Have you ever observed when you take a sip of water or coffee, you follow a suck-swallow-breathe pattern?
Like many of the things I talk about this is another function that is an unconscious action the body does without having to give it much thought.
This rhythmical and coordinated pattern, which is also called the Suck-Swallow-Breathe (SSB) synchrony, is the first developmental pattern that we learn during infancy, even before birth.
The ability of infants to breast- or bottle-feed safely and competently is not routinely a concern for the majority of new mothers. Mostly because we are suppose to instinctively learn how to feed as infants.
Unfortunately, 25 to 45% of normally developing infants/children and up to 80% of developmentally delayed infants/children, e.g., those born prematurely do experience oral feeding difficulties.
If a baby has difficulty feeding or it is painful most new mothers are not taught to look for lip and/or tongue ties as the cause. Which can be easily treated after birth.
When a mom chooses to bottle feed they are not given proper bottle feeding instructions about how the bottle should fit the baby mouth or to look at nipple size, opening for flow of liquid, holding the baby while feeding so fluid gets in the ear.. ect.
It is recognized that safe and efficient nutritive sucking does not relate solely to sucking, but rather to the synchronous activities of sucking, swallowing, breathing, and esophageal function. Together, all these functions within what may be called the ‘nutritive sucking pathway” are responsible for the swift and safe transport of a milk bolus from the oral cavity to the stomach.
These patterns help the tongue stay in the proper position for proper craniofacial development of airway and breathing and future facial and jaw development.
What is the suck/swallow/breathe synchrony?
The action pattern called the suck/ swallow/ breathe coordinates sucking, swallowing, and breathing which helps us eat and breath without choking.
The SSB synchrony allows infants to eat and breathe without choking, as well as to interact and explore the environment. This is why babies can start eating right after birth and often explore objects with their mouths.
The SSB synchrony is a primary component of our oral-motor mechanism. It is critical to many areas of our development, including airway, speech and language development, postural control, motor development, self-regulation, attention, psychosocial development, feeding/eating behaviors, eye-hand coordination and more.
For most of us, we unknowingly use some of these strategies to support our needs and function in our everyday life. For example, some people may chew on straws or gum to help stay focused when they are reading or working. Some may have a drink of water or take a deep breath when feeling frustrated or upset. Others may hold their breath or clench their teeth when lifting or pushing heavy items or working out.
It is important to observe the SSB pattern of our children. By strengthening or refining the SSB synchrony, we can facilitate their overall developmental process.
Whether sucking is nutritive or non-nutritive, i.e., involving milk transport or not, mature sucking comprises two components, suction and expression Suction corresponds to the negative intraoral pressure generated with closure of the nasal passages by the soft palate, lips tightening around breast or bottle nipple, and the lowering of the lower jaw. With no air penetration into an increased volume of the oral cavity, milk is drawn into the mouth, an action similar to that of drinking from a straw. Expression corresponds to the compression or stripping of the breast or bottle nipple by the tongue against the hard palate to eject milk into the mouth.
The normal swallowing process is commonly divided into an oral phase, pharyngeal phase, and esophageal phase.
Based on knowledge acquired from observing the development of oral feeding skills in preterm infants, we have learned that the components implicated within each of these phases may mature at different times and/or rates.
If we consider that nutritive sucking occurs at one suck per second, it is expected that there will be a bolus every second that will need to be sequentially cleared from the oral cavity, pharynx, and esophagus before the next bolus arrives. A bolus is one of the many functions of the tongue during a swallow.
To emphasize the importance of how a delayed action at any of these steps may lead to oral feeding disruption, sites at which bolus transport may be challenged due to immature neurophysiologic and motor functions.
With poor bolus formation, liquid draining into the pharynx may not trigger the swallow reflex. This, in turn, may lead to improper timing of the laryngeal elevation and epiglottic closure. Together with the potential of residual liquid lingering around the sinuses, risks of aspiration are increased, which can lead to choking or swallowing air causing gas.
The suck, swallow, breathe and bolus are important through the common pathway for the sake of safety and proper oxygen/carbon dioxide exchange.
We get more nitric oxide and oxygen to our brain when we use nasal breathing with the correct swallow pattern.
Proper functions enhance oral feeding performance, it is their coordinated activities that ultimately will lead to a safe and efficient feeding, breathing and development. As we grow the chew, swallow breath is just as important to observe.
Gaining a better understanding of the development of infants’ oral feeding skills will not only assist in identifying the potential issue, but also facilitate the development of evidence-based tools and interventions that can enhance the development of these skills.
The coordination of sucking, swallow processing, and respiration at different times and rates, is unsafe and inefficient oral feeding. Such occurrences may be a reason why infants demonstrate such wide variance in the maturation levels of their skills.
With a better understanding of the process of these physiologic functions, management of infant oral feeding issues can improve. Our expectations of what infants can achieve would be tailored around the functional maturity levels of our individual infants.
I hope you see the bigger picture that how we feed our infants from the start is what determines how they will grow, develop and breathe.
It all starts with the mouth feeding, sucking, swallowing and breathing. This affects how much oxygen they get to their brain from the start of their life.
How we breathe is the most important thing we can follow as our c children grow and develop. I am still unsure why this is not more talked about.
Breath is life. We start and end our life with a breath. Doesn’t it make sense we pay attention to how we breathe in between?
How we breathe will determine how healthy we truly are. Take a moment and breathe that in!
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