronary" type of situation. This could be the mechanism of the obstructive type of apnea recorded by Steinschneider, and of the asphyxial type of death that is suggested by autopsies on some "cot death" victims. This hypothesis is consistent with the frequency of infection of rhinitis and pharyngitis in victims of sudden infant death syndrome and with the seasonal incidence. Prevention of this obstructive type of apnea would depend on the recognition of infants showing inspiratory and expiratory changes in pharyngeal airway size as can be seen externally by the movements in the carotid triangle of the neck and confirmed by roentgenography or cinematoradiography.     

The effect of the odour of mother's milk on breastfeeding behaviour of premature neonates

AIM: To assess the effects of exposure to the odour of mother's milk on breastfeeding behaviour of premature neonates. METHODS: Thirteen preterm infants born at 30-33 weeks gestational age were tested. Seven infants were randomly assigned to the milk-odour condition, 6 to the water-control condition. During week 35 post-conceptual age, each baby was exposed to the appropriate odour stimulus for 120 sec. on 5 consecutive days immediately prior to a breastfeeding attempt. The breastfeeding bout following the final odour exposure session, and a second breastfeeding session shortly before the baby left the hospital, were analysed. Babies were weighed before and after each feeding session. RESULTS: During each breastfeeding session, babies in the milk-odour condition displayed longer sucking bouts and more bursts composed of >7 sucking movements, and also consumed more milk than the Control infants. The time spent in the hospital was significantly less for the milk-odour condition (median = 43 days vs. 55.5 days for Controls). CONCLUSION: Brief exposure to the odour of mother's milk prior to early breastfeeding trials had a positive effect on sucking behaviour and milk ingestion of preterm babies, which in turn resulted in a shortened stay in the hospital.     

Effects of routinely given pethidine during labour on infants' developing breastfeeding behaviour. Effects of dose-delivery time interval and various concentrations of pethidine/norpethidine in cord plasma

A standard dose of 100 mg of pethidine was given im to 13 healthy primiparae during labour. The aim of the study was to investigate whether developing breastfeeding behaviour in the newborn infant was associated with the dose-delivery time interval (DDI) or with the plasma concentration of pethidine and norpethidine in mixed cord blood at birth. The DDI was found to be unevenly distributed with no pethidine exposures in the time interval 5.4-8h. The material was therefore divided into a "short DDI" group (1.1–5.3h) and a "long DDI" group (8.1–9.9h). The infants in the "short DDI" group had a depressed sucking behaviour in 15–45 min of observation and a delayed initiation of lip and mouth movements when compared with the infants in the "long DDI" group. Six of the thirteen infants did not suck their mothers' breasts during the observation period. These infants had higher median plasma concentrations of pethidine at birth than the seven infants who did start sucking. No differences were found between the plasma levels of norpethidine and the behaviour. It was concluded that 100mg of pethidine im as an analgesic given under routine conditions may have unfavourable effects on infants' developing breastfeeding behaviour if the DDI is short.     

Gastric Suction in Healthy Newborn Infants Effects on Circulation and Developing Feeding Behaviour

ABSTRACT. Gastric emptying of newborn infants is a procedure performed to prevent aspiration of gastric contents. The present investigation was conducted to study the effects of gastric suction on circulatory and behavioural parameters in 21 healthy newborn children (11 cases, 10 controls). A small elevation in mean arterial blood pressure was observed during gastric suction. The incidence of retching was also increased. In all children spontaneous sucking and rooting movements, as well as state of sleep and wakefulness were recorded. In the control group spontaneous sucking and rooting movements started to occur 15 min after birth and reached a maximum at 45 and 60 min, respectively. The first hand to mouth movement was observed after a mean of 34 min and the infants found the nipple and started to suckle at about 55 min. This sequence of prefeeding behaviour was disrupted in children who had undergone gastric suction. The physiological side-effects induced by gastric suction are minor, but it seemed to be unpleasant for the child and no clear advantages are gained by the procedure.     

Gastric suction in healthy newborn infants. Effects on circulation and developing feeding behaviour

Gastric emptying of newborn infants is a procedure performed to prevent aspiration of gastric contents. The present investigation was conducted to study the effects of gastric suction on circulatory and behavioural parameters in 21 healthy newborn children (11 cases, 10 controls). A small elevation in mean arterial blood pressure was observed during gastric suction. The incidence of retching was also increased. In all children spontaneous sucking and rooting movements, as well as state of sleep and wakefulness were recorded. In the control group spontaneous sucking and rooting movements started occur 15 min after birth and reached a maximum at 45 and 60 min, respectively. The first hand to mouth movement was observed after a mean of 34 min and the infants found the nipple and started to suckle at about 55 min. This sequence of prefeeding behaviour was disrupted in children who had undergone gastric suction. The physiological side-effects induced by gastric suction are minor, but it seemed to be unpleasant for the child and no clear advantages are gained by the procedure.     

Development of sucking behavior in infants who have not been fed for 2 months after birth

BACKGROUND: Term infants are able to develop sucking behavior after birth. However, the requirements for this development have not yet been fully elucidated. In the present study, we investigated whether an oral-feed practice is necessary for the development of sucking behavior and whether non-nutritive sucking could support the development of this behavior while the infants cannot be fed. METHODS: Subjects of the present study were four term or near-term infants who had never been fed orally for approximately 2 months after birth because of gastrointestinal problems. Sucking pressure was measured with a silicone tube inserted into an artificial nipple and sucking efficiency was calculated during an entire feeding. RESULTS: Sucking pressure, frequency and duration at the first time oral feed corresponded to values obtained for normal-term infants at their first oral feed. Although infants who had not received oral feeding demonstrated poor sucking abilities initially, sucking performance improved with practice. Sucking parameters measured 1 month since oral feeding was initiated in these infants corresponded to values obtained for normal-term infants at 1 month of age. Although infants who had not received oral feeding had often sucked a pacifier for sedation, this non-nutritive sucking did not result in the development of sucking behavior. CONCLUSIONS: These results demonstrate that an oral feeding practice is necessary for the development of sucking behavior and that non-nutritive sucking does not affect the development of sucking.     

Effect of pacifier use on mandibular position in preterm infants

AIM: It has been hypothesized that the association of pacifier use with reduced risk of sudden infant death is mediated by forward movement of the mandible and tongue that helps open the upper airway. Our aim was to examine whether the mandible is moved forward when an infant is sucking on a pacifier, and if so, whether the mandible remains advanced after the pacifier is removed. METHODS: In sixty clinically stable premature infants (corrected gestation age 36.5 +/- 0.3 weeks, mean +/- SEM) the distance from each ear where the pinna met the cheek to the most prominent point of the chin was measured bilaterally, and the average was used as an index of mandibular position. Mandibular position was determined before and after allowing the infants to suck on a pacifier for 10-15 min, and after removing the pacifier. RESULTS: There was a significant forward movement of the mandible when the infants were sucking on the pacifier (59.5 +/- 0.7 vs. 58.6 +/- 0.7 mm, p = 0.001), with no significant change after the pacifier was removed. CONCLUSIONS: Pacifier use in preterm infants was associated with a small significant forward displacement of the jaw. These data suggest that pacifier use may help protect the upper airway.