Infant Sucking Research Articles

Non-Nutritive Suck and Parent Report of Feeding Skills in Infants Born With Cleft Lip and/or Palate

Objective To compare non-nutritive sucking (NNS) and caregiver-reported feeding skills in infants with cleft lip and/or palate (CL/P) to a control group of typically developing infants without CL/P. To examine differences in NNS patterns and feeding behavior between cleft phenotypes. Design Prospective, cross-sectional study comparing infants born with CL/P to an age-matched control group with no congenital anomalies. Setting Urban, academic, tertiary care children's hospital and academic department of speech-language pathology. Patients, Participants Forty-two infants (21 with CL/P; 21 without CL/P), 6 months of age and younger were included. Infants with syndromes or who underwent cleft repair were excluded. Main Outcome Measures A 5min NNS sample was collected from the infant sucking on the lab's custom research pacifier. The infant's caregiver completed the Neonatal Eating Assessment Tool (NeoEAT) bottle-feeding section about their infant's feeding behaviors. Results Infants with CL/P demonstrated slower NNS frequency ( P = .04) and reduced suck amplitude ( P = .04) compared to the control group. Caregivers of infants with CL/P reported a higher incidence of gastrointestinal symptoms ( P = .04) and overall feeding difficulties ( P = .03) relative to the control group. There were no significant differences between CL/P phenotypes for NNS or caregiver reported outcomes. Conclusions Infants with CL/P demonstrate differences in NNS physiology and caregiver report measures of feeding compared to age-matched controls. These findings support the need for interventions to optimize sucking and feeding skill development in infants with CL/P.

Simulation of Infant Suction Vacuum Pressure using WGAN

In this study, it is aimed to simulate infant suction vacuums by replicating infant suction vacuum pressures with the Wasserstein Generative Adversarial Network (WGAN) model. To understand the physiology of infants' feeding behavior, it is very important to understand the physiology of sucking. One of the most important elements of feeding physiology is the infant suction vacuum. In this context, the infant suction vacuum pressure produced by the WGAN model was successfully simulated. Data preprocessing and hyperparameter optimization were performed to ensure the most accurate simulation of the WGAN model used in the study. As a result, the low RMSE and high R2 value between the real data and the generated data show that the model works successfully. This method is promising in terms of better understanding the sucking behavior of infants and contributing to solving problems in the field of infant feeding. In the future, infant sucking simulation will be more successful if the model is supported with larger data and other elements of infant sucking physiology such as swallowing and respiration are considered. This kind of simulation will pave the way for new applications in the fields of infant feeding and breastfeeding.

Nurses' Techniques for Bottle-Feeding of Infants with Feeding Difficulties: A Qualitative Descriptive Study.

Background/Objectives: This study identified bottle-feeding techniques for infants with feeding difficulties. Methods: Between December 2021 and April 2022, a survey was distributed to nurses with at least 5 years of experience in caring for infants at 1109 hospitals in Japan. The questionnaire included open-ended questions regarding preparation before bottle-feeding, methods of nipple insertion, methods of assisting with sucking, and criteria for continuing bottle-feeding. The responses were classified according to semantic similarity. Results: In total, 514 valid responses were received. The respondents had an average of 19.16 years of experience as a nurse or midwife. The most frequently used nipples for infants with feeding difficulties were the Combi Breastfeeding Model, Pigeon Weak Sucking Nipple, and Bean Stalk Nipple. Preparation before bottle-feeding consisted of six categories, including determining the timing of feeding and stimulation to promote wakeup. Nipple insertion methods consisted of four categories, such as assisted opening of the mouth, nipple insertion, and nipple insertion depth. Methods of assisting with sucking were divided into four categories, including encouraging sucking ability from around the mouth and matching the infant's sucking pace. The criteria for continuing bottle-feeding spanned three categories, including willingness to suck and ensuring necessary nutrition. Conclusions: The variety of survey responses describes the current state of bottle-feeding technologies. A combination of several techniques indicated that feeding strategies may lead to effective and appropriate feeding. The nurses continued feeding based on an assessment of the infant's acceptance. Future studies regarding bottle-feeding techniques must consider the individuality of each infant.

Infants Sucking Pattern Identification Using Machine-Learned Computational Modeling

Abstract Breastfeeding involves a complex coordination of swallowing, breathing, and sucking, with the infant's sucking proficiency being crucial for adequate nutrient intake. However, real-time assessment of milk intake is difficult, and issues with sucking often become apparent after the infant shows signs of nutrient deficiency. Traditional assessments by clinicians rely on the expertise and subjective judgment of healthcare professionals, enabling personalized evaluations. In this research, we introduce a novel approach to identifying sucking patterns by leveraging data collected from infants during breastfeeding sessions. This method utilizes artificial nipple-based sensors to capture the tongue forces exerted by infants, generating valuable clinical data. In the analysis of the collected time-series data, we applied machine-learned computational modeling (MLCM) algorithms to extract pertinent features and identify distinctive sucking patterns. The best-performing model demonstrated an accuracy of 90%, an 80% recall score, a perfect 100% precision score, a 0.90 f1-score, and an area under the curve (AUC) of 0.80. The proposed classification system has the potential to serve as a reliable decision-support tool for clinicians, offering valuable insights into infants' sucking behaviors. By integrating machine learning (ML)-based computational modeling into clinical practice, we aim to enhance the early identification of unhealthy sucking patterns, allowing for timely interventions and pro-active healthcare management.

The association between infant non-nutritive suck and oral motor development

This study investigated if non-nutritive suck (NNS) at 3 months is related to subsequent oral motor and motor skills using caregiver-reported scores on the Child Oral and Motor Proficiency Scale (ChOMPS) at 12 months in a cohort of 69 full-term infants and their caregivers. Longer NNS burst durations were associated with lower oral motor coordination and total ChOMPS scores. More NNS cycles per minute was associated with lower complex motor movement scores. More NNS bursts, cycles per burst, and cycles per minute were related with lower total ChOMPS scores. Early NNS outcomes can provide valuable insight in future neuromotor development.

Infant Suck Strength Exam: Introduction of an Accessible Clinical Technique for Measuring Infant Suck at the Breast.

One of the core skills required in lactation support is understanding and correcting ineffective or painful breastfeeding. The behavior being corrected, however, occurs inside the infant's mouth, making it difficult to see and assess. When providing care in the field, we use standardized tools and digital suck exams. In research, instruments have been developed to measure infant suck strength with a pacifier, bottle, or at the breast using ultrasound. The aim of this article is to introduce a simple manual clinical technique to identify areas of weakness in an infant's suck and describe one treatment option that can be used to reduce weakness in the identified area. During the Infant Suck Strength Exam, the lactation support provider places a finger on the breast 2 to 4 cm from the edge of the infant's mouth at the upper and lower lip and then at both corners of the mouth, testing the strength of the suck in each of these four areas. To address any specific areas of weakness, the nursing parent can be taught to apply light skin traction back toward the chest wall at the affected area. This engages the suckling reflex and amplifies the strength of the infant's suck in that particular area. The traction applied should not indent the breast but rather just pull back on the skin. It should be applied with enough strength to challenge the infant without pulling the breast out. This is a teaching tool, and is typically only needed for a few weeks before the infant improves their nursing habits.

An examination of the association between infant non-nutritive suck and developmental outcomes at 12 months.

To determine the association between infant non-nutritive suck (NNS) dynamics at 3 months and developmental outcomes at 12 months of age in full-term infants. We hypothesized that infants with more mature NNS at 3 months, as evidence by shorter burst duration, fewer cycles per burst, cycles per minute, higher amplitude, and more bursts, would have higher (better) scores on the developmental outcomes at 12 months. This was a prospective study that utilized objective and self-report measures. A five-minute NNS sample was collected from 67 infants (54% male) at 3 months of age (average age 2.99 (0.27) months). At 12 months (average age 11.91 (0.26) months), the Development Profile-3 was administered through caregiver interview. Infant NNS burst duration, cycles per burst, and cycles per minute were significantly negatively associated with the Development Profile-3 cognitive domain and general scores at 12 months. This is consistent with our hypothesis that infants who have more efficient NNS (fewer bursts and cycles) at 3 months would have higher (better) scores on the Development Profile-3 at 12 months. Findings from this work complement emerging research linking infant NNS with subsequent neurodevelopmental outcomes. This is the first time that these associations have been examined using a quantitative and physiologic-based measure of NNS. These results seem to indicate that specific NNS metrics, which demonstrate maturation of this complex skill, may be useful predictors of neurodevelopment later in life.

Effects of a valved infant-bottle with ergonomic teat on the coordination of sucking, swallowing, and respiration in late-preterm infants. The Safe Oral Feeding randomized Trial.

Breastfeeding naturally enables the coordination of sucking, swallowing, and respiration patterns for safe feeding. When breastfeeding is not possible a feeding device that releases milk in response to intra-oral vacuum could potentially offer improved coordination of sucking, swallowing, and breathing patterns compared to conventional devices. The aim of the study is to evaluate the effect of a valved infant-bottle with an ergonomic teat compared to a standard infant-bottle. This unblinded randomized controlled trial focused on late preterm infants fed by bottle for at least three meals over the day, admitted to the Neonatal Unit of Sant'Anna Hospital (Turin, Italy). Infants were randomized to be fed with a valved infant-bottle with an ergonomic teat (B-EXP arm) or with a standard infant-bottle (B-STD arm). Monitoring included a simultaneous synchronized recording of sucking, swallowing and respiration. The main outcome was the swallowing/breathing ratio. Forty infants (20 B-EXP arm; 20 B-STD arm) with a median gestational age of 35.0 weeks (IQR 35.0-36.0 weeks) completed the study. Four infants were censored for the presence of artifacts in the polygraphic traces. The median swallowing/breathing ratio was 1.11 (1.03-1.23) in the B-EXP arm and 1.75 (1.21-2.06) in the B-STD (p = .003). A lower frequency of swallowing events during the inspiratory phase of breathing was observed in B-EXP arm compared with B-STD arm (p = 0.013). The valved infant-bottle with an ergonomic teat improves the coordination of sucking-swallowing-respiration and limits the risk of inhalation reducing the frequency of swallowing during the inspiratory phase.

Standardization of sucking patterns during breastfeeding in healthy term neonates: Across-sectional study.

Nutritive disorders like sucking and swallowing problems are common in infants. The necessity for a clinical tool to assess these issues has never been more evident. This study aims to evaluate sucking patterns and standardize them in healthy neonates. A cross-sectional study involving 223 neonates breastfeeding in the Maternity Ward of Shahid Sayyad Shirazi Hospital, Gorgan, Iran, from April to September 2021 was conducted. Neonatal swallowing skills (maximum sucking pressure and number of sucking actions) were assessed using a swallowing skill assessment device. The 95% confidence interval for maximal sucking pressure and the number of sucking actions within a normal distribution were estimated. Out of 223 infants, 112 (50.2%) were female, 176 (74.9%) were delivered via cesarean section, and their mean birth weight was 3154.48±371.48 grams. The maximum sucking pressure was -6.82, with a 95% confidence interval of (-13.21, -3.52) in infants. The mean number of sucking actions within a 15-second interval was 6.74, with a 95% confidence interval of (2.23, 20.37). Regarding this data and the high prevalence of sucking disorders in preterm infants worldwide, we can employ this information in conjunction with an oral-motor skill assessment tool to evaluate infant sucking patterns in hospitals, clinics, and during home visits.

Non-Nutritive Suck Assessment Tool Development to Characterize Sucking Patterns in Infant with Various Hunger Levels

Sucking abilities are critical in early infant development, and the patterns of non-nutritive suck (NNS) have been found to potentially predict neurodevelopmental issues in the future. Proper NNS assessments are essential to ensure valid conclusions. Previous studies have shown that the level of infant arousal significantly affects NNS patterns. However, the author did not find any studies that observed the influence of infant hunger levels on NNS patterns. Therefore, this study aimed to develop an NNS assessment tool to characterize NNS patterns in infants with various hunger levels. The NNS assessment was conducted using a pressure transducer connected to a pacifier. The results showed that the level of hunger significantly affected the intra-burst frequency and the sucking pressure. The more hungry the infant, the more frequent the intra-burst frequency became, while the sucking pressure tended to decrease. The intra-burst frequency of infant sucking was 2.3, 2.46, and 2.5 Hz on average for a relative hunger index of 0.67, 0.83, and 1.0, respectively. The NNS pressure of infant sucking was 6.31, 4.51, and 2.62 kPa on average for a relative hunger index of 0.67, 0.83, and 1.0, respectively. This study's results suggest that during NNS assessments, the measurement time should consider the next feeding schedule for the infant.

Quantitative non-nutritive sucking measurement as a predictor of oral feeding readiness in newborns.

The purpose of this study is to examine the relationship between the parameters of a silver nanowire-based flexible pressure sensor developed to measure the non-nutritive sucking (NNS) performance and predict the nutritive sucking status in preterm infants. Preterm infants who were referred for feeding difficulty during the transition period from tubal feeding to oral feeding were enrolled in our study. A flexible pressure sensor was used to measure the non-nutritive sucking parameters of neonates. The evaluator stimulated the infants' lips and tongue with a pacifier integrated with a sucking pressure sensor, to check whether non-nutritive sucking had occurred. When the sucking reflex was induced, it was measured. The infants' sucking characteristics were subdivided into classifications according to the NOMAS criteria and full oral feeding (FOF) status. Quantitative NNS measurement according to the feeding state was compared between groups. When comparing the quantitative NNS measurement by feeding characteristics, the average sucking pressure was significantly higher in infants in the FOF capable group than those in the incomplete FOF group. In addition, the maximum and average sucking pressure was significantly higher in infants with a normal sucking pattern compared to those with a disorganized sucking pattern. The average NNS pressure was divided over the range of 0-3 kPa and the same weight was assigned to each item. When the optimal cut-off value for the sensitivity and specificity of the average NNS pressure to estimate the FOF was set, a pressure of 1.5 kPa yielded the highest sensitivity (84.62%) and specificity (67.65%) on the receiver operating characteristic (ROC) curve. The area under the curve (AUC) was 0.786, and this result was statistically significant. This study presents a quantitative parameter for non-nutritive sucking in preterm infants with the use of a flexible pressure sensor. Results show possible quantitative indicators that can aid in predicting when preterm infants can transition to oral feeding and their prognosis. This will serve as a basis for future research on determining the feeding transition period of newborns with health conditions that affect oral feeding.

Characterization of a Vigorous sucking style in early infancy and its predictive value for weight gain and eating behaviors at 12 months

This study sought to identify sucking profiles among healthy, full-term infants and assess their predictive value for future weight gain and eating behaviors. Pressure waves of infant sucking were captured during a typical feeding at age 4 months and quantified via 14 metrics. Anthropometry was measured at 4 and 12 months, and eating behaviors were measured by parent report via the Children's Eating Behavior Questionnaire-Toddler (CEBQ-T) at 12 months. Sucking profiles were created using a clustering approach on the pressure wave metrics, and utility of these profiles was assessed for predicting which infants will have weight-for-age (WFA) percentile changes from ages 4–12 months that exceed thresholds of 5, 10, and 15 percentiles, and for estimating each CEBQ-T subscale score. Among 114 infants, three sucking profiles were identified: Vigorous (51%), Capable (28%), and Leisurely (21%). Sucking profiles were found to improve estimation of change in WFA from 4 to 12 months and 12-month maternal-reported eating behaviors above infant sex, race/ethnicity, birthweight, gestational age, and pre-pregnancy body mass index alone. Infants with a Vigorous sucking profile gained significantly more weight during the study period than infants with a Leisurely profile. Infant sucking characteristics may aid in predicting which infants may be at greater risk of obesity, and therefore sucking profiles deserve more investigation.

Associations of exposure to phenols during pregnancy with non-nutritive suck in full-term infants in two US birth cohorts

Associations of exposure to phenols during pregnancy with non-nutritive suck in full-term infants in two US birth cohorts

33458 Infantile sucking bruise to the lip could be easily mistaken for nonaccidental injury

A 4-month-old infant was referred with bruising on the lower lip, with a suspicion of nonaccidental injury. This was recurrently appearing in the same area over a period of months and spontaneously resolved within a few days. Her mother described the infant sucking on her lower lip during teething, bringing the mark on. Examination revealed a well-defined dark bruise to the central lower lip, with no surface changes or induration. There were no signs of a vascular birthmark, and this would not completely disappear between episodes.

A comparison of objective and subjective measurements of non-nutritive sucking in preterm infants

Background Of preterm infants born before 32 weeks of gestation, 40-70% have atypical and immature feeding skills, which could delay initiation of oral feeding. A formal objective measurement of non-nutritive sucking may increase the accuracy of determining the right time to initiate oral feeding, however, most hospital perinatology care units do not own a suction pressure measurement device to objectively measure non-nutritive sucking parameters.
 Objective To compare objective and subjective non-nutritive sucking (NNS) based on sucking pressure, number of suctions per burst, and time between bursts.
 Methods One hundred twenty preterm infants born at 28-34 weeks’ gestation were evaluated for objective and subjective NNS. Data were collected from August to November 2021 at five hospitals in Jakarta. Objective NNS was measured by a suction pressure measurement device, while subjective NNS was clinically examined. Number of suctions per burst, sucking pressure, and time between bursts were analysed by Spearman’s correlation test.
 Results A positive and significant correlation between objective and subjective NNS was found in all parameters (P<0.001). The highest correlation was found in time between bursts (r=0.74; P<0.001), followed by number of suctions per burst (r=0.60; P<0.001), and sucking pressure (r=0.58; P<0.001).
 Conclusion The correlation between objective and subjective NNS examination was moderate in preterm infants. Therefore, an objective NNS measurement is still required for optimizing the examination.

A comparison of objective and subjective measurements of non-nutritive sucking in preterm infants

Background Of preterm infants born before 32 weeks of gestation, 40-70% have atypical and immature feeding skills, which could delay initiation of oral feeding. A formal objective measurement of non-nutritive sucking may increase the accuracy of determining the right time to initiate oral feeding, however, most hospital perinatology care units do not own a suction pressure measurement device to objectively measure non-nutritive sucking parameters.
 Objective To compare objective and subjective non-nutritive sucking (NNS) based on sucking pressure, number of suctions per burst, and time between bursts.
 Methods One hundred twenty preterm infants born at 28-34 weeks’ gestation were evaluated for objective and subjective NNS. Data were collected from August to November 2021 at five hospitals in Jakarta. Objective NNS was measured by a suction pressure measurement device, while subjective NNS was clinically examined. Number of suctions per burst, sucking pressure, and time between bursts were analysed by Spearman’s correlation test.
 Results A positive and significant correlation between objective and subjective NNS was found in all parameters (P<0.001). The highest correlation was found in time between bursts (r=0.74; P<0.001), followed by number of suctions per burst (r=0.60; P<0.001), and sucking pressure (r=0.58; P<0.001).
 Conclusion The correlation between objective and subjective NNS examination was moderate in preterm infants. Therefore, an objective NNS measurement is still required for optimizing the examination.

The effectiveness of Kinesio taping on nutritive sucking in premature infants admitted to the NICU: a randomized clinical trial

ABSTRACT Objective Oral feeding is one of the greatest challenges for preterm infants and a cause of delay in discharge for these infants. Interventions that result in more rapid achievement of oral feeding are necessary for these infants. In a randomized trial, we investigated and compared the use of kinesio tape (KT) as a new approach to oral stimulation (OS) on the nutritive sucking of premature infants admitted to the NICU. Methods The randomized controlled experimental study was conducted on 26 preterm infants, 8 of whom were did not meet study criteria, and 18 enrolled and randomized. The infants were divided into two groups by the simple randomization method. In the KT group (n = 9), KT + OS was used, while in the OS group (n = 9), only OS was used. The number of days from the start of the intervention to the first and full oral feeding was compared between the two groups. Results and conclusions After the start of the intervention, infants in the KT group achieved the first and full oral feeding in significantly fewer days than the OS group (p = 0.025; p = 0.011). Premature infants who received KT with an oral stimulation program achieved the first and full oral feeding earlier than infants who received an oral stimulation program only. It appears that the use of KT + OS can effectively accelerate the achievement of feeding milestones. This is clinically significant and may reduce the length of stay (LOS) and ultimately the negative consequences and costs of hospitalization for this population.

A Pilot Study of Developing an Infant Sucking Tester Instrument

Objectives: Most preterm infants experience oral feeding disorder. Sucking is the most appropriate way for oral feeding, but it may be immature in preterm infants. Regarding the increased risk of feeding problems in preterm infants, investigating and monitoring their sucking patterns to present appropriate and timely intervention is recommended The current research aimed to report the design of an instrument for measuring the suction pressure in preterm infants through a pilot study. We also checked the validity and reliability of the instrument. Methods: A pilot study was conducted to measure the validity and reliability of this instrument. First, the instrument was developed, and in the next step, discriminant validity, test-retest reliability, and comparison in terms of sex were investigated by measuring the suction pressure of 20 full-term and 15 preterm infants. The Mann-Whitney U test and Wilcoxon test were used to establish the discriminant validity, comparison in terms of sex, and test-retest reliability in SPSS v. 23 software. Results: Two groups showed a significant difference in the suction pressure (P<0.001) to support the discriminant validity of the instrument. We obtained satisfactory values for the test-retest reliability in two groups (r=0.97, P<0.001). Boys and girls did not significantly differ between full-term (P=0.9) and preterm infants groups (P=0.5). Discussion: Performing the pilot study on 35 infants through an infant sucker tester proved the instrument’s discriminant validity and test-retest reliability. However, conducting the studies with a larger sample size is essential to make this instrument available commercially.

Dynamic Characteristics of Peristaltic-like Movements During Infant Sucking

Dynamic Characteristics of Peristaltic-like Movements During Infant Sucking

The rates and factors of perceived insufficient milk supply: A systematic review.

Perceived insufficient milk supply (PIMS) is one of the major reasons for discontinued breastfeeding. We aimed to estimate the rates and evaluate related factors of PIMS. We searched four databases for relevant articles published from January 2000 to March 2021. We then performed a meta‐analysis of the pooled data to estimate the rates and related factors of PIMS using Stata 15.0. Descriptive analyses of textual data were performed to summarise the related factors of PIMS if data could not be synthesised quantitatively. The quality of included studies was assessed using Newcastle–Ottawa scale (NOS), AHRQ checklist or Consolidated Criteria for Reporting Qualitative Research (COREQ). Overall, 27 studies were included in this review. At different periods after delivery, approximately 50% of mothers reported PIMS as the reason for stopping breastfeeding, while for breastfeeding mothers, the incidence of PIMS ranged from 10% to 25%. Breastfeeding initiation (OR 4.22, 95%CI 1.57–11.34) and breastfeeding knowledge (OR 7.10, 95%CI 2.00–25.26) were two factors influencing PIMS. Besides, PIMS had a strong negative relationship with breastfeeding self‐efficacy (r = −0.57); moderate negative association with infant suck ability (r = −0.46) and planned breastfeeding duration (r = −0.45); and a moderate positive correlation with formula supplementation (r = 0.42). Descriptive analyses revealed that infant crying was reported to be a sign of PIMS, and inadequate intake of energy/liquids was a reported cause of it. This review identified a high proportion of women reporting PIMS, particularly among those who stopped breastfeeding. Deliberate interventions were needed to improve breastfeeding for mothers at risk.