Variability in Swallowing Biomechanics in Infants with Feeding Difficulties: A Videofluoroscopic Analysis.
Laura Fuller, Anna Miles, Isuru Dharmarathna and 1 others
PMID 35298686WHAT IT FOUND
Swallow timing and displacement vary naturally in infants with feeding difficulties and do not predict aspiration risk.
However, a suck-to-swallow ratio greater than 3:1 and high variability in that ratio are significantly associated with increased aspiration risk.
Key findings
01Variability in pharyngeal timing and displacement measures was present within infants but showed no significant correlation with aspiration status or Penetration-Aspiration Scale scores.
02Infants with a suck-to-swallow ratio greater than 3 sucks per swallow had a higher frequency of aspiration (66%) compared to those with fewer than 3 sucks per swallow (33%).
03Greater variability in the suck-to-swallow ratio within a single feed was significantly associated with higher maximum Penetration-Aspiration Scale scores.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Small sample size (50 infants) limits the generalisability of the findings. The study excluded infants who could not complete a 20-second feed loop due to severe aspiration or non-compliance, potentially biasing the sample towards those with more stable feeding patterns. Gestational age was not recorded, only corrected chronological age, making it difficult to account for prematurity effects. Bolus volume was not measured, so variability in swallowing mechanics could have been a response to changes in flow rate or volume rather than intrinsic biomechanical inconsistency. No normative data for healthy infants was available for comparison, so it is unclear if the observed variability is typical for this age group.
Declared interests
Funding was provided by the University of Auckland. The authors declared no other conflicts of interest.
The easy way to misread this
Do not assume that irregular swallow timing or displacement indicates pathology in infants. The study found these variations are common and unrelated to aspiration. Safety concerns should be driven by the suck-to-swallow ratio and its variability, not by biomechanical inconsistency alone.