The use of non-nutritive sucking to promote functional sucking skills in premature infants: an exploratory trial.

Feeding has long been established as a routine that is important for developing a positive bond between parents and infants and therefore has the potential to make a long-term contribution to the development of well-being in the child. As well as being a social activity, feeding involves the use of tactile and olfactory senses that are essential in an infant’s early development. Management of these skills in a vulnerable infant population requires a sensitive, multidisciplinary approach to maximise each infant’s potential. Sucking in particular is vital in the early development of the infant whether it involves breast or bottle feeding. It is essential for the means of receiving nutrition, of providing stability in distress and also a means of exploring the environment. Successful and effective feeding is an energetic activity that is described as being complex, requiring the coordination of a suck-swallow-breathe cycle. There is also evidence that a stable swallow rhythm appears to be established earlier than a suck rhythm. In the highrisk neonatal population, the suckswallow-breathe sequence is rarely well coordinated before 34 weeks. Premature infants often require approximately 20 postnatal days to achieve a maximal suck rate and their suck-swallow patterns are immature, displaying a dysrythmic pattern, although individual variation is recognised within this population. Infants use two types of sucking. Nutritive sucking is the process of obtaining nutrition with a rate of one suck per second, and is constant over the course of feeding. It involves intake of fluid due to the alternation of expression and suction. Suction is the negative intra-oral pressure which occurs when the tongue and jaw become lower and the soft palate closes the naso-pharynx. In contrast, non-nutritive sucking occurs at two sucks per second, in the absence of nutrient flow and may be used to satisfy an infant’s basic sucking urge or as a state regulatory mechanism. The two forms also differ in their influence on respiratory rate. Paludetto et al and Daniels et al suggest that increases in transcutaneous oxygen levels occur during non-nutritive sucking. They suggest that there is a higher respiratory rate during pauses in nutritive sucking, whereas in non-nutritive sucking, the respiration occurs during the sucking. Key environmental factors also influence the feeding process. They are the presence/ absence of fluid and its viscosity as well as satiation, i.e. the presence of milk in the stomach which inhibits nutritive sucking. Breastfeeding is widely recognised as having many benefits for the developing child although there are many cultural, personal and health issues which affect the decision as to whether to breastfeed or not. However, it can prove particularly difficult for premature infants and this has posed something of a challenge for nurses and speech and language therapists who play a specific role in promoting breastfeeding in young infants. Nevertheless the speech and language therapist’s principle role is to maximise an infant’s functional sucking skills regardless of the mother’s choice of feeding. Concerns have been raised on the use of pacifiers and teats during breastfeeding. However, there is no evidence that the inter-changeable use of teats and nipple presentations cause confusion or that The use of non-nutritive sucking to promote functional sucking skills in premature infants: An exploratory trial