The development of normal feeding and swallowing

Department of Pediatrics, Kluge Children's Rehabilitation Center, University of Virginia School of Medicine, Charlottesville.
Pediatric Clinics of North America (Impact Factor: 2.12). 01/1992; 38(6):1439-53.
Source: PubMed


The development of feeding skills is an extremely complex process influenced by multiple anatomic, neurophysiologic, environmental, social, and cultural factors. Most children negotiate the necessary developmental sequence without significant difficulties. An understanding of the development of normal feeding abilities aids the pediatrician in monitoring this remarkable process in his or her normal patients. This understanding also helps equip the pediatrician who is challenged by a child with complex feeding problems. The following statements summarize the major elements of feeding development. 1. Structural integrity is essential to the development of normal feeding and swallowing skills. Infant anatomy differs from adult anatomy. Anatomic changes associated with growth affect feeding function. 2. Normal infant feeding is reflexive, under brainstem control, and does not require suprabulbar input. As feeding development progresses, basic brainstem-mediated responses come under voluntary control through the process of encephalization. 3. The mature swallow consists of a voluntary oral-preparatory phase, a voluntary oral phase, and involuntary pharyngeal and esophageal phases. The infant swallow does not have a voluntary oral-preparatory and oral phase but is otherwise similar. 4. The neurophysiologic control of feeding and swallowing is complex and involves sensory afferent nerve fibers, motor efferent fibers, paired brainstem swallowing centers, and suprabulbar neural input. Close integration of sensory and motor functions is essential to the development of normal feeding skills. 5. Feeding development, although dependent on structural integrity and neurologic maturation, is a learned progression of behaviors. This learning is heavily influenced by oral sensation, fine and gross motor development, and experiential opportunities. 6. The basic physiologic complexity of feeding is compounded by individual temperament, interpersonal relationships, environmental influences, and culture. 7. The main goal of feeding is the acquisition of sufficient nutrients for optimal growth and development. Malnutrition may result directly from feeding problems and may also help perpetuate them. 8. Protection of the airway during swallow is a reflexive, multileveled function consisting of the apposition of the epiglottis and aryepiglottic folds and the adduction of both false and true vocal folds.

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    • "Deglutition (i.e., swallowing) is a fundamental, but complex human function which involves groups of muscles in the head and neck and activity across several regions of the central and peripheral nervous systems, that produces the transportation of food from the oral cavity via pharynx and esophagus to the stomach (Ertekin and Aydogdu, 2003; Stevenson and Allaire, 1991). "
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    ABSTRACT: Electroencephalography (EEG) systems can enable us to study cerebral activation patterns during performance of swallowing tasks and possibly infer about the nature of abnormal neurological conditions causing swallowing difficulties. While it is well known that EEG signals are non-stationary, there are still open questions regarding the stationarity of EEG during swallowing activities and how the EEG stationarity is affected by different viscosities of the fluids that are swallowed by subjects during these swallowing activities. In the present study, we investigated the EEG signal collected during swallowing tasks by collecting data from 55 healthy adults (ages 18-65). Each task involved the deliberate swallowing of boluses of fluids of different viscosities. Using time-frequency tests with surrogates, we showed that the EEG during swallowing tasks could be considered non-stationary. Furthermore, the statistical tests and linear regression showed that the parameters of fluid viscosity, sex, and different brain regions significantly influenced the index of non-stationarity values. Therefore, these parameters should be considered in future investigations which use EEG during swallowing activities.
    Brain Research 09/2014; 1589. DOI:10.1016/j.brainres.2014.09.035 · 2.84 Impact Factor
    • "This evidence of volitional overide of the swallowing response offers promise for exploiting skill-learning during swallowing. Stevenson and Allaire (1991) comments that swallowing movements are reflexive at birth; however, the ability to modify the swallowing response across development is linked to a process of encephalization. This suggests that although brainstem central pattern generators drive the primitive swallowing response, the ingestive " skill " component of swallowing is acquired through cortical expansion and modulation of that primitive response. "
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    ABSTRACT: Experience-dependent plasticity (EDP) is a general term used to describe neural and associated behavioral adaptations resulting from experience. Because the objective of dysphagia rehabilitation is to induce long-term permanent change in swallowing physiology, understanding EDP processes is crucial for documenting the efficacy of treatments. There is little information about natural processes of EDP related to swallowing (i.e., changes associated with aging and impairment). Therefore, the “baseline” on which we apply dysphagia treatments remains unclear. Because EDP is characterized by peripheral and central adaptations of physiologic and functional measures over time, effectively documenting EDP requires multiple outcome measures at multiple time points. This review will discuss mechanisms of endogenously induced EDP, including aging and impairment. A review of current dysphagia rehabilitation literature will be provided to indicate the state of evidence for exogenously induced EDP. Future considerations for the study of EDP related to dysphagia will also be offered.
    12/2013; 1(4):231-241. DOI:10.1007/s40141-013-0025-y
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    • "If there is disruption or abnormality in the development of these structures, interruption of typical feeding development is likely to occur. For instance, clefts in the lip or palate can lead to difficulty in sucking, subsequently having an adverse effect on the development of bottle feeding as well as the development of oral-motor skills necessary for later feeding (Stevenson & Allaire, 1991). "
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    ABSTRACT: To date, no standardized measures have been developed to evaluate the mealtime behavior of children with autism. The Brief Autism Mealtime Behavior Inventory (BAMBI) was designed to measure mealtime behavior problems observed in children with autism. Caregivers of 40 typically developing children and 68 children with autism completed the BAMBI, the Behavioral Pediatric Feeding Assessment Scale (BPFAS), the Gilliam Autism Rating Scale (GARS), the Youth/Adolescent Questionnaire (YAQ), and a 24-hour recall interview. The BAMBI demonstrated good internal consistency, high test-retest reliability, a clear factor structure, and strong construct and criterion-related validity in the measurement of mealtime behavior problems in children with autism.
    Journal of Autism and Developmental Disorders 03/2008; 38(2):342-52. DOI:10.1007/s10803-007-0401-5 · 3.34 Impact Factor
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