The Development of Oral Feeding Skills in Infants

Abstract

Appropriate nutritional intake is a major component of growth in infants. Interests in nutrition customarily have been centered on the types of nutrients and caloric intake offered, for example, the benefits of mother's milk over that of formula, presence/absence of growth factors, and potential advantages provided by probiotics early in life [1, 2]. An important component of infant nutrition that has been overlooked until recently is the ability of infants to take their nutrients by mouth safely and successfully. As the majority of healthy term newborns are readily taken to the breast or bottle soon after birth, the ability to feed by mouth generally does not raise concern. However, over the last two decades, health professionals along with families of infants born prematurely have come to realize that a great number of these infants, notwithstanding the type of milk taken (mother/donor milk, formula), cannot readily feed by mouth which puts them at risk of adverse events ranging from oxy-gen desaturation to aspiration pneumonia [3]. Long-term oral feeding difficulties resulting from such early incom-petence have also been identified through the increased feeding disorders clinics that follow these infants [4–6]. Unfortunately, basic knowledge regarding the development and physiology of infant oral feeding skills is still lacking. No medical events solely impact on a patient's condition [7]. This is particularly true with infants who are helpless and must rely on caregivers, particularly their mother, for survival. Consequently, infant's growth and development become a function, not only on their own maturing attributes and their surroundings, for example, neonatal intensive care unit or home environment, but also on the quality of their interactions with mother/caregivers during difficult times. If feeding difficulties persist, consideration of the quality of interactions within the mother-infant dyad must be taken into account. Figure 1 is an attempt to summarize the complexity of this paradigm. This special issue presents some of the latest clinical and basic research concerns in this area, but is by no means representative of the intricacies of the above model. Each of these studies addresses a particular piece of the puzzle. How-ever, if safe and successful oral feeding is of primary concern when working with infants, it is essential to keep in mind that multiple factors can lead to the same adverse outcomes, rendering the identification of the primary causes difficult. N. Bertoncelli et al. presented a summary review of our current understanding of bottle feeding competence in healthy preterm infants. A. Jenik et al. addressed one of the most common clinical issues experienced by preterm infants when transitioning from tube to independent oral feeding, namely, hypoxic episodes during bottle feeding. However, based on the above oral feeding puzzle, pulmonary imma-turity/insufficiency ought not be systematically presumed as the culprit. S. M. Barlow et al. noted that frequency modu-lation and spatiotemporal stability of nonnutritive sucking bursts were differentially expressed in infants with and without respiratory distress syndrome. As these measures