Suckling And Sucking Milestones: How They Help in Developing Swallow in Infants

As mothers we know the journey of a child from cooing to babbling to first word for speech and language development. However, we do not know much about the milestones needed to achieve for swallow development. Swallowing food plays a crucial role in sustaining one’s life. Of this life support, very little is discussed of suckling and sucking in infants. To investigate the status of  ‘suck- swallow- breathe’ coordination, mothers should think about

• the journey of breast feeding
• transition to bottle feeding
• newborn’s weight gain issues
• susceptibility to chronic illness
• frequent respiratory illness

behavioural stress such as chin tugging, nasal flaring,  eyes as if alarmed, eyebrow lifting, to name a few.

Investigating these questions can help in gaining insight on incoordination with suckling and sucking.

So, what is Suckling and Sucking?

Suckling: Birth to 6- 9 months of age.

Newborns begin their swallowing process with suckling. Suckling is observed when, the tongue, the lower lip, the jaw, and hyoid bone, together move downward- forward in a motion followed by immediate upward and backward motion. This entire apparatus bring together suckling for about two times per second.

Suckling is divided into nutritive suckling and  non- nutritive suckling.

Nutritive suckling is crucial for breast feeding to express milk. When the newborn begins to feed, they suck with a continuous burst and gradually these bursts become shorter and intermittent as the feeding progresses. As they master this art along with growing oral cavity, they perform two to three sucks to one swallow.

Non- nutritive suckling, are repetitive in nature like for e.g., suckling on a finger or an object. As the infant grows, they perform six or eight sucks per swallow.

Sucking: Begins around 6- 9 months of age.

This is the time when an infant progresses from a suckle to true sucking milestone. By now, an infant has grown oral cavity, giving more room to the tongue body to move upward and downward. It pushes against the mother’s nipple creating positive pressure in the mouth. The pattern of sucking may vary from an infant to infant and also, may change within the same feed, for e.g., normal infants use anywhere from 2-7 tongue pumps (pushing against the nipple) to express milk, until a swallow is triggered, notes Nancy Swigert in her book The Source for Pediatric Dysphagia

How important are they to develop swallow?

Successful suckling is important for early bottle and breast feeding whereas sucking is important for an infant to suck on food only after which an infant progresses to holding solid food in their mouth for biting and chewing.

Suckling and sucking together assess as one of the functioning of the oral- motor apparatus. If there is an incoordination in suckling/ sucking with breathing it will typically reflect a disorganized rhythm for sucking, however, will not reflect any disorganized functioning of the oral- motor apparatus. When infant swallow, there is increased air- way protection and their nasal breathing stops for that instant of swallow.

Whether its suckling or sucking, the nursing mother has an advantage wherein she can feel an infant’s body, its tone and organization, the strength of infant’s latch on the nipple, tongue movements; feel, hear, observe the rise and fall of the infant’s chest during breathing, and can hear and feel their swallow. Mothers can gauge the state of alertness of the baby prior to initiate feeding. Decreased arousal or fatigue baby may affect child’s ability to coordinate sucking, swallowing, breathing. According to Pediatric Dysphagia: Signs and Symptoms, there are therapeutic techniques to intervene these milestones so that an infant progresses safely and smoothly to the next milestone of feeding.

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