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A Study to Assess the Sucking Reflex of Neonates Born at Selected Hospitals

Authors:

Abstract

Introduction: A reflex is a movement or action that is performed involuntarily or automatically. Reflexes perform many of our basic body functions. Many of newborn baby's body movements are due to reflexes. Some reflex movements occur spontaneously as part of baby's normal day to day activities, other occur in response to other triggers. 1 Sucking problem is a cause of concern for many new mothers, that makes the mothers worried about their babies. Objectives: To assess the sucking reflex of newborn. Method: A descriptive approach was used in assessing sucking reflex of neonates, 120 samples were selected by probability sampling technique. Demographic Performa & Early feeding skill assessment tool used for data collection. Results: It showed that majority of the neonates 97(80.8%) were having very good sucking reflex, 23 (19.2%) were having fair sucking reflex.
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391
Volume 5 Issue 12, December 2016
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
A Study to Assess the Sucking Reflex of Neonates
Born at Selected Hospitals
Charanpreet Kaur1, Mukesh Chandra Sharma2
1M.Sc Child Health Nursing
2Associate Professor Child Health Nursing
Abstract: Introduction: A reflex is a movement or action that is performed involuntarily or automatically. Reflexes perform many of
our basic body functions. Many of newborn baby’s body movements are due to reflexes. Some reflex movements occur spontaneously as
part of baby’s normal day to day activities, other occur in response to other triggers.1Sucking problem is a cause of concern for many
new mothers, that makes the mothers worried about their babies. Objectives: To assess the sucking reflex of newborn. Method: A
descriptive approach was used in assessing sucking reflex of neonates, 120 samples were selected by probability sampling technique.
Demographic Performa & Early feeding skill assessment tool used for data collection. Results:It showed that majority of the neonates
97(80.8%) were having very good sucking reflex, 23 (19.2%) were having fair sucking reflex.
Keywords: Sucking reflex, Neonate
1. Introduction
The sucking reflex which is present in most full-term babies
& some pre-term babies, usually fades by around 3 months
of age. The sucking reflex is strongest when the palate is
stimulated. Sucking not only provides a source of
nourishment it also has calming effect on babies. The urge to
suck is stronger in some babies than in others. Many babies,
particularly those under 3 months of age, will want to suck
for periods of time in addition to when they are feeding.2
2. Background
The sucking reflex is probably one of the most important
reflexes in newborn, especially when it is paired with the
rooting reflex. If we touch the roof of the baby’s mouth with
finger, a pacifier or a nipple, he will instinctively begin
sucking. Around 2 to 3 months of age, baby’s sucking will
be a result of conscious effort & no longer a reflex. Every
time the baby exhibits this reflex, it doesn’t necessarily
mean that he is hungry. Sucking is soothing enjoyable
activity for the baby.3
Yawning, sucking a thumb & swallowing amniotic fluid can
first be seen in babies at about 12 to 13 weeks of the
pregnancy. The sucking & swallowing reflexes do not fully
mature until about 36 weeks of the pregnancy. The baby
needs to coordinate the reflexes simultaneously to drink
milk. This is known as sucking-swallowing-breathing
sequence. Sucking can be triggered when a finger, breast,
bottle or dummy is placed into the mouth of the baby &
pressure is applied to their palate. This stimulates the
sucking reflex, which can be quite strong & rapid .3
3. Material & Methods
Research Design
In relation to the study descriptive design was selected.
Observation of the neonates was done during feeding by
using Early Feeding Skill Assessment Scale.
Research Setting
The study was conducted at Gian Sagar Medical College &
Hospital and Rajindra Hospital of District Patiala, Punjab.
Rajindra hospital is also a multispecialty 1250 bedded
government hospital with high patient ratio.
Target population
The target population for a study is the entire set of
individuals to be used to make inferences. In this study the
target population was of neonates from birth to 48 hours of
delivery.
Sample & Sampling Technique
In this study total 120 neonates from birth to 48 hours of life
from the Gian Sagar Medical College & Hospital, Rajindra
hospital of Distt. Patiala were selected by using probability
sampling technique. Firstly the researcher located the
sample then checked for the inclusion criteria. After that
random allocation of subjects was done by lottery method.
Inclusion criteria
1) Neonates born by Normal Vaginal Delivery.
2) Neonates born with Lower Segment Caesarian Section.
3) Pre-term neonates >34 weeks.
4) Out born neonates who have sucking problems.
5) Neonates born with instrumental delivery
Exclusion criteria
1) Pre-terms <32 weeks of gestation.
2) Meconium aspirated babies.
3) Sick neonate requiring mechanical ventilation.
4) Cleft lip & cleft palate.
5) Trachea-esophageal fistula & Atresia.
6) Diaphragmatic hernia.
7) Neonates who already initiated their feeding.
8) Whose parents do not agree to participate
Selection & development of tool
Tools were selected according to the objectives of the study.
Demographic Performa to assess the characteristics of
neonates & Early Feeding Skills assessment scale (EFS) was
Paper ID: ART20163729
1268
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391
Volume 5 Issue 12, December 2016
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
used to assess the sucking reflex of newborns. Early Feeding
Skills assessment scale (EFS) is a standardized tool & the
demographic performa was developed after discussion with
guide.
Score Interpretation
In the score interpretation part scores were 3, 2, 1. Score 3
was assigned to very good response, score 2 was assigned to
fair response, 1 was assigned to poor response. Maximum
score was 45 & minimum was 15.
Validity
Early Feeding Skills (EFS) assessment scale is a
standardized tool developed by Suzanne Thoyre. The author
did the validation of the tool with the help of experts from
the scientific publication library the Cochrane reviews.
Reliability
The author of the tool Suzanne Thoyre calculated the
reliability with the help of Kappa inter-rater reliability that is
>0.80 & the tool was reliable.The reliability of the tool was
also tested by the experts of Cochrane library & the author
of the tool.
Pilot study
It was conducted on 12 subjects after obtaining permission
from the concerned authority of hospital. The subjects were
selected by probability random sampling technique.
Data Collection Procedure
A written permission was obtained from the concerned
authority prior to the study. 120 samples were selected by
researcher by using probability random sampling technique
by lottery method. Parents and guardians of the neonates
were explained about the purpose of the study & written
consent was taken from them, parents information sheet was
also provided to them for their knowledge in their respective
language. Socio-demographic Performa & Early Feeding
Skill assessment scale (EFS) was used by the researcher to
assess the sucking reflex. Then the researcher started data
collection. Observation was done by using the Early feeding
Skill assessment scale.
Ethical consideration
The study was started after the approval of the ethical
committee of Gian Sagar Medical College & Hospital, Ram
Nagar, Rajpura, District Patiala & concerned authorities of
selected hospitals of Distt. Patiala Parents of the subjects
were assured about the confidentiality of data collected.
Plan For Data Analysis
The data collected was planned to analyze in terms of
objectives of the study by using descriptive statistics.
4. Results
Table 1: Frequency and Percentage distribution of the
sample characteristics
S.
No.
Demographic Characteristics
Sample
f
%
1
Any Intervention Done At Birth
Yes
No
1
119
1
99
2
Apgar Score at 1 & 5 minute
0-3
4-6
7-10
0
7
113
0
6
94
3
Age of the neonate
12 hours
24 hours
48 hours
31
45
44
25
38
37
4
Weight of the baby
Less than 2.5 kg
3kg
Above 3 kg
46
55
19
38
46
16
5
Length of the baby
41-44c.m
45-48c.m
49-52c.m
110
10
0
92
8
0
6
Head circumference
33c.m
34c.m
35c.m
118
2
0
98
2
0
7
Chest circumference
30c.m
31c.m
32c.m
33c.m
116
4
0
0
97
3
0
0
8
Gender of the baby
Male
Female
77
43
64
36
9
Baby born
Pre-term
Term
Post-term
5
114
1
4
95
1
10
Gestational age
Less than 34 weeks
34 weeks
34-37 weeks
0
2
118
0
2
98
11
Mode of the delivery
Normal vaginal delivery
Lower segment caesarian section
Instrumental delivery
53
67
0
44
56
0
12
Place of the delivery
In hospital born
At home
Out hospital born
120
0
0
100
0
Table 1 reveals about the demographic characteristics of the
sample, their frequency & percentage distribution. In this
table it is shown that the majority of the neonates 119(99%)
received no intervention at birth. Maximum of the neonates
113(94%) were having normal apgar score at 1 minute & 5
minutes, only 7(6%) were having fairly low apgar score.
About the age, majority of the neonates 45(38%) were
having age of the 24 hours, 44(37%) were having 48 hours
of age, only 31 (26%) were having 12 hours of age.
Regarding the weight of the baby majority of the neonates
55(46%) were having weight of 3 kg, whereas only 19(16%)
were having weight above 3 kg. Regarding length, majority
of the neonates 110(92%) were having length up to 44 c.m,
10(8%) were having up to 48 c.m. Regarding head
circumference, majority of the neonates 118(98%) were
Paper ID: ART20163729
1269
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391
Volume 5 Issue 12, December 2016
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
having upto 33 c.m, 2(2%) were having upto 34 c.m.
Regarding the chest circumference majority of the neonates
116(97%) were having normal chest circumference, only
4(3%) were having upto 31 c.m. About the gender of the
neonates 77(64%) were male & 43(36%) were female.
About the birth, 114(95%) were born at term, only 5(4%)
were born pre-term. Regarding the gestational age majority
of the neonates 117(98%) were having gestational age upto
37 weeks, only 3 (3%) were having gestational age of 34
weeks. About the mode of delivery, maximum 67(56%)
neonates were born by lower segment caesarian section,
53(44%) were born by normal vaginal delivery. Regarding
the place of the delivery 120(100%) neonates were born in
hospital department.
Table 2: Frequency & Percentage Distribution of sucking
reflex scores of neonates by Early Feeding Skill Assessment
Scale (N=120)
Table 2 depicts the frequency & percentage of sucking
reflex scores of neonates by Early Feeding Skill assessment
Scale. It shows that majority of the neonates 97(80.8%) were
having very good sucking reflex, 23 (19.2%) were having
fair sucking reflex.
Table 3: Mean, SD of sucking reflex scores of neonates
Table 3 shows that mean & SD scores of sucking reflex of
neonates was 32.30±2.55 by Early Feeding Skill
Assessment Scale.
5. Discussion
Similar studies related to the sucking reflex by Alberts4et al
conducted an observational study & observed that the
babies who are born with normal delivery have a good
sucking reflex as compared to those who are born with
LSCS. This study showed that how the event of birth & birth
stimuli contribute to learn to sucking an important step
towards the management of early feeding problems. Tolly5
et al conducted a thematic analysis study in which it was
concluded that sucking reflex outcomes are poor after LSCS
as compared to normal vaginal delivery. 115 mothers were
taken as sample & interviews were conducted. Majority of
the mothers were facing the same difficulties like pain &
positioning, due to this feedings of babies were delayed as a
result sucking reflex was poor. Loke6et al conducted a
descriptive correlation study design & a total of 199 women
recruited after the delivery & concluded that the 33%
mothers after C-section are not ready to feed the baby
immediately because of the pain present at suture site & the
need of assistance for the positioning.(p=.045). 48% were
feeling pain at episotomy & were primi. White-Traut7et al
et al conducted a prospective study to assess the feeding
problems & feeding progression weekly. Sucking
progression was measured by the Medoff Cooper Nutritive
Sucking Apparatus (M-CNSA) which measured the negative
sucking pressure generated during oral feedings was poor.
Scheeren8et al conducted a observational study in which the
sample consisted on 26 mother/ baby born with LSCS. Data
was collected from medical records, & the observation of
the babies was conducted during feeding. The finding of the
study is that the reason for poor sucking is position of the
mother & child, affection & due to the responses of the baby
to the feed were very poor. Vineeta Raghavan9et al
conducted a prospective observational cohort study on 400
mothers who delivered term healthy babies (normal,
instrumental or caesarean section). Breastfeeding was
initiated to 255 out of 400, i.e 64% of babies. Cesarean
delivery & male gender were strongest risk factors for a
delayed initiation of breastfeeding (95%) & 83% babies
were exclusively breastfed & 43% failed to continue
breastfeed due to poor sucking reflex.
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Paper ID: ART20163729
1270
... Research shows 19.2% neonates born were having fair sucking reflex. 8 Oral stimulation in the neonate can stimulate the maturation of the motor sensory system in the oromuscular area for sucking and the breastfeeding process. 8 Stimulation in the oromuscular in neonatal preterm has been shown to shorten the transition period of oral feeding to full oral feeding, and increase feeding efficiency. ...
... 8 Oral stimulation in the neonate can stimulate the maturation of the motor sensory system in the oromuscular area for sucking and the breastfeeding process. 8 Stimulation in the oromuscular in neonatal preterm has been shown to shorten the transition period of oral feeding to full oral feeding, and increase feeding efficiency. 3 ...
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The purpose of this article was to present the case of a premature infant who displayed immature feeding progression because of nasal occlusion. Two male preterm infants of 33 weeks' gestational age at birth from a larger randomized trial were observed in a comparative case study. Using a prospective design, feeding assessments were conducted weekly from initiation of oral feeding until hospital discharge. Sucking organization was measured using the Medoff-Cooper Nutritive Sucking Apparatus (M-CNSA), which measured negative sucking pressure generated during oral feedings. Oral and nasogastric (NG) intake and vital signs were recorded. At 35 weeks, infant A demonstrated an immature feeding pattern with the M-CNSA NG feedings prevailing over oral feedings. When attempting to feed orally, infant A exhibited labored breathing and an erratic sucking pattern. During the third weekly feeding evaluation, nasal occlusion was discovered, the NG tube was discontinued, and phenylephrine (Neo-Synephrine) and humidified air were administered. Following treatment, infant A's sucking pattern normalized and the infant maintained complete oral feeding. Infant B demonstrated normal feeding progression. Nasal occlusion prevented infant A from achieving successful oral feeding. The M-CNSA has the ability to help clinicians detect inconsistencies in the sucking patterns of infants and objectively measures patterns of nutritive sucking. The M-CNSA has the potential to influence clinical decision making and identify the need for intervention.
First hour initiation of breastfeeding & exclusive breastfeeding at six weeks prevalence & predictors in a tertiary care
  • R Vineeta
  • B Bhavneet
  • K Praveen
Vineeta R, Bhavneet B, Praveen K. First hour initiation of breastfeeding & exclusive breastfeeding at six weeks prevalence & predictors in a tertiary care. IJN 2013;73:267-70
Early conditions in the breastfeeding of pre-mature newborn infants
  • B Scheeren
  • Ap Mengu
  • Bs Devincenzi
Scheeren B, Mengu AP, Devincenzi BS. Early conditions in the breastfeeding of pre-mature newborn infants. 2012 Nov;17(9):1648-57
Sucking & swallowing disorders in the newborn. Sucking & swallow disorders in the newborn Available from: URL:http://www.uptodate
  • C Lau
Lau C. Sucking & swallowing disorders in the newborn. Sucking & swallow disorders in the newborn [online] 1996 [2014 Feb 13]; [2 pages]. Available from: URL:http://www.uptodate.com/.../
Suck problems during breastfeed
  • T A Behar
Behar TA. Suck problems during breastfeed. [online].
Sucking problems & breastfeed
  • M K Nagim
Nagim MK. Sucking problems & breastfeed. [online].
Maternal accounts of their breastfeeding infant & early challenges
  • K P Tolly
Tolly KP et al. Maternal accounts of their breastfeeding infant & early challenges. 2013 Nov;18:224-28