Athletic development specialists dedicated to the art and science of excellence in movement

Suck-Swallow-Breathe: The Origins of Advanced Motor Control

“Infant feeding is a complex process, requiring the precise coordination of sucking, swallowing, and breathing. The pharynx is the shared anatomic pathway for both swallowing and breathing; however, these two activities are mutually exclusive. Therefore, the pharynx must be continually reconfigured so that an infant can successfully eat and breathe at the same time” (Goldfield 2009)

Suck-swallow-breathe coordination is one of the first motor control benchmarks for a young child.  The muscles required for suck-swallow-breathe aid mature posture and movement.  These muscles develop in concert with other senses too, but their origins live with maturation and coordination in the nervous system.  Looking, reaching, uprighting, and nearly all reflex movement patterns rely on the suck-swallow-breathe musculature. 

It is also believed that suck-swallow-breathe synchrony allows for advanced attentional focus.  Sucking is one of the first tasks the infant learns to do for an extended period, and shifting to swallowing is one of the first ways the infant learns to divide its attention by shifting tasks.  Quite simply, if the baby can’t focus on sucking for nutrition, it stands a poor likelihood of survival.  Tunnel vision on a particular task is not optimal, but lack of focus (ADD for older kids...) is equally undesirable.  There’s still much unknown about HOW this actually occurs, but it’s obvious that healthy babies have developed competency at this skill, otherwise they would not be healthy.    Failure to master this skill as an infant can be fatal (common in preemies) or lead to permanent disability (cerebral palsy, etc).  

Evidence actually quantifies how this skill improves over time...Kelly (2007) studied 15,073 swallows among infants and found a noted shift toward post-expiratory swallows with age, moving away from mid-expiratory swallows.  Younger infants (48 hours) primarily utilized mid-expiratory swallowing patterns, before shifting to inspiratory-expiratory swallowing as the dominant pattern through month 12.  Beyond month 12, the pattern shifted toward having independent swallow-breathe phases, which is the mature pattern naturally used by healthy adults.  

Inadequate development of suck-swallow-breathe synchrony is not commonly discussed in adults but is one possible theory behind sleep apnea, poor stability, and overall poor motor control.  Further, basic observation shows that most adults have poor breathing mechanics for a variety of reasons.  Nevertheless, dysfunctions are not permanent.  Suck-swallow-breathe patterns result from central pattern generators.  Central pattern generator simply means we have a downloaded code for suck-swallow-breathe, just as we have central pattern generators for other movements like reaching, walking, and squatting, among many others.  

The central pattern generators are believed to be independent programs, development of one program can support other programs.  Hence, it is possible that addressing suck-swallow-breathe can improve other dysfunctions.   (“Relevant central pattern generator networks and their neuromuscular targets attain functional status at different rates, which ultimately influences cross-system CPG interactions.  Cross-system interactions among these CPGs represent targets of opportunity for new interventions, which optimize experience-dependent mechanism”) (Barlow 2009)

What does this mean for performance?   Breathing is critical.  The ability to control breathing and simultaneously perform other high level tasks is inherent in sports.  Oral/facial mechanics are often overlooked, but are critical for oxygen saturation and trunk stability.  The ability to simultaneously respirate AND retain a stable trunk begins with suck-swallow-breathe synchrony.   

Still doubt the importance of suck-swallow-breathe synchrony?   How well do you suck-swallow-breathe under high stress?  Food ingestion and breathing are both elementary tasks, yet become extraordinarily difficult under acute stress.  These tasks also suffer during chronic stressful periods.  As Professor Sapolsky reminds us, stress is a beneficial adaptation to deal with life threatening events...when you are being chased by a lion on the savannah, you’re not thinking about swallowing your next meal...you’re worried about not becoming the lion’s next meal!  The subconscious ability to funnel survival resources is a beneficial adaptation to keep us alive, but can have profound impacts on movement when stress is chronic.    

Above all, suck-swallow-breathe is a critical movement milestone.  We know that failure to achieve mastery of certain milestones will have consequences at various levels, from serious neuromuscular disorders to motor control limitations in higher level skill acquisition.  Looking at suck-swallow-breathe coordination is just potentially viable way of “going back to basics.”  

Barlow SM. Central pattern generation involved in oral and respiratory control for feeding in the term infant.  Curr Opin Otolaryngol Head Neck Surg.2009 Jun;17(3):187-93.

Kelly BN,Huckabee ML,Jones RD,Frampton CM.  The first year of human life: coordinating respiration and nutritive swallowing.  Dysphagia.2007 Jan;22(1):37-43. Epub 2007 Jan 13.

Eugene C Goldfield, Michael J Richardson, Kimberly G Lee, and Stacey Margetts Coordination of Sucking, Swallowing, and Breathing and Oxygen Saturation During Early Infant Breast-feeding and Bottle-feeding Pediatric Research(2006) 60, 450–455; doi:10.1203/01.pdr.0000238378.24238.9d


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