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Timing of infant swallowing within the respiratory cycle during breastfeeding

During feeding, the infant must briefly cease respiration during swallowing. This can occur mid expiration (EE), mid inspiration (II), between inspiration and expiration (EI) or the opposite (IE). When the majority of swallows (60–75%) are followed by expiration this is considered a mature pattern. Since milk flow rates are highly variable during breastfeeding we hypothesized that the frequency of EE and IE swallows would not comprise the majority of swallows. Simultaneous measurements of infant tongue movement, intra‐oral pressure, swallowing and breathing were made for a breastfeed in 10 infants (mean age: 47 days; range 18 – 115). For nutritive sucking (NS) the most frequent phase of respiration for a swallow was EE (median %; interquartile range, 35; 18–53) and EI (33; 11–49) followed by IE (10; 0–21) and II (4; 0–18). There was no difference in frequency for EE and EI however EE occurred more often than IE and I‐I (P<0.01). Less than half of the NS swallows were followed by expiration. Preliminary results suggest a predominance of swallows followed by expiration do not necessarily represent a mature swallowing pattern in breastfed infants and the ability to swallow in response to variable flow rates may contribute to breastfeeding success.