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Sucking and swallowing disorders in the newborn

Chantal Lau, PhD
Section Editor
Steven A Abrams, MD
Deputy Editor
Melanie S Kim, MD


The ability to feed by mouth is critical for newborns. Healthy term infants readily take to the breast or bottle immediately after birth. Preterm infants must be fed by naso or oro-gastric tube until they develop the ability to feed orally. Infants with medical complications may require an alternative to oral feeding even after hospital discharge. (See "Nutritional composition of human milk and preterm formula for the premature infant" and "Discharge planning for high-risk newborns".)

Safe and successful oral feeding depends upon the proper development of sucking, swallowing, and breathing, and their coordination in order to minimize oxygen desaturation, apnea, bradycardia, and/or aspiration, and enhance feeding efficiency. Because of methodologic limitations, these processes have been studied primarily during bottle feeding. However, mechanisms involved in bottle feeding are likely to apply to breastfeeding as well [1,2].

This topic will review the physiology and development of sucking, swallowing, respiration, and their coordinated activities, as well as feeding disorders, including their management.


Sucking requires appropriate integration and timing of movements of the lips, cheeks, tongue, and palate in order to draw milk into the mouth, form a bolus, and propel it to the back of the pharynx to initiate the swallowing reflex [3]. The activity of the oropharyngeal muscles must be coordinated to protect the airway and the nasal passages as the bolus travels to the esophagus.

In healthy term infants, mature sucking consists of a rhythmic alternation between suction and expression (waveform 1) [4-6]. Suction corresponds to the negative intraoral pressure exerted by the infant when milk is drawn into the mouth, while expression corresponds to the positive pressure resulting from mouthing, stripping, and/or compression of the nipple between the tongue and the hard palate to eject milk from the nipple [1,5-7].


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Literature review current through: Apr 2015. | This topic last updated: Oct 10, 2012.
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