Introduction
Proper formation of the swallowing and suckling reflexes, along with synchronous breathing, is mandatory for safe and successful oral feeding in neonates.
Based on the frequency and intensity of sucking, it is segregated into two variants that are nutritive and non-nutritive sucking. Any disruption or disturbance in these coordinated reflexes can result in the risk of apnea, bradycardia, failure to thrive, oxygen desaturation, and aspiration in infants. Therefore, the identification of abnormal sucking patterns is very crucial to prevent feeding disorders and other associated complications due to abnormal sucking patterns. Read the article to know more about the factors responsible for the abnormal sucking pattern in neonates.
What Are the Types of Sucking Patterns?
There are basically two types of sucking patterns observed in infants according to the research:
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Nutritive Sucking: It appears at a slow pace and is around one sucks per second. Burst usually appears with a pause initially. The rooting reflex (movement of the infant's head towards the touch on the cheek followed by mouth gaping) develops at birth in infants with normal neurological development.
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Non-Nutritive Sucking: The sucking pattern observed in a few infants shows the sucking of the thumbs, pacifiers, or other objects. This is referred to as non-nutritive sucking. It varies around two sucks per second and the burst duration is around 2 to 12 seconds. However, the burst duration and frequency increase with time. As soon as the milk ejection reflex develops the infant is encouraged to nutritive sucking.
When Does the Normal Sucking Reflex Develop?
The normal sucking reflex usually develops during the twenty-eighth week of the gestational period. The infants, after birth, begin the sucking mechanism, which is divided into 2 phases:
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Expression Phase: in this phase, the infant puts their lips around the areola with the nipple far back between the hard and soft palate and presses the breast between tongue and palate, resulting in the expression phase -forcing the milk out.
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Milking Action: In this phase, the tongue shifts from the areola towards the nipple, resulting in milk ejection into the baby's mouth.
These coordinated reflexes of sucking, swallowing, and breathing become one complex task for newborns.
What Is an Abnormal Sucking Pattern?
An abnormal sucking pattern develops due to disturbances affecting the coordination of normal sucking, swallowing, and breathing reflexes. Abnormal sucking patterns affect the growth and development of the baby due to non-nutritive sucking. Therefore, it is important to urgently diagnose and treat the underlying condition to prevent serious health complications.
What Are the Factors Responsible for Abnormal Sucking Patterns in Newborns?
Various factors can result in abnormal sucking patterns in the newborns, such as:
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Abnormal Jaw Movements: Abnormal movements of the jaws result in an inability to form a proper seal during the sucking.
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Abnormal Tongue Movements: Uncontrolled or abnormal tongue movement is seen in infants resulting in an inability to suck properly.
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Delayed Formation of Suckling Reflex: In some cases, the suckling mechanism is delayed in infants' formation, resulting in abnormal sucking patterns. It becomes very difficult for doctors to diagnose and rule out the difference between early brain damage signs and developmental delay of the suckling mechanism.
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Presence of Neonatal Brain Injuries: Injuries to the brain in neonates can disrupt the coordinated movements needed for an effective normal sucking mechanism. In addition, damage to the brain can disrupt the transmission of signals to the brain. At the same time, the sucking mechanism of the brainstem is responsible for the normal and coordinated suckling and swallowing mechanism.
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Premature Births: Infants born preterm usually show abnormal sucking patterns. Preterm births have a greater impact on the brain's normal development, such as disturbance in the formation of the white and gray matter of the brain and formation of myelin sheath on the nerve (myelination). These disturbances during brain development can impair the infant's cognitive and motor skills development. Regular follow-ups with the doctor and monitoring of the sucking reflexes at each appointment to diagnose and rule out if the infant is developing a normal swallowing reflex or not with time. Magnetic resonance imaging (MRI) of the brain should be performed for accurate diagnosis.
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Infants Born With Underlying Systemic Disease: Infants born with systemic conditions like bronchopulmonary dysplasia (BPD) are more likely to have an abnormal or uncoordinated suckling pattern due to arrhythmic swallowing and sucking reflex.
What is Neonatal Oral-Motor Assessment (NOMAS)?
A neonatal oral-motor assessment scale (NOMAS) can be used to assess the sucking patterns in infants. It is the most reliable tool for evaluating nutritive and non-nutritive sucking patterns. In addition, this tool helps to diagnose and rule out the different sucking patterns like:
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Normal Sucking Patterns: Infants with coordinated swallowing, suckling, and breathing reflex due to normal movements of the tongue and jaws.
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Disorganized Sucking Patterns: Infants with uncoordinated swallowing, suckling, and breathing reflex due to arrhythmic movements of the tongue and jaws.
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Dysfunctional Sucking Patterns: Infants with abnormal movements of the tongue and jaw resulting in a disruption in the sucking mechanism.
What Are Different Technologies Developed to Assess Neonatal Sucking?
Different technologies developed to quantify neonatal sucking are:
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Kron Nutritive Sucking Apparatus (KNSA): It was developed by Kron in the year 1963 and was used to measure the pressure exerted on the nipples while suckling. The software was used to measure the sucking parameters of KNSA (Kron Nutritive Sucking Apparatus) like sucking duration, frequency, and the total number of bursts in a session.
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Nutritive Sucking Apparatus (NSA): It was the modified version of KNSA developed by Medoff-Cooper. The device consisted of a standard milk bottle and customized nipple which is attached to a pressure sensor, signal processor, and memory drive.
Conclusion: Nutritive sucking is very crucial for the growth and development of the child. There are various factors like preterm births, early neonatal brain injuries, or congenital anomalies that have a greater impact on normal nutritive sucking. Therefore, doctors need to diagnose and rule out the exact underlying cause behind the abnormal sucking patterns of the infant and treat them in the early stages of life. Any delay in diagnosis and management can result in potentially serious complications to the health of newborns.
