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Reduction of masseter muscle activity in bottle-fed babies
Abstract
Our previous studies suggested that there are significant differences in the growth of the jaw and in muscle activity between breast- and bottle-fed infants. To confirm these differences quantitatively, myoelectric activities of the masseter muscles of bottle-fed babies were studied. Twelve bottle-fed babies, as well as 12 breast-fed babies as a control group, were examined electromyographically during bottle or breast feeds. The duration time of sucking bursts, interval time, cycle time, 0-to-peak amplitude, integrated amplitude of bursts, and integrated amplitude/duration time were measured and the number of bursts over 30 microV was counted. All differences of means were significant by t-test. The masseter muscle activity in bottle-fed babies is significantly reduced. Our results are contrary to previous papers in which almost the same sucking actions in both breast and bottle feeding were reported. The reason why previous researchers thought that the sucking patterns in breast- and bottle-fed babies are essentially the same is considered, and the implications of the differences for dental health are discussed.
... In addition to the beneficial effects of being fed breastmilk as compared to formula (reviewed in [1]), there are several biomechanical and physiologic benefits to breastfeeding in both infancy and beyond [2][3][4][5][6][7]. Infants that are breastfed have been argued to have reduced rates of dysphagia, improved muscle function during suckling as well as during mastication in early childhood, reduced malocclusion, and have been implicated to have different respiratory functioning than bottle fed infants [8][9][10][11][12][13][14]. One potential causal factor in the observed differences in performance and development could lie in the biomechanical differences that exist between breastfeeding and bottle feeding. ...
... One potential causal factor in the observed differences in performance and development could lie in the biomechanical differences that exist between breastfeeding and bottle feeding. As compared with bottle feeding, during breastfeeding, infants generate greater intraoral suction [12,15], increase cranial muscle activation [9,12], and experience greater oxygen saturation due to improved coordination of breathing and feeding [16]. Because of the ethical limitations on understanding the neurophysiology and biomechanics of human infant breast vs. bottle feeding, we do not have a full understanding of the differences in these modalities [17]. ...
... Our observation that intraoral suction generation increases during feeding on a ducted nipple implies that this design can better replicate breastfeeding, as infants generate more suction during breastfeeding than during bottle feeding when using a conventional cisternic nipple [15]. In fact, several studies have noted that bottle feeding is more similar to drinking from a cup than it is to breastfeeding, and that the neuromotor system functions fundamentally differently during the two behaviors [9,12]. Several experiments have demonstrated that nipples with suction-only milk release can improve feeding dynamics in infants with feeding difficulties such Table 2 Results from logistic regression analyses, relative to an infant with a safe swallow raised on a cisternic nipple feeding on a cisternic nipple (log odds ± se, p) as those born prematurely remains unknown, and in some instances the requirement to generate suction to acquire milk may not improve feeding outcomes, as many populations struggle with the ability to generate suction [41, [83][84][85]. ...
Breastfeeding is widely regarded as the optimal form of feeding infants, as it provides both nutritional and physiological benefits. For example, breastfed infants generate greater intraoral suction and have higher amplitude muscle activities compared to bottle-fed infants, with downstream implications for motor function, development, and health. One mechanism that might explain these physiological differences is the structure of the nipple an infant is feeding on. Breasts in most mammals are ducted soft-tissue structures that require suction to be generated for milk to be released, whereas bottle nipples are hollow and allow milk to be acquired by compression of the nipple. We used a validated animal model (pigs) to test how being raised on a novel ducted nipple impacted feeding physiology and performance compared to infants raised on a standard (cisternic) nipple. At the end of infancy, we fed both groups with both nipple types and used high-speed videofluoroscopy synchronized with intraoral pressure measurements to evaluate feeding function. Nipple type did not have a profound impact on sucking or swallowing rates. However, when feeding on a ducted nipple, infant pigs raised on a ducted nipple generated more suction, consumed milk at a faster rate, swallowed larger boluses of milk, and had decreased likelihood of penetration and aspiration than those raised on a cisternic nipple. These data replicate those found when comparing breast- and bottle-fed infants, suggesting that a ducted, biomimetic nipple may provide bottle-fed infants with the physiologic benefits of breastfeeding.
... It was observed by Sakashita et al [11] in 1996, in their qualitative and quantitative study of myoelectrical activity in bottle fed and breastfed infants, with a chewing type bottle teat. e same authors showed in their earlier study (1995) that masseter work in infants fed with a regular sucking type bottle teat is reduced as compared to breastfed infants [12]. Many authors point to the fact that during bottle feeding there is no synchronization between swallowing and nose breathing, which may contribute to establishing an oral breathing route [5] Infant feeding technique is signi cantly a ecting the development of the maxillofacial structures. ...
... Many authors point to the fact that during bottle feeding there is no synchronization between swallowing and nose breathing, which may contribute to establishing an oral breathing route [5] Infant feeding technique is signi cantly a ecting the development of the maxillofacial structures. e growth and development of the infant's craniofacial region is determined by genetic factors and physiological stimulation during breathing, sucking, swallowing and chewing [12]. e correct development of the maxilla and mandible is also impacted by muscular stimulation, as during muscle contraction the bone is pulled or pushed, which then leads to its proper growth [13]. ...
... Later papers, published a er 1991, point to a more frequent occurrence in lateral crossbite in exclusively bottle fed children [12]. However, in spite of almost 1000 papers being reviewed and 223 chosen for analysis, only 10 of those, the cohort studies, were considered, due to the credibility inclusion criteria. ...
The method and technique of feeding a young child affect the shape of the maxillofacial complex. Breastfeeding is the recommended method of feeding in the first six months of life. It is encouraged to continue natural feeding in later months, simultaneously developing other food extraction techniques. The correct formation of the stomatognathic system is a result of the correct organization of the motor patterns during feeding.
... Two case control studies focused on myofunctional changes on infants exclusively, during breastfeeding and bottle feeding. 17,18 These studies reported significantly lower activation of masseter and temporalis muscles in bottle fed infants than breastfed infants. ...
... In the bottle fed group, the masseter showed lower activation (27.9 µv) and its activity occasionally disappeared during feeding. 17 The research concluded that higher masseter activation is present in breastfed and chewing-type artificial teat fed infants and this muscle activity was significantly lower in bottle feeding. ...
... It is important that we critically assess these studies because they were carried out on relatively small samples and consisted of a single measurement in time. 17,18 That said, these findings do corroborate other authors' description of breastfeeding mechanism compared to bottle feeding, with higher masseter and temporalis activation leading to energetic jaw compression. 8,19 On the other hand, a higher range of buccinator muscle activity was observed during bottle feeding, although this finding was not significant. ...
Introduction: Exclusive breastfeeding is recommended for at least six months in infants and encouraged up to two years of age. However, only 35% of infants are breastfed up to six months in the US. This rate drops down to 16% for breastfeeding at 12 months. Some authors suggest that breastfeeding also plays an important role in optimal musculoskeletal development of the orofacial system in the infant. On the contrary, bottle feeding could negatively affect these musculoskeletal structures resulting in abnormal development of the stomatognathic system. This review aims to answer the question: "What are the musculoskeletal effects of bottle feeding versus breastfeeding in infants' orofacial development and function?" Methods: Online databases (PubMed, ResearchGate, Cochrane; ICL, EBSCO, SCielo) have been searched to identify relevant articles. No limit was set for date, study design and level. Results: The search resulted in identifying four systematic reviews and two case control studies. Four literature reviews highlighted great heterogeneity in methodology and findings. Authors agreed that exclusive breastfeeding and breastfeeding duration were associated with optimal development of palate, dentition and myofunctional habits. Bottle feeding, on the other hand, influenced the activity and function of masseter, tongue and temporalis muscles, leading to a V shaped palate and long-term malocclusions. Conclusion: There were few large-sample high-quality studies focusing specifically on infants' orofacial development; further research is needed to deepen the knowledge of factors relating to musculoskeletal development during infancy.
... It was observed by Sakashita et al [11] in 1996, in their qualitative and quantitative study of myoelectrical activity in bottle fed and breastfed infants, with a chewing type bottle teat. e same authors showed in their earlier study (1995) that masseter work in infants fed with a regular sucking type bottle teat is reduced as compared to breastfed infants [12]. Many authors point to the fact that during bottle feeding there is no synchronization between swallowing and nose breathing, which may contribute to establishing an oral breathing route [5] Infant feeding technique is signi cantly a ecting the development of the maxillofacial structures. ...
... Many authors point to the fact that during bottle feeding there is no synchronization between swallowing and nose breathing, which may contribute to establishing an oral breathing route [5] Infant feeding technique is signi cantly a ecting the development of the maxillofacial structures. e growth and development of the infant's craniofacial region is determined by genetic factors and physiological stimulation during breathing, sucking, swallowing and chewing [12]. e correct development of the maxilla and mandible is also impacted by muscular stimulation, as during muscle contraction the bone is pulled or pushed, which then leads to its proper growth [13]. ...
... Later papers, published a er 1991, point to a more frequent occurrence in lateral crossbite in exclusively bottle fed children [12]. However, in spite of almost 1000 papers being reviewed and 223 chosen for analysis, only 10 of those, the cohort studies, were considered, due to the credibility inclusion criteria. ...
The method and technique of feeding a young child affect the shape of the maxillofacial complex. Breastfeeding is the recommended method of feeding in the first six months of life. It is encouraged to continue natural feeding in later months, simultaneously developing other food extraction techniques. The correct formation of the stomatognathic system is a result of the correct organization of the motor patterns during feeding.
... Craniofacial growth and development are affected by functional stimuli such as sucking, chewing, swallowing and breathing [1]. Nutritive sucking, which includes breastfeeding and bottle-feeding and non-nutritive sucking (NNS), which includes pacifier and digit sucking, have been associated with growth and development of the maxillomandibular complex. ...
... An absence or short duration of breast-feeding results in a longer duration of bottle-feeding. The sucking mechanism used during bottle-feeding is markedly different from that used during breast-feeding [1,5,6]. Compared with breast-feeding, bottle-feeding requires less forceful muscle action and thus, does not facilitate mandibular development to the same degree. ...
... Compared with breast-feeding, bottle-feeding requires less forceful muscle action and thus, does not facilitate mandibular development to the same degree. This difference could potentially predispose those children who undergo prolonged bottle-feeding to malocclusion or other distinctive occlusion characteristics [1]. However, more evidence is needed to support this association. ...
Early transition from breastfeeding and non-nutritive sucking habits may be related to occlusofacial abnormalities as environmental factors. Previous studies have not taken into account the potential for interactions between feeding practice, non-nutritive sucking habits and occlusal traits. This study assessed the effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Peking city.
This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents/guardians. The examination was performed by a single, previously calibrated examiner and the following variables were evaluated: presence or absence of deep overbite, open bite, anterior crossbite, posterior crossbite, deep overjet, terminal plane relationship of the second primary molar, primary canine relationship, crowding and spacing. Univariate analysis and multiple logistic regressions were applied to analyze the associations.
It was found that a short duration of breast-feeding (never or ≤6 months) was directly associated with posterior cross bite (OR = 3.13; 95%CI = 1.11-8.82; P = 0.031) and no maxillary space (OR = 1.63; 95%CI = 1.23-2.98; P = 0.038). In children breast-fed for ≤6 months, the probability of developing pacifier-sucking habits was 4 times that for those breast-fed for >6 months (OR = 4.21; 95%CI = 1.85-9.60; P = 0.0002). Children who were bottle-fed for over 18 months had a 1.45-fold higher risk of nonmesial step occlusion and a 1.43-fold higher risk of a class II canine relationship compared with those who were bottle-fed for up to 18 months. Non-nutritive sucking habits were also found to affect occlusion: A prolonged digit-sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit associated with excessive overjet and absence of lower arch developmental space.
Breastfeeding duration was shown to be associated with the prevalence of posterior crossbite, no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a digit-sucking habit were more likely to develop an open bite.
... The masseter is a powerful muscle which is responsible for the movements of mandibular protrusion, elevation and retrusion [3,[7][8][9][18][19][20]. As there is greater involvement of the masseter muscle, to the detriment of the other muscles involved, while sucking to the breast [18,21,22], masseter muscle activity during breastfeeding could be considered a standard with which to compare other alternative methods of feeding in the neonatal period. ...
... Due to the anatomical configuration and location of the masseter muscle on the surface of the facial region, its activity can be measured using surface electromyography (EMG), a safe and non-invasive method [23,24] introduced into research in the last decade which allows for objective quantification of muscle energy [24,25]. It is a safe effective method for evaluating the orofacial muscles of preterm [12] or term infants [18,21,22], children and adults [25,26] during feeding. ...
... Various studies have assessed muscle activity by means of surface electromyography during breastfeeding and other feeding methods in the first year of life, and have concluded that the masseter is more active in breastfed than in bottlefed or cup fed infants [18,21,22,27,28]. However, little is known about muscle activity during breastfeeding in newborns. ...
Background
When breastfeeding is difficult or impossible during the neonatal period, an analysis of muscle activity can help determine the best method for substituting it to promote the child’s development. The aim of this study was to analyze the electrical activity of the masseter muscle using surface electromyography during suction in term newborns by comparing breastfeeding, bottle and cup feeding.
Methods
An observational, cross-sectional analytical study was carried out on healthy, clinically stable term infants, assigned to receive either breast, or bottle or cup feeding. Setting was a Baby Friendly accredited hospital. Muscle activity was analyzed when each infant showed interest in sucking using surface electromyography. Root mean square averages (RMS) recorded in microvolts were transformed into percentages (normalization) of the reference value. The three groups were compared by ANOVA; the “stepwise” method of the multiple linear regression analysis tested the model which best defined the activity of the masseter muscle in the sample at a significance level of 5%.
Results
Participants were 81 full term newborns (27 per group), from 2 to 28 days of life. RMS values were lower for bottle (mean 44.2%, SD 14.1) than breast feeding (mean 58.3%, SD 12.7) (P = 0.003, ANOVA); cup feeding (52.5%, SD 18.2%) was not significantly different (P > 0.05). For every gram of weight increase, RMS increased by 0.010 units.
Conclusions
Masseter activity was significantly higher in breastfed newborns than in bottle-fed newborns, who presented the lowest RMS values. Levels of masseter activity during cup-feeding were between those of breast and bottle feeding, and did not significantly differ from either group. This study in healthy full term neonates endorses cup rather than bottle feeding as a temporary substitute for breastfeeding.
... miRNA genlerinin, kromozomal anomaliler için kırılgan bölgeler ve sık rastlanan mutasyon bölgeleri ile sık sık eşleştiği veya tümör gelişimiyle korele olan kanser yatkınlık lokuslarının yakınında bulunduğu gösterilmiştir [71][72][73]. Genom üzerinde çok sayıda miRNA genlerinin lokalize olmasına karşın, kümelenmiş olanlar birden fazla genin fonksiyonuyla ilişkili yani polisistronik birimler olarak ifade edilmektedirler [74]. İlk zamanlar miRNA genlerinin protein kodlamayan intergenik bölgelerde bulunduğu düşünülmesine rağmen, günümüzde miRNA'lar kodlandıkları genomik bölgeye göre gruplara ayrılmışlardır. ...
... Dünya Sağlık Örgütü ve Birleşmiş Milletler Çocuklara Yardım Fonu (UNICEF) bebekleri sütten kesmek için emzik ve biberon kullanımını önermemektedir.Emzik kullanımı ve biberonla beslenme kemik büyümesini engelleyebilir ve dentisyon,solunum ve konuşma süreçlerinin gelişimini tehkikeye sokar. (74,75) 1991 yılında "Ulusal Sağlık Mülakat Araştırması'nın Çocuk Eki"nden elde edilen veriler, 6 aylık bebekten 5 yaşına kadar çocukların yaklaşık %95'inin biberon kullandığını göstermiştir. Her 6 çocuktan 1'inin su dışında içeriği olan bir biberonla uyuduğu bildirilmiştir. ...
... The WHO and the United Nations Children's Fund (UNICEF) do not recommend pacifiers and bottle-feeding, in order to prevent early weaning (WHO, 1998). Suckling habits and bottle-feeding can hinder bone growth and jeopardize the development of dental positions and respiratory and speech processes (10,11). ...
... of pacifier use is worrying considering the possible consequences, including early weaning and the occurrence of malocclusions (10,11). Related work developed in Brazil evaluated 278 premature babies. ...
The immaturity of born to preterm infants may predispose to sucking difficulties. This research aimed to evaluate if pacifier use is associated with preterm birth and influenced in type of infant feeding. This comparative cross-sectional study was conducted in Belo Horizonte, Brazil and evaluated 250 children aged 3 to 5 years. As a sample, two groups were established: the normal term children group (n=125) was selected at a day-care centre and the group of preterm children (125) was identified at a public university hospital with a preterm care project from birth to seven years of age. To collect data, a pre-tested questionnaire regarding information on gestational age, infant development, infant feeding and non-nutritive sucking habits was used for both groups. Bivariate and multivariate Poisson regression was used for the statistical analysis. Pacifier use was more prevalent in the preterm group (PR=1.20, 95% CI=1.02-1.42) who used the bottle (PR=1.38, 95% CI=1.15-1.64) and were breastfed for less than six months (PR=1.19, 95% CI=1.01-1.41). The majority of breastfed infants were of normal term birth (PR=1.14, 95% CI=1.04-1.20) and had monthly family income greater than USD 450.28 (RP= 1.10, 95% CI=1.01-1.20). In this study, pacifier use was more prevalent among preterm infants and associated with less than six months of breastfeeding and used of bottle. Monthly family income was associated with a prevalence of breastfeeding.
... This muscular action is believed to promote optimal craniofacial growth and development compared to bottle feeding. [14][15][16] shape and flexibility of the human breast ...
... These studies found that infants who are exclusively breastfed were less likely to develop dysfunctional muscular patters that might predispose them to developing a malocclusion. 14,15 More recently, systematic reviews and meta-analyses have been carried out to try to ascertain if breastfeeding has any effect on the occlusion. A systematic review and meta-analysis in 2015 found that the presence of malocclusion was 46% lower in children who were exclusively breastfed than in those who were not exclusively breastfed. ...
The effects of breastfeeding on the occlusion have been much debated, and it is often suggested that breastfeeding facilitates optimal development of the jaws and the dentition, thus preventing the development of a malocclusion. Despite these claims, the evidence is equivocal, and the majority of studies are of low quality and only assess the deciduous dentition. Therefore, at present there is currently no high quality evidence to support claims that breastfeeding has a positive effect on the occlusion, thus the method of feeding should be chosen due to the health benefits and personal preference, not due to any claims regarding occlusal benefits that cannot be substantiated.
... Research on the use of surface electromyography (EMG), which is a method for recording variations in muscle electrical activity during contraction [16], is also scarce, especially in terms of the evaluation of sucking function in infants [7,[17][18][19][20][21][22][23][24][25][26]. EMG is considered an easy, fast, low-cost, safe, and non-invasive procedure that can provide important information about muscle function [7,16,17,[23][24][25][26], which can be used to diagnose oral motor dysfunction accurately [23,24]. ...
... Some studies have evaluated the activity of orofacial muscles using surface electromyography during breastfeeding and other feeding methods [7,[18][19][20][21][22][23][24]26]. However, to the best of our knowledge, no study has analyzed the activity of the suprahyoid muscles in newborns and infants in terms of the sucking function and the effect on breastfeeding based on lingual frenulum attachment. ...
Muscle electrical activity analysis can aid in the identification of oral motor dysfunctions, such as those resulting from an altered lingual frenulum, which consequently impairs feeding. Here, we aim to analyze the suprahyoid muscle electrical activity of infants via surface electromyography, based on lingual frenulum attachment to the sublingual aspect of the tongue and floor of the mouth during breastfeeding. In the present study, we have studied full-term infants of both genders, aged between 1 and 4 months old. The mean muscle activities were recorded in microvolts and converted into percent values of the reference value. Associations between the root mean square and independent variables were tested by one-way analysis of variance and Student’s t-test, with a significance level of 5% and test power of 95%, respectively. We evaluated 235 infants. Lower mean muscle electrical activity was observed with the lingual frenulum attached to apex/lower alveolar ridge, followed by attachment to the middle third/lower alveolar ridge, and between the middle third and apex/lower alveolar ridge. Greater suprahyoid muscle activity was observed with lingual frenulum attachment to the middle third of the tongue/sublingual caruncles, showing a coordination between swallowing, sucking, and breathing. Surface electromyography is effective in diagnosing lingual frenulum alterations, the attachment points of which raises doubt concerning the restriction of tongue mobility. Thus, it is possible to identify oral motor dysfunctions.
... The sucking mechanism used during bottle feeding differs from that used during breastfeeding. [67][68][69] Viggiano and colleagues 67 described the breastfed child as one who "draws milk, putting both the nipple and areola into the mouth; the movement of lips and tongue contribute more to squeezing than to sucking … [and] the tongue compresses the soft breast nipple against the palate using a peristaltic-like motion." The bottle-fed child "uses the tongue with piston-like motion in order to compress the artificial teat against the palate." ...
... 67 Challenges exist in designing an investigation of the influence of sucking behaviors on craniofacial growth; however, the results of studies in which researchers used electromyography suggest that the muscle activity of infants who are breastfed exclusively renders them less likely to develop the dysfunctional muscular patterns that might predispose bottlefed infants to develop a malocclusion. 68,69 We identified four clinical studies in which investigators directly examined occlusal characteristics in the primary dentition of children who were bottle-fed versus those who were breastfed as infants. 67,[70][71][72] Investigators in two of these studies 70,72 found that breastfeeding was more conducive to the favorable development of occlusion than was bottle feeding. ...
Background:
Breastfeeding is the reference against which alternative infant feeding models must be measured with regard to growth, development and other health outcomes. Although not a systematic review, this report provides an update for dental professionals, including an overview of general and oral health-related benefits associated with breastfeeding.
Types of studies reviewed:
The authors examined the literature regarding general health protections that breastfeeding confers to infants and mothers and explored associations between breastfeeding, occlusion in the primary dentition and early childhood caries. To accomplish these goals, they reviewed systematic reviews when available and supplemented them with comparative studies and with statements and reports from major nongovernmental and governmental organizations.
Results:
When compared with health outcomes among formula-fed children, the health advantages associated with breastfeeding include a lower risk of acute otitis media, gastroenteritis and diarrhea, severe lower respiratory infections, asthma, sudden infant death syndrome, obesity and other childhood diseases and conditions. Evidence also suggests that breastfed children may develop a more favorable occlusion in the primary dentition. The results of a systematic review in which researchers examined the relationship between breastfeeding and early childhood caries were inconclusive.
Conclusions and clinical implications:
The American Academy of Pediatric Dentistry, Chicago, suggests that parents gently clean infants' gums and teeth after breastfeeding. The American Academy of Pediatrics, Elk Grove Village, Ill., recommends that breastfeeding should be exclusive for about the first six months of life and should continue, with the introduction of appropriate complementary foods, to at least age 12 months or beyond, as desired by mother and child. Dentists and staff members can take steps to ensure they are familiar with the evidence and guidelines pertaining to breastfeeding and to oral health. They are encouraged to follow the surgeon general's recommendations to promote and support optimal breastfeeding and oral health practices among their patients.
... Another important advantage to exclusive breastfeeding that is not always considered is its positive effect on the development of the orofacial musculature, which can ultimately affect a child's food acceptance. Children who are nursed at the chest present a markedly different pattern of sucking, with greater facial and masticatory muscle activity than those who are bottlefed [87,88], as observed by electromyographic analysis comparing breast-and bottle-feeding [89]. During breastfeeding, the child is forced to drink human milk through a squeeze action with the movement of lips, tongue, and mandible, whereas for children who are bottle-fed, the movement for obtaining the milk is more passive and effortless [90]. ...
Infancy and early childhood are important periods for the development of food choices and eating preferences that are tracked into adult life, influencing weight gain, body composition, and metabolism and ultimately affecting the balance between health and disease. In this narrative review, we discuss studies focused on the effects of fetal programming and early food experiences, highlighting recent advances in the discovery of factors that contribute to the development of food preferences and eating behavior. Food preference can be influenced by early direct contact with flavors, textures, and aromas, as well as by environmental adversities during early development. Evidence suggests that exposure to intrauterine growth restriction is associated with increased preferences for highly palatable foods, such as those rich in carbohydrates and fats, over the life course. Early flavor experiences, whether from amniotic fluid or human milk, may also shape the development of food preferences. Finally, children are more likely to accept textures that they are able to manipulate, and early exposure to a range of textures facilitates the acceptance of foods of various textures later on. Improving dietary habits during gestation (fetal) and postnatal periods is of critical importance for the establishment of positive eating habits and healthy growth in infants and should be an important focus of primary prevention efforts.
... The sucking mechanism used in bottlefeeding differs significantly from that used in breastfeeding [17]. This distinction may predispose children who are bottle-fed for an extended period to malocclusion or other distinctive occlusion characteristics [18]. ...
Background
Bottle feeding should be avoided since it interferes with optimal breastfeeding and it causes diarrheal-related morbidity and mortality. Despite the WHO’s recommendation that children to avoid bottle feeding, it is still widely practiced in developing countries including our country, Ethiopia. Therefore, this study aimed to assess the spatial variations, and determinants of bottle feeding among children aged 0–23 months using the recent demographic and health survey data for Ethiopia.
Methods
A secondary data analysis was conducted using the 2019 Ethiopian mini demographic and health survey data. The total weighted sample of 2067 children aged 0–23 months was included in this study. Spatial analysis was done to identify the hotspot areas of bottle feeding among children in Ethiopia. Multivariable multilevel logistic regression was used to identify predictors of bottle feeding. The spatial analysis was done using ArcGIS 10.7 and Sat Scan 9.6 software.
Result
The prevalence of bottle feeding among children aged 0–23 months was 21.52% with 95% CI(19.80%, 23.34%). Age of the child from 6–11 months, and 12–23 months age, having secondary and above education [AOR = 2.09; 95%CI; 1.31, 3.32], being from middle and rich household [AOR = 2.14; 95%CI; 1.37, 3.34] and [AOR = 2.30; 95%CI; 1.46, 3.63], and twin birth [AOR = 8.06; 95%CI; 2.87, 22.58] were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions of Ethiopia.
Conclusion
Bottle feeding practice was found to be spatially clustered in Ethiopia. Education, wealth index, parity, and child’s age were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions. Special attention should be directed towards mothers residing in hotspot areas, educated mothers, mothers of multiple births, and mothers from rich households through community education programs focused on child feeding practices to reduce the practice of bottle-feeding in Ethiopia.
... The second literature review [16] had an aim similar to the one of the current scoping review but focused on research implementing sEMG during feeding only in infants (0-12 months old) and used search strategies that ended in April 2009. Of eight revealed studies, two investigated feeding in preterm infants [19,20], and six involved term infants [21][22][23][24][25] including one study that recruited infants with Down syndrome [26]. ...
Surface electromyography (sEMG) could be used for diagnostic and therapeutic purposes in various health conditions. For example, sEMG biofeedback is shown to be beneficial in adults with swallowing disorders (dysphagia), whereas there are no easily identifiable studies to support such evidence in paediatrics. The current review aimed to evaluate the feasibility of implementing sEMG during swallowing tasks in paediatric populations with various diagnoses. Additionally, the review aimed to describe findings in publications involving participants with cerebral palsy (CP) and dysphagia. Paediatric-related publications were sourced using English keywords and phrases across the following seven databases: PubMed, EMBASE, CINAHL, Web of Science, PsycINFO, and ProQuest Dissertations and Theses Global. The search included all available publications without language and date restrictions. Publications using sEMG during chewing tasks were also accepted in the review as chewing is considered to be part of the act of swallowing. The feasibility of measuring sEMG during swallowing in children with various health conditions was supported by 116 publications (n = 6 literature reviews) that met the inclusion criteria for the final full-text review. However, a few publications described some difficulties occurring directly during the sEMG data collection sessions. The review identified 15 publications involving 177 participants with CP who underwent sEMG while swallowing (n = 1 publication focused solely on the assessment of chewing). Ten publications described studies that recruited children with dysphagia. Children with CP who had dysphagia were recruited in five of these studies.
Conclusions: The acquisition of sEMG measurements while performing swallowing tasks was shown to be feasible in children with various diagnoses including those who have CP and dysphagia. Future studies should investigate the implementation of sEMG as a part of paediatric dysphagia therapy alongside biofeedback swallowing skill training. What is Known:
• Surface electromyography (sEMG) could be implemented for diagnostic and therapeutic purposes in various health conditions.
• Biofeedback using sEMG is beneficial in adults with swallowing disorders (dysphagia).
What is New:
• Implementation of sEMG was shown to be feasible during swallowing tasks in paediatric populations with various diagnoses, including dysphagia and cerebral palsy.
• The usage of sEMG biofeedback as a part of paediatric dysphagia management should be investigated in future studies.
... It has been shown the masseter and temporalis muscles are less active during bottle feeding in comparison to breast feeding. With the safe assumption that perfect breastfeeding biomechanics recruits the perfect muscles necessary, then it has been shown that bottle feeding leads to a reduction of activity in the tongue, lips, temporalis muscle, masseter muscle and the pterygoids, with increased activity of both the mentalis and buccinator [89][90][91]. The differences in tongue position can be clearly seen between breastfeeding and bottle feeding in Figure 15, and this consequently must result in altered function. ...
... The guidelines of the American Association of Pediatric Dentistry suggest that bottle feeding should stop between the ages of 12 and 18 months and drinking from a cup from should be encouraged from the first birthday onward [28]; it is also strongly recommended that infants should not be put to sleep with a formula bottle. Long-term bottle feeding leads to a reduction in masseter muscle activity [29], posterior crossbite, and altered occlusion, and these features are more pronounced in infants with non-nutritive sucking habit [30]. Bottle feeding also has negative consequences on orofacial development, such as lack of lip seal, persistent infantile swallowing, and reduced nasal breathing [31]. ...
The rate of preterm birth is increasing worldwide and preterm infants are susceptible to oral health problems. Hence, this study aimed to investigate the effect of premature birth on dietary and oral characteristics as well as dental treatment experiences of preterm infants using a nationwide cohort study. Data was retrospectively analyzed from National Health Screening Program for Infants and Children (NHSIC) of the National Health Insurance Service of Korea. 5% sample of children born between 2008 and 2012 who completed first or second infant health screening were included and divided into full-term and preterm-birth groups. Clinical data variables such as dietary habits, oral characteristics, and dental treatment experiences were investigated and comparatively analyzed. Preterm infants showed significantly lower rates of breastfeeding at 4–6 months (p<0.001), delayed start of weaning food at 9–12 months (p<0.001), higher rates of bottle feeding at 18–24 months (p<0.001), poor appetite at 30–36 months (p<0.001) and higher rates of improper swallowing and chewing function at 42–53 months (p = 0.023) than full-term infants. Preterm infants also had eating habits leading to poor oral conditions and higher percentage of absence of dental visit compared to full-term infants (p = 0.036). However, dental treatments including 1-visit pulpectomy (p = 0.007) and 2-visit pulpectomy (p = 0.042) significantly decreased when oral health screening was completed at least once. The NHSIC can be an effective policy for oral health management in preterm infants.
... Electromyography revealed significantly higher activity of masseters and temporalis in newborns during breastfeeding compared to bottle feeding where, instead, they operate in hypofunction [França, 2014;Gomes, 2006;Inoue, 1995]. Conversely, buccinators result more activated during bottle feeding [Gomes, 2006]. ...
Aim:
Paediatric sleep breathing disorders represent an emerging paediatric health concern. Despite risk factors are widely discussed in literature, evidences about protective factors are lacking. The aim of this systematic review was to examine the available evidence about the effect of breastfeeding on snoring and obstructive sleep apnea in childhood, and to methodically describe the underlying mechanism of interaction.
Methods:
The study protocol was registered in advance in PROSPERO (CRD42020212529). Electronic search of the literature was performed up to October 10th, 2020 using four databases: PubMed, ScienceDirect, Medline and Scopus. Two authors independently retrieved potentially relevant articles to meet eligibility criteria. PRISMA guidelines were followed. Prospective, retrospective, case-control, cohort, clinical trial and cross-sectional studies investigating the association between breastfeeding and paediatric sleep-disordered breathing were included and data were extracted. No restrictions on language or date of publication were set. Subsequently, a search in the literature was further done to investigate underlying mechanisms of interaction.
Conclusion:
This review suggests that breastfeeding can effectively protect children and adolescents from sleep-disordered breathing, especially from habitual snoring, by preventing the associated risk factors. Future prospective studies with more efficient design are required.
... During feeding, infants use suction to acquire milk, and then move their tongue in a wave posteriorly to transport it to the valleculae (Elad et al., 2014;German et al., 1992). Tongue movements and suction generation during this process have been demonstrated to respond to sensory feedback (Mayerl et al., 2020a), and infants use different neuromotor patterns and suction generation capacities depending on nipple properties and milk flow (Inoue et al., 1995;Moral et al., 2010). After milk arrives in the valleculae, a swallow is triggered by sensory fibers associated with the internal superior laryngeal nerve when a threshold volume is attained Lang et al., 2014), and the resulting swallow is thought to be primarily reflexive (Miller, 2008). ...
Infants experiencing frequent aspiration, the entry of milk into the airway, are often prescribed thickened fluids to improve swallow safety. However, research on the outcomes of thickened milk on infant feeding have been limited to documenting rates of aspiration and the rheologic properties of milk following thickening. As a result, we have little insight into the physiologic and behavioral mechanisms driving differences in performance during feeding on high viscosity milk. Understanding the physiologic and behavioral mechanisms driving variation in performance at different viscosities is especially critical, because the structures involved in feeding respond differently to sensory stimulation. We used infant pigs, a validated animal model for infant feeding, to test how the tongue, soft palate, and hyoid respond to changes in viscosity during sucking and swallowing, in addition to measuring swallow safety and bolus size. We found that the tongue exhibited substantive changes in its movements associated with thickened fluids during sucking and swallowing, but that pharyngeal transit time as well as hyoid and soft palate movements during swallowing were unaffected. This work demonstrates the integrated nature of infant feeding and that behaviors associated with sucking are more sensitive to sensorimotor feedback associated with changes in milk viscosity than those associated with the pharyngeal swallow, likely due to its reflexive nature.
This article is protected by copyright. All rights reserved.
... Breastfeeding is a useful action for developing and growing teeth and jaws of infants [1][2][3][4]. The mechanism used in for the time of bottle-feeding is markedly different from that used during breast-feeding [5][6][7]. In the course of sucking mother's milk, more muscles are activated to get milk than to drink milk from the bottles. ...
... similar. Our results are also most generalizable to infants fed on bottles, as breastfeeding fundamentally differs from bottle feeding in terms of both muscle function and pressure generation (23,37,52), and an effective latch depends not just on the infant, but also on the caregiver during breastfeeding. Future work should examine the impact of nipple properties and the differences between breast and bottle in the integrated framework presented here. ...
Mammalian infants must be able to integrate the acquisition, transport, and swallowing of food in order to effectively feed. Understanding how these processes are coordinated is critical, as they have differences in neural control and sensitivity to perturbation. Despite this, most studies of infant feeding focus on isolated processes, resulting in a limited understanding of the role of sensorimotor integration in the different processes involved in infant feeding. This is especially problematic in the context of preterm infants, as they are considered to have a pathophysiological brain development and often experience feeding difficulties. Here, we use an animal model to study how the different properties of food acquisition, transport, and swallowing differ between term and preterm infants longitudinally through infancy in order to understand which processes are sensitive to variation in the bolus being swallowed. We found that term infants are better able to acquire milk than preterm infants, and that properties of acquisition are strongly correlated with the size of the bolus being swallowed. In contrast, behaviors occurring during the pharyngeal swallow, such as hyoid and soft palate movements, show little to no correlation with bolus size. These results highlight the pathophysiological nature of the preterm brain and also demonstrate that behaviors occurring during oral transport are much more likely to respond to sensory intervention than those occurring during the 'pharyngeal phase'.
... 35 Second, the brachycephalic mandibular arch format is more common when the child is breastfed, which allows an appropriate tooth eruption position and decreases the chances of malocclusion. 36 Last, exclusive breastfeeding is strongly and inversely associated with the frequency, intensity, and duration of pacifier use, which in turn may lead to severe malocclusion. 20 conclusIon Maternal education is directly associated with the decreased duration of breastfeeding, which in turn leads to higher chances of malocclusion, Mallampati scoring, and the level of posterior crossbites. ...
... 17 Maksillofasiyal bölgedeki büyüme ve gelişim emme, çiğneme, yutkunma ve solunum gibi fonksiyonel uyarılardan etkilenmektedir. 18 Çocuğun anne sütü ile beslenmesi sırasında; emme, yutkunma ve solunum fonksiyonları santral sinir sistemi ile koordine edilir. 19 Çocuk emme fonksiyonunu yaparken, perioral kasların uyarıları çene-yüz sisteminin dengeli bir şekilde gelişmesine katkıda bulunurken 20 bir yandan da yeterli dudak kapanışı ve dilin doğru pozisyonda konumlanması sağlanır. ...
Amaç: Bu çalışmanın amacı, ortodontik anomalilere sebep olabilen oral alışkanlıkların görülme sıklıklarını incelemek ve doğum şekli ve doğum sonrası faktörlerle (anne sütü alımı ve kardeş sayısı) ilişkisini saptamaktır.
Gereç ve Yöntem: Kırıkkale Üniversitesi Diş Hekimliği Fakültesi Ortodonti Ana Bilim Dalı’na 2012-2015 yılları arasında başvuran, 48’i erkek, 92’si kız olmak üzere toplamda 140 çocuğun (yaş ortalaması: 13.56±2.34 yıl) anamnez ve muayene formlarındaki bilgiler değerlendirildi. Çocukların doğum şekli (normal/sezaryen doğum), anne sütü alıp/almama durumu, kardeş sayıları ve oral alışkanlıklarının (parmak veya dudak emme, tırnak yeme, diş sıkma, anormal yutkunma ve ağız solunumu) bulunup bulunmadığı tespit edildi. Ardından doğum şekli, anne sütü alımı ve kardeş sayısının oral alışkanlık ile ilişkisi değerlendirildi. İstatistiksel değerlendirme için ki-kare testi kullanıldı ve p
... Most studies, however, cannot link bottle-feeding with any specific increase in malocclusion. [4,5] Some researchers believe that the tongue position and facial muscles used in bottle-feeding cause malocclusions; [6,7] others believe the shape and texture of the bottle's nipple cause malocclusions. [8] None of the previous articles have related the cause of malocclusions to bottle or nipple angle. ...
Early correction of anterior crossbite in the primary dentition can encourage proper growth and development of the maxilla and mandible, reducing the need for future orthodontic therapy. Correction is typically initiated after the age of 3 when a fixed or removable appliance can be fabricated and worn. This case study describes an instance of exceptionally early intervention without the use of an appliance. A bottle-fed 10-month-old boy presented with anterior crossbite, and a contributing factor may have been the position of the bottle's nipple during feeding. Correction of the anterior crossbite was achieved in 5 months by changing the bottle position to a counterbalancing angle. Although this technique warrants further investigation, it has the potential to reduce the need for and length of future procedures.
... Sucking from the breast induces a stronger aspiration and intra-buccal depression, requiring stronger activity of the lips and propulsion/retro-propulsion movements of the mandible compared to sucking from a bottle [33]. A reduction in masseter activity was indeed observed during bottle feeding compared to breastfeeding [34][35][36][37]; ultimately this different organization may affect craniofacial growth and oral functions [32,38]. The impact of breastfeeding on the duration and number of chewing cycles required to eat solid, viscous and puréed food in infants aged between six and 24 months has not been systematically examined [39]. ...
Complementary feeding (CF), which should begin after exclusive breastfeeding for six months, according to the World Health Organization (WHO), or after four months and before six months according to the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), is a period when the infant implicitly learns what, when, how, and how much to eat. At the onset of CF, the brain and the gut are still developing and maturing, and food experiences contribute to shaping brain connections involved in food hedonics and in the control of food intake. These learning processes are likely to have a long-term impact. Children’s consumption of fruit and vegetables (FV) is below recommendations in many countries. Thus, it is crucial to establish preferences for FV early, when infants are learning to eat. The development of food preferences mainly starts when infants discover their first solid foods. This narrative review summarizes the factors that influence FV acceptance at the start of the CF period: previous milk feeding experience; timing of onset of CF; repeated exposures to the food; variety of foods offered as of the start of the CF period; quality and sensory properties of the complementary foods; quality of the meal time context; and parental responsive feeding.
... The development of the stomatognathic system begins at birth, with the maturation of sucking, breathing, and swallowing. Breastfeeding promotes greater stimulus to the orofacial muscles in comparison with bottle-feeding (20). It may also be related to lower rates of overweight/obesity, since the use of formulas in the first years has been shown to be associated with greater weight gain and increased skin folds (21). ...
Objectives:
Mastication is an essential function that prepares the food for swallowing and digestion and may be related to nutritional status. Thus, the aims of this study were to evaluate the masticatory parameters in overweight and obese children and the relation between bite force and anthropometric evaluation, food consistency, breast/bottle-feeding, and occlusion.
Materials and methods:
The sample consisted of 204 children of both genders, age range 8-10 years, divided into normal weight, overweight, and obese. Unilateral bite force was measured using a digital gnatodynamometer with 10mm force fork. Anthropometric and nutritional evaluation involved the measurements of body mass index and skeletal muscle mass using bioelectric impedance analysis. Occlusion was evaluated as regards orthodontic treatment need and food consistency was analysed using a structured questionnaire. In addition, the time of breast- and bottle-feeding was investigated. The results were submitted to chi-square and correlation tests, analysis of variance, and multiple linear regression to determine the relation between bite force and the independent variables under study (α = 0.05).
Results:
Statistical analysis showed that the time of breast- and bottle-feeding and food consistency did not differ among groups. The regression model showed that body mass index, orthodontic treatment need, and body skeletal muscle mass contributed significantly to the variation in bite force.
Conclusions:
Breast- and bottle-feeding behaviour and food consistency did not differ in normal-weight, overweight, and obese children. However, bite force was dependent on body skeletal muscle mass, body mass index, and orthodontic treatment need.
... Its use in studies to determine the action of the oral muscles in the numerous feeding ways is recent, and few studies are available in the literature about the theme (10,17) . The studies carried out show similarities between the electrical muscle activity in BF and during cup-feeding (10,14,17) and the reduced activity of the masseter muscle in the bottle-feeding than in the cup-feeding (17)(18)(19)(20) . ...
Purpose:
To measure and compare the electrical activity of masseter, temporal, and suprahyoid muscles in premature newborn infants during breast-feeding and cup-feeding.
Methods:
This cross-sectional observational study was carried out by the electromyographic assessment of 36 preterm infants, 53% of whom were male, with mean gestational age of 32 weeks and birth weight of 1,719 g, fed via oral route, by full breast-feeding and supplementation of diet, through cup with expressed breast milk, until 15 days after hospital discharge. Children with neurological disorders, genetic syndromes, oral-motor, and/or congenital malformations were excluded. The different methods of feeding and the variables gestational age at birth, corrected gestational age, chronological age, birth weight and size, head circumference, and Apgar scores at 1 and 5 minutes were analyzed and compared by appropriate statistical analysis.
Results:
No difference was observed between breast-feeding and cup-feeding in the analysis of the temporal and masseter muscles. However, higher activity of suprahyoid musculature was observed during cup-feeding (p=0.001). The other variables were not correlated with the electrical activity of the muscles during the different feeding methods.
Conclusion:
There may be a balance between the activity of the temporal and masseter muscles during breast-feeding and cup-feeding. There was higher activity of suprahyoid musculature during cup-feeding. This can be explained by the greater range of tongue movement, as premature infants usually perform tongue protrusion to get the milk from the cup.
... Few studies evaluated the impact of mode of milk feeding (breast, bottle 383 and cup) on oral muscles activities. A reduction in masseter activity was observed during bottle-384 feeding compared to breastfeeding (Gomes, et al., 2009;Gomes, et al., 2006;Inoue, et al., 1995;385 Sakashita, et al., 1996). Muscles' activity was also shown to change with mode of milk feeding as 386 ...
The first section of this chapter describes the evolutions in oral physiology (anatomical motor components, oral motor skills and feeding skills) in healthy children (< 3 years). The second section describes how each type of texture is accepted at each oral physiology stage, and how exposures to textures impact oral physiology development and acceptability of textures. The third section shows how the need to modify food texture for infant foods is addressed, through national regulations or recommendations from public health bodies, and describes practices of texture modification, based on national surveys and case reports (including baby-led weaning). The chapter is closed by a commentary on future trends and by a description of sources of further information and advice.
... The process of sucking differs between children who are breastfed and those who are fed from a bottle. Children who are breastfed present greater facial muscle activity than those who are bottle-fed, thus promoting more adequate craniofacial growth and development of jaw bones (3,4). The movement of lips and tongue during breastfeeding forces the child to draw breast milk through a squeeze action, while for children who are bottle-fed the movement for obtaining the milk is more passive; therefore, there is greater potential to develop a malocclusion (5). ...
The objective of this systematic review was to investigate if breastfeeding decreases the risk of malocclusions.
Six databases were systematically searched to the end of October 2014. Observational and interventional studies were included. Breastfeeding was evaluated in three categories: a) ever versus never; b) exclusive versus absence of exclusive; c) longer periods versus shorter periods. All types of malocclusion were considered as the outcome. Pooled adjusted odds ratio and its 95% confidence interval (95%CI) were obtained from meta-analyses. Heterogeneity was assessed with both the Q-test and the I-square. Funnel plots and Egger's test were employed to assess publication bias.
Forty-eight studies were included in the systematic review and 41 were included in the overall meta-analysis (n =27,023 participants). Subjects who were ever breastfed were less likely to develop malocclusions than those never breastfed (OR 0.34; 95% CI 0.24; 0.48), those who were exclusively breastfed presented lower risk to present malocclusion than those with absence of exclusive breastfeeding (OR 0.54; 95% CI 0.38; 0.77), and subjects longer breastfed were less likely to have malocclusions than those with shorter breastfed (OR 0.40; 95% CI 0.29; 0.54).
Breastfeeding decreases the risk of malocclusions. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
... 20 Second, the brachycephalic mandibular arch format is more easily reached when the child is breastfed, which in turn allows appropriate tooth eruption position. 21 Finally, exclusive breastfeeding is strongly and inversely associated with the frequency, intensity, and duration of pacifier use, which in turn may lead to severe malocclusion. 8,10 A systematic review regarding the risks and benefits of pacifier use highlighted the negative impact of pacifier use on breastfeeding. ...
The distinct effect of exclusive and predominant breastfeeding on primary dentition malocclusions is still unclear. We hypothesized that exclusive breastfeeding presents a higher protective effect against malocclusions than predominant breastfeeding and that the use of a pacifier modifies the association between breastfeeding and primary dentition malocclusions.
An oral health study nested in a birth cohort study was conducted at age 5 years (N = 1303). The type of breastfeeding was recorded at birth and at 3, 12, and 24 months of age. Open bite (OB), crossbite, overjet (OJ), and moderate/severe malocclusion (MSM) were assessed. Poisson regression analyses were conducted by controlling for sociodemographic and anthropometric characteristics, sucking habits along the life course, dental caries, and dental treatment.
Predominant breastfeeding was associated with a lower prevalence of OB, OJ, and MSM, but pacifier use modified these associations. The same findings were noted between exclusive breastfeeding and OJ and between exclusive breastfeeding and crossbite. A lower prevalence of OB was found among children exposed to exclusive breastfeeding from 3 to 5.9 months (33%) and up to 6 months (44%) of age. Those who were exclusively breastfed from 3 to 5.9 months and up to 6 months of age exhibited 41% and 72% lower prevalence of MSM, respectively, than those who were never breastfed.
A common risk approach, promoting exclusive breastfeeding up to 6 months of age to prevent childhood diseases and disorders, should be an effective population strategy to prevent malocclusion.
Copyright © 2015 by the American Academy of Pediatrics.
... On the one hand, Neiva, Cattoni, Ramos, and Issler (2003) reported that the act of sucking during breastfeeding is important because it promotes the proper development of chewing and swallowing abilities. Moreover, bottle-feeding may delay the growth of the jawbones and contribute to a toothto-denture-base discrepancy (Inoue, Sakashita, & Kamegai, 1995;Sakashita, Kamegai, & Inoue, 1996). Thus, breastfed infants are better able to accept the texture of new foods presented when the weaning process begins. ...
The introduction of weaning foods is a major transition in the development of infants’ eating behavior. Previous studies showed that greater variety at the beginning of the weaning period can later influence an infant’s acceptance of new foods. The aim of the present study was to describe maternal feeding practices in the first year (breastfeeding duration, age at the initiation of weaning, variety of new foods introduced) and to study whether they impacted infants’ later acceptance of new foods in a longitudinal survey of French children’s eating behavior.
Objective:
To demonstrate the importance of utilizing fiberoptic endoscopic evaluation of swallowing (FEES) when evaluating breastfeeding infants with suspected dysphagia. Failure to recognize and account for the fundamentally different physiology of the primarily breastfed infant can lead to false assumptions about the safety of breastfeeding in this understudied patient population.
Methods:
Case-series. The medical records of patients referred to an urban, university-based, pediatric hospital for FEES from February 2017 to October 2020 were reviewed. Their presenting symptoms, dysphagia severity, comorbidity, dysphagia workup, and management were analyzed. The standardized Dysphagia Outcome and Severity Scale was used to appraise dysphagia severity.
Results:
204 FEES exams were reviewed. 35 were conducted on breastfed infants. 34 of the 35 infants calmed for the FEES exam while breastfeeding. Cohorts were defined by a particular presenting sign (cough, laryngeal congestion, choking, and respiratory illness) and anatomical characteristic (laryngomalacia, vocal cord paralysis, aspiration, penetration, etc.) and then compared to all other exams. The average dysphagia score for all the exams was 2.37. Patients presenting with laryngeal congestion had an average dysphagia score of 2.81. There was no difference in dysphagia score based on comorbidities or anatomy.
Conclusions:
FEES is the instrumental exam of choice when evaluating a primarily breastfed infant who has suspected dysphagia. The exam is well tolerated and provides accurate, objective information while accounting for this population's unique swallowing physiology. Primarily breastfed infants presenting with laryngeal congestion are more likely to have clinically worse dysphagia than those presenting with other clinical symptoms.
Level of evidence:
Level 4 Laryngoscope, 2023.
Oral health is an integral part of overall health, and its deterioration negatively affects the general health and the quality of human life. Therefore, the relationship between pregnancy and oral health has been frequently investigated, and possible mechanisms are discussed. The purpose of this chapter is to briefly discuss this relationship and shed light on the importance of preserving oral health during pregnancy.KeywordsOral healthOral infectionsOtolaryngologyPregnancyPostpartum period
The aim of this study was to determine the maximum bite force (MBF) in Amazonian children and young adolescents with normal dental occlusion, the average craniofacial morphology, and investigate associations between craniofacial morphology and body mass with MBF. Ninety-seven children and young adolescents, 21 with primary dentition and 76 with permanent denti-tion and normal dental occlusion were included in the study. Subjects were from Amazonian tribes studying at three schools in Leticia, Amazonas, Colombia. MBF was determined by means of a digital hydraulic pressure gauge. Body mass index (BMI), facial morphology index, and dental arches transverse dimensions were computed in each subject. Mann Whitney test, a one-tailed non-parametric statistical analysis, was used to contrast MBF between primary dentition and permanent dentition. The same statistical analysis was used to determine MBF statistical differences between the various facial morphologies. Pearson correlation statistical analysis was used to evaluate associations between MBF with BMI, dental arches transverse dimensions or facial morphology. Statistical significance was determined at 95 percent level of confidence. A significant difference was found for the MBF between subjects in primary dentition (incisors: 116.57 ± 48.30; right molars: 368.38 ± 105.52; left molars: 322.76 ± 83.77) and those in permanent dentition (incisors: 260.88 ± 85.73; right molars: 459.63 ± 167.11; left molars: 645.67 ± 170.60). In addition, an association was observed between MBF and facial morphology index. It was concluded that MBF significantly increases from primary to permanent dentition in subjects with normal dental occlusion. Furthermore, this study agrees with other reports stating that MBF is associated with the morphology of the face, but not with BMI or dental arches transverse dimensions. Descriptors: Maximum bite force, body mass index, facial morphology, transverse dimensions, primary and permanent dentitions. Resumo O presente estudo teve como objetivo determinar a força máxima de mordida (FMM) e morfologia cra-niofacial média de crianças e adolescentes da região do Amazonas com oclusão dentária normal, e investi-gar associações entre índice de massa corpórea (IMC), morfologia craniofacial e FMM. Participaram do estudo 97 crianças e adolescentes, 21 deles com dentição pri-mária e 76 com dentição permanente, todos com oclu-são dentária normal. Os indivíduos pertencentes a tri-bos amazônicas estudavam em três escolas em Leticia, Artigo original / Original article Orthod. Sci. Pract. 2013; 6(22):158-163. 159 Amazonas e Colombia. A FMM foi determinada utilizando medidor de pressão hidráulica digital. Índice de massa corporal (IMC), índice morfológico, e dimensões transversais dos arcos dentários de cada indivíduo foram registrados. O teste de Mann Whitney, análise unicaudal não paramétrica, foi aplicado na comparação da força máxima de mordida em dentição decídua e permanente. A mesma análise es-tatística foi utilizada para determinar as diferenças estatís-ticas acerca da FMM entre as diferentes características da morfologia facial. O coeficiente de correlação de Pearson foi empregado para avaliar as associações entre FMM e IMC, dimensão transversal dos arcos dentários ou morfo-logia facial. A significância estatística foi determinada com intervalos de 95% de confiança. Diferença significativa foi observada para FMM entre sujeitos com dentição de-cídua (incisivos: 116.57 ± 48.30; molares direitos: 368.38 ± 105.52; molares esquerdos: 322.76 ± 83.77) e aqueles com dentição permanente (incisivos: 260.88 ± 85.73; mo-lares direitos: 459.63 ± 167.11molares esquerdos: 645.67 ± 170.60). Verificou-se ainda associação entre FMM e índi-ce de morfologia facial. Concluiu-se que há um aumento significativo da FMM em sujeitos com oclusão normal após a transição para a dentição permanente. Além disso, os re-sultados do presente estudo apontam a existência de uma associação entre FMM e a morfologia da face e nenhuma relação com IMC ou dimensões transversais dos arcos den-tários, corroborando resultados de estudos anteriores. Descritores: Força máxima de mordida; índice de massa corporal, morfologia facial, dimensões transversais, dentição decídua e permanente.
Background:
Premature infants may demonstrate feeding difficulties requiring an instrumental swallowing assessment. Fiberoptic endoscopic evaluation of swallowing (FEES) is one assessment that can evaluate bottle feeding and breastfeeding.
Purpose:
This pilot study investigated the safety and feasibility of FEES for neonatal intensive care unit (NICU) infants during breastfeeding.
Methods:
The setting for this prospective, descriptive study was an urban level III NICU that provided care for premature and critically ill infants. Participants were 5 infants recruited from a convenience sample who were at least 37 weeks postmenstrual age, demonstrated feeding difficulties during a bedside feeding and swallowing examination, and were breastfeeding. Each participant received a FEES assessment while breastfeeding (FEES-B). Adverse events and vital signs including prefeeding and postfeeding respiratory rate, heart rate, and oxygen saturation level were recorded to assess safety. Visualization of milk, laryngeal penetration, and tracheal aspiration assessed feasibility.
Results:
Participants had a mean postmenstrual age of 39.8 weeks. No adverse events, including epistaxis or laryngospasm, were reported; there were no instances of autonomic instability; and there were no statistically significant differences between prefeeding and postfeeding respiratory rate, heart rate, or oxygen saturation level. Two infants successfully breastfed during FEES-B. Human milk was observable, and laryngeal penetration was noted with 1 infant.
Implication for practice:
FEES-B was found to be safe, with limited data supporting feasibility. Infants demonstrated no physiologic instability during FEES-B, and milk was visualized in the pharynx during breastfeeding with 2 infants.
Implication for research:
Further studies are warranted to assess effectiveness of FEES-B in infants.
All human beings are born with the potential of growing and developing between normal patterns, with the exception of those born with a congenital syndrome or genetic disorder. The pioneers in orthodontics described normal growth as achieving the best proportions of the mouth in a good relation with the other structures of the craniofacial system, maintaining a balance between them, and permitting each tooth to occupy its normal position [1, 2]. Such a statement is currently supported by insights on neurobiology and epigenetics [3–5]. So, the first question regarding the etiology of malocclusions is: are they genetically or environmentally induced?
Introduction
Muscle electrical activity analysis can aid in the identification of oral motor dysfunctions such as those resulting from altered lingual fraenulum which, in turn, impairs feeding. We aimed to analyse suprahyoid muscle electrical activity of infants based on lingual fraenulum attachment to the sublingual (ventral) aspect of the tongue and floor of the mouth, during breastfeeding.
Methods and Results
We studied full-term infants of both genders aged between 1–4 months. Lingual fraenulum evaluation and surface suprahyoid muscle electromyography was performed during breastfeeding. Mean muscle activities were recorded in microvolts and converted into percent values (normalisation) of the reference value. Associations between root mean square and independent variables were tested by one-way analysis of variance and Student’s t-test with significance level of 5% and test power of 95%.
We evaluated 235 infants while breastfeeding. The lingual fraenulum was commonly attached to the tongue’s ventral aspect between middle third and apex, and on the mouth floor visible from the lower alveolar ridge. Lower muscle activity was observed with lingual fraenulum attached to apex/lower alveolar ridge, followed by attachment to middle third/lower alveolar ridge, and between middle third and apex/lower alveolar ridge. Highest activity observed in Infants with attachment to middle third/sublingual caruncles, had a thin lingual fraenulum, performed several sucks followed by short pauses, showed coordination between swallowing, sucking, and breathing, did not “bite” nipple, and showed no tongue snapping nor stress.
Conclusion
Greater suprahyoid muscle activity during breastfeeding was observed with lingual fraenulum attachment to middle third of the tongue/sublingual caruncles, showed coordination between swallowing, sucking, and breathing. Surface electromyography is effective in diagnosing lingual fraenulum alterations, whose attachment point raises doubts as restriction of tongue mobility. This technique identifies possible oral motor dysfunctions, enables direct therapeutic interventions and early intervention, and prevents feeding and communication alterations.
Après avoir exposé la physiologie de la lactation et la composition du lait maternel, nous avons souligné l'importance du lait humain tant pour la santé de la mère que de l'enfant. Les médicaments pris par la femme qui allaite et les pathologies transmissibles à l'enfant par le biais de l'allaitement sont également abordés.Ensuite, la responsabilité de l'allaitement maternel dans l'apparition de caries précoces chez le jeune enfant est étudiée. Le lait humain possède des propriétés carioprotectrices mais aussi cariogènes. Son pouvoir cariogène est limité mais certaines pratiques liées à un allaitement prolongé peuvent représenter comme de véritables facteurs de risque associés. Des moyens de prévention sont alors envisagés. Enfin, l'influence de la tétée au sein et au biberon sur la morphogenèse cranio-faciale est soulevée. Par la stimulation de médiateurs morphogénétiques à une période de croissance exceptionnelle et par l'apprentissage de nombreuses fonctions, l'allaitement maternel peut être considéré comme un moyen de prévention néonatale des dysmorphoses maxillo-faciales.
Ce travail s'intéresse à l'allaitement artificiel et à ses conséquences sur l'enfant. La Franceprésente un des taux d'allaitement maternel les plus bas d'Europe. Les raisons de l'utilisation dubiberon sont variées : difficultés de mise en place de l'allaitement maternel, contre-indicationsmédicales de l'allaitement maternel, difficultés sociologiques, aspects pratiques pour les jeunesmères au travail... La physiologie de la tétée est rappelée et les mécanismes de succion,notamment l'extraction du lait, décrits et comparés en fonction du mode d'allaitement. Par la suite,seront décrites les conséquences médicales, économiques et environnementales de l'allaitementartificiel. Ce mode d'alimentation peut avoir des répercussions médicales : troubles gastrointestinaux,reflux gastro-oesophagiens, otite moyenne, mais susciter également des habitudes desuccion non nutritives, responsables de malocclusion. Ce travail s'intéresse également auxdifférents constituants du lait maternel et du lait artificiel, au biberon lui-meme, avec un intérettout particulier porté à l'importance de la tétine, avec les différents types de tétines et leurscaractéristiques.
Many women do not initiate breastfeeding or breastfeed to the duration recommended by professional associations or public health officials. This is despite epidemiological evidence suggesting substantial positive breastfeedingrelated health effects for children and women. Countries and states have initiated many policies including leave and wage support that can help women to offset some of the career costs that limit breastfeeding initiation and duration. However, the economics of policy do not always suggest that comprehensive policy will be efficient. Efficient policy should be based on the best scientific evidence that the maternal positive health behaviour within the targeted population is low at present and has a high likelihood of changing in ways that have a large impact maternal and child health.
Breast milk is the 'gold standard' of infant nutrition providing not only nutrition for optimal growth but immune protection as well. Many women initiate breastfeeding however few continue to breastfeed for the recommended 6 months (WHO). Management of lactating women is predominately experience-based therefore lack of diagnostic tests and evidence-based treatment is likely to contribute to early weaning. Ultrasound imaging is not routinely used as a diagnostic tool during lactation however new research suggests that is a promising modality capable of identifying both breast and infant sucking pathologies. Imaging of the non-lactating breast is well established however little imaging is performed during lactation.Ultrasound during lactation is relatively simple provided settings are optimized to accommodate the increased amount of glandular tissue. Furthermore an understanding of the growth of the breast during pregnancy and changes during lactation as well as lactation pathology enhance diagnoses. Ultrasound can also be utilized to confirm normal function of the lactating breast. While sufficient milk must be synthesised for the optimal growth of the infant it must also be released during breast feeding or breast expression by the milk ejection reflex.Increasing duct diameter and visualisation of milk flow at milk ejection confirms that the reflex is intact. A successful lactation depends upon the infant's ability to remove milk from the breast. Infant tongue action can be visualised during both breast and bottle feeding. Recently this technique has been employed to assess infants with oral anomalies such as ankyloglossia.It can also be applied to the infants of mother experiencing pain during breastfeeding to determine if compression of the nipple is a contributing factor. Ultrasound techniques have also been developed to image swallowing in both breast and bottle fed infants but have not yet been used extensively to identify swallowing pathology.
INTRODUÇÃO É conceito universal que crianças alimentadas no peito são muito me-nos propensas a desenvolver doenças do que aquelas que receberam outro tipo de alimentação nos seus primeiros meses de vida. Mas o presente capítulo não tratará das doenças decorrentes da subs-tituição do leite materno por leite de vaca ou por fórmulas lácteas industrializa-das. É verdade que, historicamente, as amas-de-leite, as ações entre amigas-do-peito, as doações de leite entre as mulheres lactantes e diversas outras mo-dalidades de aleitamento com leite humano, foram responsáveis por salvar mui-tas vidas. E, modernamente, o leite humano coletado e pasteurizado é uma so-lução brilhante para as mães que não conseguem amamentar os seus filhos. Mas não importa somente o líquido. Este capítulo tratará, isto sim, das doenças decorrentes da utilização da mamadeira (estrutura física) e seus bicos artificiais (diversos tipos) e o quanto eles podem ser nocivos ao desenvolvimento do bebê e à sua saúde como um todo. O conteúdo da mamadeira não será a parte mais importante deste texto. Das várias diferenças entre o peito materno e as mamadeiras, três de-las merecem atenção especial:-Pega, posicionamento da língua e deglutição.-Forma de extração do leite.-Forma e elasticidade dos bicos.
OBJETIVO: apresentar uma proposta de protocolo de avaliação da atividade elétrica dos músculos masseter e supra-hióideos em recém-nascidos pré-termo durante a alimentação. MÉTODO: inicialmente foi realizada uma revisão da literatura nas bases de dados Lilacs e MEDLINE e literatura impressa com o objetivo de identificar protocolos utilizados em estudos nacionais e internacionais sobre a avaliação eletromiográfica em bebês durante a alimentação, priorizando os últimos quinze anos. Foram coletadas informações dos protocolos utilizados em pesquisas com outras populações que pudessem ser usados como base teórica para este estudo. A partir da leitura e análise do material encontrado, foi elaborado um protocolo inicial de avaliação eletromiográfica e este foi aplicado em seis recém-nascidos pré-termo, para verificação da sua viabilidadeRESULTADOS: a busca na literatura e testagem na população resultaram em um protocolo composto por subitens com definição de musculatura avaliada, recomendações de preparação da pele, colocação dos eletrodos, posicionamento para a avaliação, normalização do sinal, atividades para a avaliação, além de sugestões de análise e interpretação do sinal. CONCLUSÃO: o estudo mostra a possibilidade de aplicação deste protocolo da eletromiografia na avaliação destes músculos em recém-nascidos pré-termo durante a alimentação. Os músculos masseter e supra-hióideos são recomendados como uma boa opção para o estudo da atividade elétrica de músculos ativados durante a alimentação em pré-termos. O protocolo ainda recomenda procedimentos de normalização do sinal para melhor interpretação dos dados.
The aim of this study was to develop a minimally invasive technique to evaluate respiratory patterns in preterm infants during feeding.
Methodology
Respiratory flow was obtained with a pneumotachograph coupled initially to a mask and then to a prong, both with a differential pressure transducer. Respiratory plethysmography was used to measure thoraco-abdominal movements. This recording allowed calibration of the preterm infant’s tidal volume prior to feeding experiments. Electromyography was used to monitor oral muscle movements through electrodes attached to the buccinator, masseter and mentalis muscles. A pulse oximeter and cardiac monitor were used for continuous monitoring of vital signs. The infants were positioned vertically in a semi-sitting position in an infant seat.
Results
The methodology developed here was considered effective in achieving the proposed aims. With the integration of all these systems, it was possible to evaluate the respiratory patterns of preterm infants during cup feeding.
Conclusion
This method allows the analysis of respiratory flow, volume, and O2 saturation during feeding and identification of the moment in which a change in breathing occurs (i.e., pausing or feeding). This method is minimally invasive, providing the preterm infant with an environment that is as close to normal as possible.
Breastfeeding is a dynamic process in which the infant recruits several muscle groups in his face, head and throat.
The objective of this study was to explore the relative role of the submental muscle group, the orbicularis oris and the sternocleidomastoid muscles to breastfeeding process and to the relatively high intra-oral vacuum measured during this process.METHODS: Electromyography (EMG) measurements were conducted on 11 infants (mean age 1.91 ± 1.0 days, mean weight 3364 ± 328 g) using surface electrodes. The EMG data were filtered with a low pass filter to yield the linear envelopes (IEMG). The maximal and mean value and the area under each linear envelope curve were examined.RESULTS: During active suckling significantly higher activity (P< 0.05) of the submental muscle group were measured compared with the orbicularis oris and sternocleidomastoid muscles (mean ± SE values of the maximal linear envelope were 24.4 ± 1 μV, 9.6 ± 0.6 μV and 14 ± 0.7 μV, respectively).
These results confirmed that jaw movements have the primary role during breastfeeding, but also revealed that the inspiratory muscles have a substantial contribution to this process and probably have an important role in the generation of intra oral vacuum measured during breastfeeding.
El desarrollo posnatal de las estructuras faciales y dentales dura entre 18 y 25 años. Esta larga duración del período de erupción permite que factores genéticos y ambientales influyan sobre la dentición y la armonía facial. No existe un acuerdo total sobre el momento en el que debe tratarse una maloclusión. Sin embargo, se acepta que las intervenciones tempranas están destinadas a eliminar los factores etiológicos que provocan la maloclusión y a tratar las discrepancias transversales, anteroposteriores y verticales. Las intervenciones tempranas pueden contribuir al desarrollo normal de la oclusión y armonía facial, y cuando ha cesado el crecimiento craneofacial las posibilidades terapéuticas son más limitadas.
This paper aims to present a simple account of the mechanisms by which a baby removes milk from the breast, gleaned from past and current literature, to counter the tendency for inaccurate descriptions of the mechanics of infant sucking to be reproduced. The process is described by which milk is expressed from the lactiferous sinuses within the nipple and breast, by compression of the nipple against the palate by rhythmical pulsations of the surface of the tongue. Active in the process of milk transfer are the roles played by negative suction pressure by the infant, and positive ductal pressure due to action of the mother's milk ejection reflex, which interact in making milk available for removal. The reflexes which the newborn possesses to aid feeding are described and suggestions offered as how best to utilise these reflexes in order to fix a baby successfully on the breast. The intention is that armed with an appropriate understanding of the underlying processes by which milk is transferred from mother to baby a midwife is best equipped to advise a mother regarding the correct technique for achieving trouble-free breast-feeding.
Fourteen newborn babies of different gestational ages (33 to 40 weeks) but similar postnatal age (four to 19 days) were studied during bottle‐feeding using real‐time ultrasonography, combined with respiratory monitoring. Previously undescribed tongue movements and graded changes in the temporal relationships between tongue movements, swallowing and breathing were observed among infants of differing maturity. These were most marked in the least mature infants, but were occasionally seen in term infants. The results suggest that adequate neuromuscular co‐ordination is more a function of gestational maturity than of postnatal sucking experience. The pattern of intraoral events for infants of differing maturity described in this study provides a framework for the study of feeding problems of term and preterm infants.
RÉSUMÉ
Développement de la coordination, de la succion, de la déglutition et de la respiration chez les nourrissons nés à terme et chez les prématurés
Quatorze nouveaux‐nés d'âges differents de gestation (33 à 40 semaines) mais d'âges post‐nataux semblables (quatre à 19 jours) on*** été étudiés durant l'alimentation au biberon en utilisant une échographie en temps reel combinée avec un contrôle respiratoire. Des mouvements de langue non décrits antérieurement et des modifications graduées dans les relations temporelles entre les mouvements de langue, la déglutition et la respiration ont été observés chez les nourrissons de differentes maturités. Ils étaient au plus élevé chez les moins matures des enfants étudiés mais observés occasionnellement chez les nourrissons à terme. Les résultats suggèrent que la coordination neuro‐musculaire adéquate est plus une fonction de la maturité de gestation que de l'expérience post‐natale de succion. La distribution des évènements intra‐oraux pour les nourrissons de differentes maturités décrites dans cette étude fournit une base de travail pour l'étude des problèmes d'alimentation chez les nourrissons à terme et prématurés.
ZUSAMMENFASSUNG
Koordinationsentwicklung von Saugen, Schlucken und Atmen bei reif‐ und frühgeborenen Kindern
Bei 14 Neugeborenen mit verschiedenem Gestationsalter (33 bis 40 Wochen), aber etwa gleichem Lebensalter (vier bis 19 Tage) wurden während der Flaschenfütterung Real‐Zeit Ultraschalluntersuchungen mit gleichzeitigen Aufzeichnungen der Atmung durchgeführt. Es wurden bisher nicht beschriebene Zungenbewegungen und abgestufte Veränderungen in der zeitlichen Relation zwischen Zungenbewegungen, Schlucken und Atmen bei Kindern mit unterschiedlichem Reifegrad festgestellt. Diese waren bei den unreifsten Kindern am ausgeprägtesten, wurden aber auch bei einigen reifen Kindern beobachtet. Die Ergebnisse zeigen, daβ eine richtige neuromuskuläre Koordination eher eine Funktion der Gestationsreife als der postnatalen Saugerfahrung ist. Die Muster intra‐oraler Abläufe bei Kindern unterschiedlicher Reife, die in dieser Studie beschrieben werden, bilden die Basis für Untersuchungen von Fütterungsproblemen bei reif‐ und frühgeborenen Kindern.
RESUMEN
Desarrollo de la coordinación de la succión, deglución y respiración en lactantes a término y pretérmino
Catorce reciàn nacidos de diferentes edades gestacionales (33 a 40 semanas) pero de edad postnatal similar (de cuatro a 19 dias) fueron estudiados durante la toma del biberón usando una ultrasonografia a tiempo real en combinaciòn con la monitorización de la respiración. Entre los lactantes con diferente madurez se observaron movimientos de lengua no descritos previamente, así como cambios graduales en las relaciones temporales entre los movimientos de la lengua, la deglución y la respiración. Esto era marcado sobre todo en los lactantes menos maduros mientras que se observaron raramente en los lactantes a término. Los resultados sugieren que la adecuada coordinación neuromuscular es más una función de la maduración gestacional que de la experiencia succional postnatal. El esquema de los acontecimientos intraorales en lactantes de diferente madurez descritos en este estudio proporciona un marco para el estudio de los problemas de alimentación de lactantes a término y a pretérmino.
Healthy infants' sucking, swallowing and breathing movements were observed ultrasonographically during breast‐ and bottle‐feeding between two and five days after birth. Sucks were found to occur either on their own or in combination with a swallow. Swallows did not occur on their own. Younger babies' swallowing invariably was associated with a pause in breathing. Older babies generally showed better co‐ordination of sucking, swallowing and breathing than younger ones, whether breast‐ or bottle‐feeding.
RÉSUMÉ
Etudes à l'ultrason de l'organisation de la succion et de la déglutition chez le nouveau‐né La succion, la déglutition et les mouvements respiratoires de nouveau‐nés en bonne santé ont étéétudiés par enregistrement ultrasonores durant l'alimentation au sein ou au biberon, entre deux et cinq jours aprts la naissance. La succion a été trouvée isolte ou en combinaison avec un mouvement de déglutition. La déglutition ne survient pas isolément. La déglutition des plus jeunes nouveau‐nés est associée invariablement à une pause respiratoire. Les bébés plus âgés ont montré généralement une meilleure coordination entre succion, déglutition et respiration que chez les plus jeunes, qu'il s'agisse d'alimentation au sein ou au biberon.
ZUSAMMENFASSUNG
Sonographische Untersuchungen des Saugens und Schluckens bei Neugeborenen
Vom zweiten bis fünften Tag nach der Geburt wurden bei gesunden Neugeborenen die Saug‐, Schluck‐ und Atembewegungen beim Stillen und beim Flaschetrinken sonographisch registriert. Das Saugen konnte allein oder in Verbindung mit dem Schlucken auftreten. Das Schlucken wurde nicht allein registriert. Bei jüngeren Babies war das Schlucken immer mit einer Atempause verbunden. Bei älteren Babies war die Koordination zwischen Saugen, Schlucken und Atmen besser als bei den jungeren, unabhängig ob sie gestillt oder mit der Flasche gefüttert wurden.
RESUMEN
Estudio ultrasonográfico de la organización de la succión y deglución en los recién nacidos Se observaron los movimientos de succión, deglución y respiración en lactantes sanos utilizando ultrasonografia durante la alimentación al pecho y al tomar el biberón, dos y cinco dias después del nacimiento. Se observó que el chupeteo tenía lugar aisladamente o en combinación con la deglución. La deglución no tenía lugar aisladamente. La deglución de los niños más pequeños se asociaba invariablemente a una pausa en la respiración. Los niños mayores, en general mostraban una mejor coordinación en la succión, deglución y respiración que los niños más jóvenes tanto si tomaban el pecho como el biberón.
Tooth to denture base discrepancy, one of the major etiologic factors of malocclusion, is considered to have its origin in human evolution. The objective of this study is, therefore, to survey the general trend of the transitional change of frequencies of malocclusion and discrepancy through the history of man.The materials used were 122 skulls from Jomon, Kofun, Medieval, and Yedo eras, preserved in the University Museum, The University of Tokyo. On these materials, the occlusal patterns (malocclusions) and their pathogenetic factors were investigated. The control data for modern Japanese were cited from previous papers of the present authors.Frequencies of normal occlusion were 80% in Jomon period, but gradually decreased to 23.8% in modern age, while those of discrepancy showed a rise from 8.9% up to 63.1%. These remarkable changes seem to support the authors' opinion that the most substantial progress of discrepancy has occurred during these two thousand years, giving a marked influence to the distribution of malocclusions.
Thesis (Ph. D.)--Iowa, 1949.
Electromyographic results may be influenced by electrical interference or artefacts. This investigation shows that when discrepancies occurred between readings made by different operators they were of low magnitude and rarely reached the level of statistical significance. Assuming that recordings are made under ideal conditions, the data may be accepted as a true and reproducible measure of muscle activity.
Suckling is the form of feeding unique to infant mammals. The mechanism used by infant mammals to withdraw liquid from the nipple is the subject of considerable debate. Suckling has been examined in two species of infant mammals: miniature pigs and long-tailed macaques. In both species radio-opaque markers were inserted into the tongue and jaws; the movements of the jaw and tongue (and also of specific regions within the tongue) plus the movement of milk containing barium were studied by high-speed cineradiography (100 and 150 frames/sec). In the case of macaques, simultaneous pressure transducer recordings were also made. In both species, liquid moved out of the nipple as the intraoral space was expanded by a combination of tongue movement (negative pressure pumping) coupled with jaw opening. There was no evidence for expression (positive pressure on the nipple) in either species, strongly supporting the view that a suction mechanism is responsible for acquisition of milk from the nipple. Subsequent intraoral transport was different in the two species. The pigs used a second pump mechanism at the base of the tongue to transport liquid through the pillars of the fauces into the valleculae. The monkeys used a "squeeze-back" mechanism similar to the transport mechanism documented for adult macaques. Further work with other species can test our tentative hypothesis that all mammals use a negative pressure suction for acquisition, but, as is true for adult mammals, infants may use different transport mechanisms to form and move the bolus.
In this study the authors used ultrasound to demonstrate characteristic internal actions of the tongue during suckling. Its medial portion, into which the genioglossus is inserted, moves in relation to its lateral portions, into which the styloglossus and hyoglossus are inserted. A peristaltic wave of successive inferior and superior displacements moves posteriorly in the medial portion, compressing or ‘milking’ the nipple and propelling the expressed milk towards the pharynx. The lateral portions of the tongue enclose the nipple and the bolus and serve as reference for the displacements of the medial portion. These observations are related to anatomical studies of the tongue. The coordination pattern of suckle is compared with that of pharyngeal swallow. In instances where suckle and swallow are immediately sequential, the peristalsis which is common to both is continuous in the oral and pharyngeal portions of the food pathway.
RÉSUMÉ
Démonstration échographique des mouvements de langue durant l'allaitement
Les mécanismes de base de l'allaitement sont précisés. Dans cette étude, les auteurs démontrent une action interne caractéristique de la langue. Sa portion médiane dans laquelle est inséré le génioglosse, se déplace par rapport à ses portions latérales dans lesquelles s'insérent styloglosse et hyoglosse. Une onde péristaltique, de déplacements successifs vers le bas puis vers le haut, se propage postérieurement dans la portion médiane, comprimant ou ‘tirant’ le mamelon et propulsant le lait exprimé vers le pharyns. Les portions latérales de la langue entourent le mamelon et le bolus, et servent de référence pour les déplacements de la portion médiane. Ces observations sont reliées aux études anatomiques de la langue. Le groupement coordonné de l'allaitement est comparé à la déglutition pharyngée. Dans les cas ou succion lactée et déglutition se suivent immédiatement, le péristaltisme commun est continu dans les portions orale et pharyngée de l'alimentation.
ZUSAMMENFASSUNG
Ultraschalldemonstration von Zungenbewegungen beim Saugen
Die Grundmechanismen des Saugens werden dokumentiert. In dieser Studie zeigen die Autoren charakteristische motorische Abläufe in der Zunge. Der mittlere Teil, in den der M. genioglossus einstrahlt, bewegt sich zusammen mit den seitlichen Teilen, in die die Mm. styloglossus und hypoglossus einmünden. Eine peristaltische Welle von aufeinanderfolgenden Bewegungen nach unten und oben verlauft im mittleren Teil nach posterior und komprimiert oder ‘melkt’ den Sauger und bewegt die herausgedrückte Milch in den Pharynx. Die lateralen Teile der Zunge umschließen den Sauger und den Bolus und richten sich nach den Bewegungen des mittleren Teils. Diese Beobachtungen entsprechen anatomischen Untersuchungen der Zunge. Das Koordinationsmuster des Saugens wird mit dem des pharyngealen Schluckaktes verglichen. Wenn Saugen und Schlucken unmittelbar aufeinanderfolgen, ist die Peristaltik im oralen und pharyngealen Anteil des Nahrungsweges kontinuierlich.
RESUMEN
Visión por ultrasonido de los movimientos linguales durante la alimentación por succión
Se ilustran los movimientos básicos de la succión. En este estudio los autores demuestran las acciones internas características de la lengua. Su parte media, donde se inserta el geniogloso, se mueve en relación con sus partes laterales, donde se insertan el estilogloso y el hiogloso. Una onda peristáltica de desplazamientos sucesivos hacia arriba y hacia abajo, se mueve posteriormente en la parte media, comprimiendo un “ordeñado” del pezón y empujando la leche exprimida hacia la faringe. Las partes laterales de la lengua encierran el pezón y el bolo y sirven de referencia para los desplazamientos de la parte media. Estas observaciones se relacionan con los estudios anatómicos de la lengua. El esquema de coordinación de la succion se compara con la deglución faríngea. Cuando la succión y la deglución son inmediatamente secuenciales la peristalsis que es comon a ambas es continua en los segmentos oral y faríngea del paso del alimento.
Suckling is universal among terrestrial mammals, but it is not clear whether mechanisms of suckling are the same in mammals of differing morphology or feeding ecology. An evaluation of the literature on tongue movements during suckling suggests that pigs and dogs may use the tongue differently, with humans being intermediate. Electromyographic (EMG) recordings of the middle and posterior portions of genioglossus of pigs and dogs were compared in order to (1) see whether neuromotor patterns for tongue movement during suckling can be recognized and (2) identify interspecific differences in neuromotor patterns if present. A single pattern of coordination was found in dogs, but results from pigs indicated plasticity, both within and between individuals. The literature on humans indicates that, as in pigs, suckling patterns may vary. In addition to the difference in variability, pigs and dogs differed in EMG burst duration and cycle length. The performance of suckling in pigs, dogs and humans, respectively, resembled the tongue movements used in drinking in each species. The greater plasticity of suckling behavior in pigs (and possibly humans) may be related to an ability to acquire milk under a variety of environmental conditions or to a generally variable feeding process characteristic of omnivorous mammals.
Our study of 16 normal term, breast-fed infants documents real-time ultrasound as a technique for evaluating the oral portion of the sucking mechanism in infants. We also describe the mechanics of sucking used by the infants during breast-feeding.
The sucking rhythms of infants with a benign perinatal course are compared to those of infants with a history of perinatal distress. The ontogenesis of sucking rhythms, and the sucking patterns of children with major congenital malformations of the brain and various metabolic disorders are described. The analysis of rhythms of non-nutritive sucking discriminates to a statistically significant degree between normal infants and infants with a history of perinatal distress who have no gross neurological signs.
An electromyographic investigation of the masseter muscle was undertaken under standardized conditions. Analyses of variance showed no statistical differences in same-day recordings whereas between-day observations were significantly different. After consideration of these results and those of other workers, it is concluded that the source of between-day variation is probably lack of precision in re-locating the electrodes rather than in variable muscle activity.RésuméUne étude électromyographique du muscle masséter est réalisée dans des conditions standardisées. Les analyses de variance ne montrent pas de différences statistiques sur les enregistrements du même jour, alors que les observations entre divers jours sont significativement différentes. En considérant ces résultats et ceux d'autres auteurs, on peut conclure que l'origine des différences d'un jour à l'autre est probablement le manque de précision dans la mise en place des électrodes, plus qu'une activité musculaire variable.ZusammenfassungUnter standardisierten Bedingungen wurde der M. masseter elektromyographisch untersucht. Varianzanalysen ergaben bei Befunden vom gleichen Tag keine statistischen Unterschiede, während Beobachtungen an verschiedenen Tagen signifikant unterschiedlich waren. In Anbetracht dieser Ergebnisse und der anderer Autoren wird der Schluβ gezogen, daβ der Anlaβ für Unterschiede an verschiedenen Tagen vermutlich eher in der mangelhaften Reproduzierbarkeit bei der Lokalisation der Elektroden als in einer variablen Muskelaktivität zu suchen ist.
Influence of tooth-to-denture-base discrepancy on so-called physiologic migration of the first molar was studied on serial dental casts of 116 boys and girls, obtained through a dental health program for school children in an area in which there was no dentist. The alteration of spaces following premature loss of deciduous molars was examined comparing the anterior to posterior discrepancies between tooth and denture base. Modes of space alteration showed positive correlation with the size of the discrepancy, especially in the mandibular dental arches. The space deficiency in the posterior region seemed to have a positive effect on the mesial migration of the first molar. Mesial migration of the first molar seems to be pathologic rather than physiologic and is strongly affected by tooth-to-denture-base discrepancies. Space maintenance does not seem to be useful, because it is not necessary in minimum discrepancy cases and is not effective in severe discrepancy cases.
Cineradiographic films have been taken of babies, lambs and kid goats, taking a mixture of milk and barium from a bottle.
The various types of teat supplied for feeding babies were comparatively ineffective when compared with the soft veterinary rubber teats used for feeding the animals; the performance of the babies was thus not so good as that of the lambs or kid goats.
Our conclusions are:
1. The influence of gravity is important in bottle feeding. It ensures that the bulb of the teat fills. If the hole in the teat is large anough milk drips into the mouth; when rigid teats are used this may be the only way the child can obtain an adequate supply of milk.
2. The lambs and kid goats take one teat full of milk with each jaw and tongue movement; the neck of the teat is completely occluded by approximation of the jaws and the contents of the bulb are expressed into the mouth by elevation of the tongue towards the soft palate, the tongue indenting the bulb from before backwards. Babies usually attempt this movement but in most instances are only partly successful; the teats normally supplied are too rigid and the hole is too small.
3. Following compression of the bulb of the teat by the squeezing action of the tongue, the lowering of the jaw and tongue must cause some degree of suction which may aid in the refilling of the bulb and it may also draw milk into the mouth; the amount of milk obtained in this manner may in favourable circumstances equal the amount obtained by expression.
4. During the phase of compression of the bulb of the teat by elevation of the tongue in the forepart of the mouth there is also taking place simultaneously a lowering of the tongue behind the teat which must cause some suction.
5. Factors relating to the design of different teats have been considered.
6. When milk is swallowed, naso-pharyngeal closure is made by elevation of the soft palate against the adenoidal pad on the roof of the epipharynix, the mode of closure differing from that seen in adults. The relevant variations in anatomy between infants and adults are discussed.
7. The bolus passes through the pharynx on both sides of the superior laryngeal aperture. The larynx is closed as each bolus is expressed from the pharynx and reopened just before the next bolus enters. The theory that young babies and members of the herbivora are able to continue feeding by passing food down into the oesophagus on either side of the laryngeal aperture without closing the airway is disproved.
Cineradiographic films were taken of 41 mothers breast feeding; the mother's nipple and areola were coated with a paste of barium sulphate in lanoline.
Our conclusions are:—
1. The nipple is sucked to the back of the baby's mouth and a teat is formed from the mother's breast.
2. When the jaw is raised this teat is compressed between the upper gum and the tip of the tongue resting on the lower gum. The tongue is applied to the lower surface of the teat from before backwards, pressing it against the hard palate: the teat is reduced to approximately half its former width. As the tongue moves towards the posterior edge of the hard palate the teat shortens and becomes thicker.
3. When the jaw is lowered the teat is again sucked to the back of the mouth and restored to its previous size.
4. Each cycle of jaw and tongue movement takes place in approximately 1·5 seconds. The pharyngeal cavity becomes airless and the larynx closed every time the upward movement of the tongue against the teat and hard palate is completed.
5. These movements are analogous to those seen in bottle feeding: they suggest that the contents of the ducts or cisterns of the teat are expressed into the mouth.
6. The influence of suction upon the flow of milk from the teat has not been established. It is considered that suction may be exerted during the phase of compression of the teat as the tongue is simultaneously lowered behind the teat.
7. It is suggested that the teat is formed from the nipple and the adjacent areola and underlying tissues.
Sucking patterns in newborn in-fants
- N Inoue
- R Sakashita
- T Kamegai
- K Sunagawa
Inoue, N., Sakashita, R., Kamegai, T. and Sunagawa, K. (1993): Sucking patterns in newborn in-fants (in Japanese). Child Health Res., 52, 18-27.
An experimental study on feeding style and development of jaws
- T Oseko
- K Kuroe
- H Matsuo
- H Utsu
- H Ono
- S Oshikawa
- K Yamagata
- G Ito
Oseko, T., Kuroe, K., Matsuo, H., Utsu, H., Ono, H., Oshikawa, S., Yamagata, K. and Ito. G, (1988): An experimental study on feeding style and development of jaws (in Japanese). J. Orthod West Jpn., 33, 33-38.
A study on sucking of sucklings
- Ueshiba
Ueshiba, Y. (1955): A study on sucking of sucklings (in Japanese). Ochanomizu Med. J., 3. 481-502.
Secretion mechanism of breast milk
- S H Hashiguchi
- Kato
- Science
- N Tokyo
- Inoue
Hashiguchi, S. (1983): Secretion mechanism of breast milk (in Japanese). In: Breast Feeding, pp. 187-198. Editor: H. Kato, Medi-Science, Tokyo. N. Inoue et al. /Early Human Development 42 (1995) 185-193 lY3
Unfavorable side effect of civilization In: Culture of Food and Oral Health in Maori
- N Inoue
Inoue, N. (1993): Unfavorable side effect of civilization. In: Culture of Food and Oral Health in Maori, pp. 127-136. Editor: N. Inoue, Therapeia Publishing Co., Tokyo.
Research on development of masticatory behavior
- M Yokomixo
Yokomixo, M. (1992): Research on development of masticatory behavior (in Japanese). J. Dent. Health, 42, 277-306.
For the future health of children and their mouth
- Inoue
Inoue, N. and Sakashita, R. (1992): For the future health of children and their mouth (in Japanese). pp. 1-152, Medi-Science, Tokyo.
Malocclusion, interdental space and dental arch form in colobus monkeys Effect of masticatory function on the age changes of mandibular condyles and fossae
- S Kondo
- N Shigehara
- T Setoguchi
- M Imamura
- K Kuroe
Kondo, S., Shigehara, N., Setoguchi, T. and Imamura, M. (1991): Malocclusion, interdental space and dental arch form in colobus monkeys. J. Growth, 30, 153-167. 1211 Kuroe, K. (1991): Effect of masticatory function on the age changes of mandibular condyles and fossae (in Japanese). J. Jpn. Orthod. Sot., 50, 196-209.
Maturation of orofacial musculature In: Handbook of Orthodontics
- R E R E Moyers
- Moyers
Moyers, R.E. (1973): Maturation of orofacial musculature. In: Handbook of Orthodontics, 3rd ed.. pp. 126-137. Editor: R.E. Moyers, Year Book Medical Publishers, Inc., Chicago.
Abnormal chewing-swallowing behaviors in kindergarten infants (in Japanese)
- Sakashita
Sakashita, R. (1990): Abnormal chewing-swallowing behaviors in kindergarten infants (in Japanese). Igaku-no-ayumi, 155, 753 (abstr).
Experimental approach to jaw reduction
- Ito
Ito, G., Kurce, K., Inoue, N. and Kamegai, T. (1982): Experimental approach to jaw reduction. J. Dent. Res., 61, 596 (abstr).
Dental pathology of hunter-gatherers and early farmers in prehistoric Japan Microevolution of human dentition and dental disease. Studies on tooth-to-denture-base discrepancy
- N Moue
- G Ito
- T Kamegai
Moue, N., Ito, G. and Kamegai T. (1986): Dental pathology of hunter-gatherers and early farmers in prehistoric Japan. In: Prehistoric Hunter-Gatherers in Japan, pp. 163-198. Editors: T. Akazawa and C.M. Aikens, University of Tokyo Press. Tokyo. (141 Inoue, N., Ito, G. and Kamegai, T. (1986): Microevolution of human dentition and dental disease. Studies on tooth-to-denture-base discrepancy (in Japanese), pp. l-249, Ishiyaku Publishing Co., Tokyo.
Investigation of sucking pattern in breast and bottle feeding sucklings
- Sakashita
Sakashita, R. (1991): Investigation of sucking pattern in breast and bottle feeding sucklings (in Japanese). Child Health Res. (Japanese), 50, 514-520.
Role of treatment, prevention and health promotion In: Culture of Food and Oral Health in Maori
- R Sakashita
Sakashita, R. (1993): Role of treatment, prevention and health promotion. In: Culture of Food and Oral Health in Maori, pp. 137-146. Editor: N. Inoue, Therapeia Publishing Co., Tokyo.
Microevolusion of the occlusion in some mammals (Summary)
- Shigehara
Shigehara, N. (1988): Microevolusion of the occlusion in some mammals (Summary). J. Anthrop. Sot. Nippon, 96, 195.
A study on feeding manner and shape of deciduous dentition
- Y Hachino
- M Kuwahara
- A Goto
- Y Watanabe
- K Hattori
- M Minohara
- M Otani
- A Kakei
- H Kitukuri
- K Sato
- T Yamauchi
- T Murai
- R Aoyama
- T Oka
Hachino, Y., Kuwahara, M., Goto, A., Watanabe, Y., Hattori, K., Minohara, M., Otani, M., Kakei, A., Kitukuri, H., Sato, K., Yamauchi, T., Murai, T., Aoyama, R. and Oka, T. (1988): A study on feeding manner and shape of deciduous dentition (in Japanese). J. Jpn. Stomatol. Sot., 37, 855-861.
The mechanism of suck-ling in two species of infant mammal
- R Z German
- A W Crompton
- L C Levitch
- A J Thexton
German, R.Z., Crompton, A.W., Levitch, L.C. and Thexton, A.J. (1992): The mechanism of suck-ling in two species of infant mammal. J. Exp. Zoo]., 261, 332-330.
Microevolution of human dentition and dental disease. Studies on tooth-to-denture-base discrepancy
- Inoue
Collapse of dentition in Japan
- Inoue
Malocclusion, interdental space and dental arch form in colobus monkeys
- Kondo
The mechanism of suckling in two species of infant mammal
- German
Dental pathology of hunter-gatherers and early farmers in prehistoric Japan
- Inoue
Maturation of orofacial musculature
- Moyers
A study on feeding manner and shape of deciduous dentition (in Japanese)
- Hachino
Secretion mechanism of breast milk
- Hashiguchi
Sucking patterns in newborn infants
- Inoue
Unfavorable side effect of civilization
- Inoue