Suck-Swallow-Breathe Dynamics in Breastfed Infants

Despite the importance of the suck-swallow-breathe reflex during breastfeeding, a large proportion of our understanding is derived from bottle-feeding studies. Given the differences in the delivery of milk during breast and bottle feeding, it is imperative that a more general view of the suck-swallow-breathe and milk removal process during breastfeeding is available. This systematic review aimed to assess the evidence for the mechanism of milk removal during breastfeeding; evaluate how the term infant coordinates sucking, swallowing, breathing (SSwB) and cardiorespiratory patterns; and how these patterns change with maturation during breastfeeding. A literature search of PubMed and MEDLINE was performed to assess the mechanism of milk removal and patterns of sucking, swallowing, breathing, and cardiorespiratory control during breastfeeding in healthy term infants. Seventeen studies were selected and a narrative synthesis was performed. Nine studies assessing the infant sucking mechanism consistently provided evidence that vacuum is essential to milk removal from the breast. The limited data on swallowing and breathing and cardiorespiratory control showed mixed results. Overall, results highlighted the high variability in breastfeeding studies and suggested that swallowing, breathing, and cardiorespiratory patterns change with maturation, and within a breastfeed. These findings show potential for devising breastfeeding interventions for populations at risk of SSwB problems. However, consistent methods and definitions of breastfeeding parameters are required before interventions can be adequately developed and tested.