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Nutritive and non‐nutritive suck, swallow breathe coordination during breastfeeding

Suck swallow breathe (SSwB) co‐ordination is integral to effective infant feeding but has not been extensively studied in breastfed infants. We characterised SSwB co‐ordination for nutritive (NS) and non‐nutritive (NNS) sucking bursts of one breastfeed. SSwB parameters were recorded simultaneously (intra‐oral pressure, submental ultrasound imaging, respiratory inductive plethysmography) and milk intake was measured using the test‐weigh method. Data analysis used linear mixed effect models. S:Sw and Br:Sw ratios varied within and between bursts and were higher during NNS (p<0.001 for both). Mean NS S:Sw:B ratios were 2.5: 1: 1.6 (range 1.3: 1: 0.6 to 8.7: 1: 5) increasing to 6.7: 1: 4.5 during NNS (range 2.5: 1: 1.5 to 23: 1: 14). Suck rates varied throughout the feed and were lower during NS (90 vs 107 sucks/min; p<0.01). Higher milk transfer rates were associated with lower NS sucking rates (p<0.01) and lower S:Sw ratios during NS (p=0.08). Variation in S:Sw:B ratios within infants suggests variable flow rates within a feed, consistent with multiple milk ejections. Variable SSwB ratios are likely to reflect adaptation to changing milk flow and therefore be indicative of good SSwB coordination. Research funding: Medela AG.