It is physiologically impossible to swallow solid foods and breathe at the same time, at any age. When a baby is feeding, the suck- swallow- breathe reflex coordinates in such a way that the baby doesn’t aspirate (entry of anything besides air in the lungs) or suffocate (lack of air in the lungs).

This mechanism is well-developed in full term babies, however babies born prematurely often have underdeveloped reflexes and muscles, which can make coordinating the suck-swallow-breathe reflex more challenging.

Description of the 3 Phases

When a baby latches onto the breast or bottle, they instinctively create suction by using their tongue and mouth muscles. This suction allows them to draw milk or formula into their mouth.

Once the baby has collected enough liquid in their mouth, the swallow phase kicks in. The baby's tongue moves in a coordinated manner to push the liquid to the back of the mouth and into the throat. This triggers the swallowing reflex, which propels the liquid down the esophagus and into the stomach.

While the baby is in the midst of sucking and swallowing, they momentarily pause the breathing process. This pause is essential to prevent choking. During this phase, the baby's larynx (the voice box) closes off the airway to ensure that no liquid or food enters the lungs. Once the swallow is complete, the larynx opens, and the baby resumes breathing.

Signs Indicating a Problem with the Reflex

Recognizing signs that the "suck-swallow-breathe" technique is not working properly in a baby is essential for addressing feeding difficulties and ensuring their well-being. Here are some signs that may indicate a problem with this reflex:

  1. Choking or Coughing: Frequent choking or coughing during feeding can be a clear indication that a baby is struggling to coordinate the reflex properly. It suggests that milk or formula may be entering the airway.
  2. Gulping or Sputtering: If a baby appears to gulp, sputter, or seem overwhelmed during feeds, it could signal that they are not effectively managing the milk flow, leading to liquid entering the airway.
  3. Prolonged Feeding Times: Feeding sessions that consistently last much longer than expected can indicate difficulties with the "suck-swallow-breathe" reflex. Babies may tire easily and require extended periods to consume an adequate amount of milk.
  4. Refusing to Feed: Some babies may refuse to latch onto the breast or bottle altogether if they find feeding uncomfortable or challenging. This can be a sign of frustration due to difficulties with the reflex.
  5. Falling Asleep During Feeds: While it's normal for babies to fall asleep during feeds, if it happens too frequently or too early in the feed, it can suggest that the baby is expending excessive energy trying to coordinate sucking and swallowing.
  6. Arching or Clenching: Babies who arch their backs, clench their fists, or display other signs of discomfort during feeds may be struggling with the reflex.
  7. Excessive Spitting Up or Vomiting: While some spitting up after feeds is normal, excessive or forceful spitting up can be a sign of feeding difficulties. It may indicate that milk is not staying down in the stomach.
  8. Slow Weight Gain: Insufficient weight gain or poor growth can be a long-term consequence of feeding difficulties. If a baby is not getting enough nutrition due to these issues, it may manifest as slow weight gain.
  9. Excessive Fussiness: Babies who are frustrated, fussy, or irritable during and after feeds may be experiencing discomfort related to feeding difficulties.
  10. Gagging: Frequent gagging, particularly if it occurs consistently during feeds, can be a sign that the baby is not effectively coordinating their reflex.

It is important to note that some of these signs may be typical in newborns to some extent, and individual variation exists. However, if you notice persistent or severe symptoms that are affecting your baby's ability to feed and grow, it's crucial to consult with a pediatrician or a healthcare provider. They can assess the situation, determine if there are underlying issues, and provide guidance and support to address any feeding difficulties, ensuring that your baby receives the necessary nutrition and care.

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