, Volume 22, Issue 1, pp 37–43 | Cite as

The First Year of Human Life: Coordinating Respiration and Nutritive Swallowing

  • Bronwen N. Kelly
  • Maggie-Lee Huckabee
  • Richard D. Jones
  • Christopher M. A. Frampton


This study provides the first documented report of the maturation of breathing-swallowing coordination during feeding in ten healthy term human infants through the first year of life. A total of 15,073 swallows were obtained across ten assessments between 48 h and 12 months of age. Midexpiratory swallows represented the dominant pattern of breathing-swallowing coordination within the first 48 h (mean = 45.4%), but the prevalence of this pattern declined rapidly in the first week to 29.1% (p = 0.012). Inspiratory-expiratory swallows increased with age (p < 0.001), particularly between 9 (37.0%) and 12 months (50.4%). Between 72.6% and 75.0% of swallows were followed by expiration in the latter 6 months, which is an adult-like characteristic. These data suggest that while postswallow expiration is a robust feature of breathing-swallowing coordination from birth, two major shifts in the precise patterns occur: the first after 1 week of postnatal feeding experience and the second between 6 and 12 months, most likely due to neural and anatomical maturation.


Breathing-swallowing coordination Feeding Infant Deglutition Deglutition disorders 



The authors thank the participants and their caregivers and the interraters Elizabeth Haughey, Li Pyn Leow, and Lauren Ragg. The authors also thank the Foundation for Research Science and Technology for financial support and the staff in the Medical Physics and Bioengineering Department and the Burwood Birthing Unit of the Canterbury District Health Board for their technical support and assistance in subject recruitment, respectively.


  1. 1.
    Polgar G, Weng TR: The functional development of the respiratory system from the period of gestation to adulthood. Am Rev Respir Dis 120(3):625–695, 1979PubMedGoogle Scholar
  2. 2.
    Wilson SL, Thach BT, Brouillette RT, Abu-Osba YK: Coordination of breathing and swallowing in human infants. J Appl Physiol 50:851–858, 1981PubMedGoogle Scholar
  3. 3.
    Weber F, Woolridge MW, Baum JD: An ultrasonographic study of the organisation of sucking and swallowing by newborn infants. Dev Med Child Neurol 28(1):19–24, 1986PubMedCrossRefGoogle Scholar
  4. 4.
    Thach BT, Menon A: Pulmonary protective mechanisms in human infants. Am Rev Respir Dis 131(5):S55–S58, 1985PubMedGoogle Scholar
  5. 5.
    Stevenson RD, Allaire JH: The development of normal feeding and swallowing. Pediatr Clin North Am 38(6):1439–1453, 1991PubMedGoogle Scholar
  6. 6.
    Koenig JS, Davies AM, Thach BT: Coordination of breathing, sucking, and swallowing during bottle feedings in human infants. J Appl Physiol 69(5):1623–1629, 1990PubMedGoogle Scholar
  7. 7.
    Hanlon MB, Tripp JH, Ellis RE, Flack FC, Selley WG, Shoesmith HJ: Deglutition apnoea as indicator of maturation of suckle feeding in bottle-fed preterm infants. Dev Med Child Neurol 39(8):534–542, 1997PubMedCrossRefGoogle Scholar
  8. 8.
    Bamford O, Taciak V, Gewolb IH: The relationship between rhythmic swallowing and breathing during suckle feeding in term neonates. Pediatr Res 31(6):619–624, 1992PubMedGoogle Scholar
  9. 9.
    Selley WG, Ellis RE, Flack FC, Brooks WA: Coordination of sucking, swallowing and breathing in the newborn: its relationship to infant feeding and normal development. Br J Disord Commun 25(3):311–327, 1990PubMedGoogle Scholar
  10. 10.
    Lau C, Smith EO, Schanler RJ: Coordination of suck-swallow and swallow respiration in preterm infants. Acta Paediatr 92(6):721–727, 2003PubMedCrossRefGoogle Scholar
  11. 11.
    Mizuno K, Ueda A: The maturation and coordination of sucking, swallowing, and respiration in preterm infants. J Pediatr 142(1):36–40, 2003PubMedCrossRefGoogle Scholar
  12. 12.
    Selley WG, Ellis RE, Flack FC, Curtis H, Callon M: Ultrasonographic study of sucking and swallowing by newborn infants. Dev Med Child Neurol 28(6):821–823, 1986PubMedCrossRefGoogle Scholar
  13. 13.
    Martin BJ, Logemann JA, Shaker R, Dodds WJ: Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol 76(2):714–723, 1994PubMedGoogle Scholar
  14. 14.
    Morton R, Minford J, Ellis R, Pinnington L: Aspiration with dysphagia: The interaction between oropharyngeal and respiratory impairments. Dysphagia 17(3):192–196, 2002PubMedCrossRefGoogle Scholar
  15. 15.
    Nilsson H, Ekberg O, Bulow M, Hindfelt B: Assessment of respiration during video fluoroscopy of dysphagic patients. Acad Radiol 4(7):503–507, 1997PubMedCrossRefGoogle Scholar
  16. 16.
    McPherson KA, Kenny DJ, Koheil R, Bablich K, Sochaniwskyj A, Milner M: Ventilation and swallowing interactions of normal children and children with cerebral palsy. Dev Med Child Neurol 34(7):577–588, 1992PubMedCrossRefGoogle Scholar
  17. 17.
    Pinnington LL, Smith CM, Ellis RE, Morton RE: Feeding efficiency and respiratory integration in infants with acute viral bronchiolitis. J Pediatr 137(4):523–526, 2000PubMedCrossRefGoogle Scholar
  18. 18.
    Miller MJ, Kiatchoosakun P: Relationship between respiratory control and feeding in the developing infant. Semin Neonatol 9(3):221–227, 2004PubMedCrossRefGoogle Scholar
  19. 19.
    Hadjikoutis S, Pickersgill TP, Dawson K, Wiles CM: Abnormal patterns of breathing during swallowing in neurological disorders. Brain 123:1863–1873, 2000PubMedCrossRefGoogle Scholar
  20. 20.
    Daniels H, Casaer P, Devlieger H, Eggermont E: Mechanisms of feeding efficiency in preterm infants. J Pediatr Gastroenterol Nutr 5(4):593–596, 1986PubMedCrossRefGoogle Scholar
  21. 21.
    Daniels H, Devlieger H, Minami T, Eggermont E, Casaer P: Infant feeding and cardiorespiratory maturation. Neuropediatrics 21(1):9–10, 1990PubMedGoogle Scholar
  22. 22.
    Daniels H, Devlieger H, Casaer P, Ramaekers V, van den Broeck J, Eggermont E: Feeding, behavioural state and cardiorespiratory control. Acta Paediatr Scand 77(3):369–373, 1988PubMedGoogle Scholar
  23. 23.
    Preiksaitis HG, Mills CA: Coordination of breathing and swallowing: effects of bolus consistency and presentation in normal adults. J Appl Physiol 81(4):1707–1714, 1996PubMedGoogle Scholar
  24. 24.
    Tarrant SC, Ellis RE, Flack FC, Selley WG: Comparative review of techniques for recording respiratory events at rest and during deglutition. Dysphagia 12(1):24–38, 1997PubMedCrossRefGoogle Scholar
  25. 25.
    Hoppenbrouwers T, Hodgman JE, Arakawa K, Harper R, Sterman MB: Respiration during the first six months of life in normal infants. III. Computer identification of breathing pauses. Pediatr Res 14(11):1230–1233, 1980PubMedGoogle Scholar
  26. 26.
    Curzi-Dascalova L, Christova-Gueorguieva E: Respiratory pauses in normal prematurely born infants. A comparison with full-term newborns. Biol Neonate 44(6):325–332, 1983PubMedCrossRefGoogle Scholar
  27. 27.
    Hoppenbrouwers T, Hodgman JE, Harper RM, Hofmann E, Sterman MB, McGinty DJ: Polygraphic studies of normal infants during the first six months of life: III. Incidence of apnea and periodic breathing. Pediatrics 60(4):418–425, 1997Google Scholar
  28. 28.
    Hirst LJ, Ford GA, Gibson GJ, Wilson JA: Swallow-induced alterations in breathing in normal older people. Dysphagia 17(2):152–161, 2002PubMedCrossRefGoogle Scholar
  29. 29.
    Preiksaitis HG, Mayrand S, Robins K, Diamant NE: Coordination of respiration and swallowing: effect of bolus volume in normal adults. Am J Physiol 263(3 Pt 2):R624–R630, 1992PubMedGoogle Scholar
  30. 30.
    Hiss SG, Treole K, Stuart A: Effects of age, gender, bolus volume, and trial on swallowing apnea duration and swallow/respiratory phase relationships of normal adults. Dysphagia 16(2):128–135, 2001PubMedCrossRefGoogle Scholar
  31. 31.
    Klahn MS, Perlman AL: Temporal and durational patterns associating respiration and swallowing. Dysphagia 14(3):131–138, 1999PubMedCrossRefGoogle Scholar
  32. 32.
    Praud JP, Reix P: Upper airways and neonatal respiration. Respir Physiol Neurobiol 149(1–3):131–141, 2005PubMedCrossRefGoogle Scholar
  33. 33.
    Carse EA, Wilkinson AR, Whyte PL, Henderson-Smart DJ, Johnson P: Oxygen and carbon dioxide tensions, breathing and heart rate in normal infants during the first six months of life. J Dev Physiol 3(2):85–100, 1981PubMedGoogle Scholar
  34. 34.
    Poets CF, Stebbens VA, Alexander JR, Southall DP: Breathing patterns and heart-rates at 6 weeks and 2 years. Am J Dis Child 142(12):1393–1396, 1991Google Scholar
  35. 35.
    Mizuno K, Ueda A, Takeuchi T: Effects of different fluids on the relationship between swallowing and breathing during nutritive sucking in neonates. Biol Neonate 81(1):45–50, 2002PubMedCrossRefGoogle Scholar
  36. 36.
    Parano E, Uncini A, DeVivo DC, Lovelace RE: Electrophysiologic correlates of peripheral nervous-system maturation in infancy and childhood. J Child Neurol 8(4):336–338, 1993PubMedCrossRefGoogle Scholar
  37. 37.
    Thexton AJ, Griffiths C: Reflex oral activity in decerebrate rats of different age. Brain Res 175(1):1–9, 1979PubMedCrossRefGoogle Scholar
  38. 38.
    Almli CR, Hill DL, McMullen NT, Fisher RS: Newborn rats: lateral hypothalamic damage and consummatory-sensorimotor ontogeny. Physiol Behav 22(4):767–773, 1979PubMedCrossRefGoogle Scholar
  39. 39.
    Sarnat HB: Do the corticospinal and corticobulbar tracts mediate functions in the human newborn? Can J Neurol Sci 16(2):157–160, 1989PubMedGoogle Scholar
  40. 40.
    Paulson G, Gottlieb G: Development reflexes: the reappearance of foetal and neonatal reflexes in aged patients. Brain 91:37–52, 1968CrossRefGoogle Scholar
  41. 41.
    Aboitiz F, Scheibel AB, Fisher RS, Zaidel E: Individual differences in brain asymmetries and fiber composition in the human corpus callosum. Brain Res 598(1–2):154–261, 1992PubMedCrossRefGoogle Scholar
  42. 42.
    Lieberman DE, McCarthy RC, Hiiemae KM, Palmer JB: Ontogeny of postnatal hyoid and larynx descent in humans. Arch Oral Biol 46(2):117–128, 2001PubMedCrossRefGoogle Scholar
  43. 43.
    Sasaki CT, Levine PA, Laitman JT, Crelin ES Jr: Postnatal descent of the epiglottis in man. A preliminary report. Arch Otolaryngol 103(3):169–171, 1977PubMedGoogle Scholar
  44. 44.
    Laitman JT, Reidenberg JS: The human aerodigestive tract and gastroesophageal reflux: an evolutionary perspective. Am J Med 103(5A):S2–S8, 1997Google Scholar
  45. 45.
    Rogers B, Arvedson J: Assessment of infant oral sensorimotor and swallowing function. Ment Retard Dev Disabil Res Rev 11(1):74–82, 2005PubMedCrossRefGoogle Scholar
  46. 46.
    Arvedson JC, Brodsky L: Pediatric Swallowing and Feeding: Assessment and Management, 2nd ed. (New York: Singular Publishing Group), 2002Google Scholar
  47. 47.
    Qureshi MA, Vice FL, Taciak VL, Bosma JF, Gewolb IH: Changes in rhythmic suckle feeding patterns in term infants in the first month of life. Dev Med Child Neurol 44(1):34–39, 2002PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  • Bronwen N. Kelly
    • 1
    • 4
  • Maggie-Lee Huckabee
    • 1
    • 4
    • 5
  • Richard D. Jones
    • 2
    • 3
    • 4
  • Christopher M. A. Frampton
    • 3
    • 4
  1. 1.Department of Communication DisordersUniversity of CanterburyChristchurchNew Zealand
  2. 2.Department of Medical Physics and BioengineeringChristchurch Hospital ChristchurchNew Zealand
  3. 3.Department of Medicine, Christchurch School of Medicine and Health SciencesUniversity of Otago ChristchurchNew Zealand
  4. 4.Van der Veer Institute for Parkinson’s and Brain ResearchChristchurchNew Zealand
  5. 5.Van der Veer Institute for Parkinson’s and Brain ResearchChristchurchNew Zealand

Personalised recommendations