Sucking reflex – swallowing

The sucking-swallowing reflex is one of the first reflexes demonstrated by the child in his development. This behavior can be observed during pregnancy . It usually begins to appear around the 12th to the 13th week of pregnancy . During this period, the fetus can demonstrate the beginnings of this reflex by thumb- sucking , yawning, or swallowing. At 36 weeks, the reflex is usually fully developed. At birth, the child should be able to suck and swallow immediately.


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  • 1 Function
  • 2 Permanence
  • 3 Dysfunction
  • 4 The choreography of sucking and swallowing during breastfeeding
  • 5 Types of sucking during breastfeeding
    • 1 Nutritious and non-nutritive
    • 2 Ripe and immature
    • 3 Correct or incorrect
  • 6 Newborn and infant sucking-swallowing disorders
  • 7 Source


The sucking-swallowing reflex is a vital part of the infant feeding process . Pressing an object against the palate triggers the sucking reflex. Babies often suck on any object, such as a finger, by touching that region. When fed, the sucking reflex draws milk from the breast or bottle. Since milk enters the mouth , it initiates the swallowing reflex . The two reflexes work together, allowing the baby to swallow the milk while suckling to express more.


Unlike other reflexes associated with feeding, swallowing remains reflexive as the baby becomes an adult . Adults can consciously suppress swallowing, but it is usually triggered by a reflex as the tongue moves food into the back of the mouth. The search reflex, which turns the baby’s head towards any object that touches the mouth or cheek, disappears at around four months, as the child learns to direct its own head movements , while the reflex of sucking lasts until the baby is about a year old.


The swallowing reflex is crucial for infant nutrition. When the reflex doesn’t work properly, the child’s health may be in danger. A number of different conditions affect this reflex. Premature babies or babies suffering from other diseases like cerebral palsy may not have fully developed the swallowing reflex. This reflex may not be present, or the coordination between sucking, swallowing, and breathing may be affected. This can lead to suffocation as milk blocks the baby’s airway .

Choreography of sucking and swallowing during breastfeeding

When a baby activates the search reflex (occurs by brushing his cheeks or lips with any object) the following occurs:

  • The tongue is located above the lower gum.
  • The tongue protrudes (comes out) above the gum.
  • The tongue sags into a U.
  • The lower jaw rises and directs the areolaand nipple a few millimeters beyond the point where the hard and soft palates meet (point S).
  • Short, repetitive suckling activates the milk ejection reflex.


  • The lips seal the chest and secure it inside the mouth.
  • The tongue covers and passes the lower gum, and remains in this position.
  • The baby makes a negative intraoral pressure (PIN).
  • When the baby’s tongue descends at the back, the PIN is maximum and the milk flows into the baby’s throat.

Types of sucking during breastfeeding

The sucking of the baby while breastfeeding has been classified in different ways by different authors depending on the frame of reference in which it occurs.

Nutritious and non-nutritive

Babies perform two types of sucking: the nutritive and the non-nutritive. Nutritious sucking is what they use to eat. It is a deep and rhythmic suction that usually lasts a few minutes and gives way to non-nutritive suction, which is carried out towards the end of the feeding. However, if the mother has a milk ejection reflex during feeding and the baby wants more milk, she will return to suckling.

Non-nutritive sucking, on the other hand, is superficial and rapid, and it is not uncommon to hear that the baby “is using the mother’s pacifier” when performing this type of sucking, although it is the pacifier that wants to be an imitation of chest, not the other way around. We must not neglect non-nutritive sucking, nor avoid it, since while babies do it they “practice”, so to speak, for nutritive sucking, and while they are taking small amounts of milk rich in fat that accumulate in the mouth . When they have it full, they swallow it, so even while doing this type of sucking they are feeding.

Babies combine the two types of sucking to obtain all the food they need, since in both cases they stimulate the prolactin and oxytocin receptors located in the nipple and areola, and therefore milk production.

During nutritive sucking, the child has rounded cheeks and is seen to move his jaws. You also hear how he swallows (there is a need for silence). As the baby matures and evolves, so do his sucking and swallowing patterns. The effectiveness of the shots will depend on this evolution.

Ripe and immature

Mature sucking is characterized by a cycle of 10 to 30 suctions without pauses to breathe, since the child perfectly coordinates both processes, sucking-swallowing and breathing. Once the child begins to suck, the tongue makes peristaltic movements that move the milk bolus from the esophagus, at which point swallowing occurs and the cycle begins again.

Immature sucking is characterized by a cycle of 3 to 5 sucks, followed by a pause of the same duration in which the baby breathes, since he is not able to suck and breathe at the same time in a coordinated manner.

If a baby has an immature sucking pattern, once the pathological causes are ruled out, you have to be patient and wait for it to evolve. As is often the case with spontaneous learning processes, it is a matter of time (not all children start walking at the same time: some will do so at 8 months, others at one year and others at 15 months).

Right or wrong

The correct suction is one that allows the baby to feed optimally and effectively without damaging the breast or causing any type of discomfort to the mother. On the contrary, the experience is pleasant and pleasant for both of them.

Incorrect suckling is one that can cause problems for the mother (pain, trauma, infection …), the baby (little weight gain, irritability …) or both.

Some babies are more susceptible to incorrect sucking, such as premature babies, with delayed intrauterine growth, hypertonic or hypotonic (S. Down, S. Piere Robin …) and those with some type of pathology in the oral cavity ( ankyloglossia , cleft palate , cleft lip …).

Babies who have been separated from their mothers, those born in childbirth with anesthesia or analgesia, and also those babies who are stressed or manipulated for one reason or another are also susceptible to having incorrect suckling .

Finally, babies who suck in a bad position or have suffered from the interference of pacifiers and teats will also suck incorrectly.

To redirect this situation and achieve a correct and pleasant suction, it will be necessary to analyze case by case, assess the possible causes, remedy them or find a way to compensate them. At the same time, it is necessary to ensure a sufficient milk intake by the baby and to treat the mother if necessary. In some cases it may be useful to perform suction physiotherapy exercises. Incorrect suction has also been subdivided into:

  • Disorganized sucking: the baby is able to latch on to the breast but often ineffectively, causing pain to the mother.
  • Dysfunctional sucking: The baby seems to not know what to do with the tit and is unable to latch on by itself.

Sucking-swallowing disorders of newborn and infant

Sucking-swallowing disorders may be due to malformations, neurological abnormalities, or delayed functional maturation. In newborns with facial abnormalities, neurological disorders, or early respiratory distress, the priorities are to ensure airway patency and to assess the risks of oral feeding. In infants, sucking-swallowing disorders are suspected in the face of feeding difficulties, recurrent respiratory signs, and poor weight gain. The clinical evaluation consists of the analysis of the nutritional and respiratory status, the facial, oral and general examination, as well as the observation of food intake. Radiographic scans, Electromyographic and manometric measurements help to elucidate the mechanism of the disorders and assess their severity to determine the prognosis and guide practical behavior. Obstructive anatomic abnormalities, fissures, and diastemas require ENT or maxillofacial surgery. The other situations are due to neurological alterations due to injuries or functional type, which can appear in isolation or associated with malformations. Treatment consists of applying adequate feeding modalities to prevent accidents by aspiration, while ensuring correct nutrition. The other situations are due to neurological alterations due to injuries or functional type, which can appear in isolation or associated with malformations. Treatment consists of applying adequate feeding modalities to prevent accidents by aspiration, while ensuring correct nutrition. The other situations are due to neurological alterations due to injuries or functional type, which can appear in isolation or associated with malformations. Treatment consists of applying adequate feeding modalities to prevent accidents by aspiration, while ensuring correct nutrition.


by Abdullah Sam
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