The development of normal feeding and swallowing.

The development of feeding skills is an extremely complex process influenced by multiple anatomic, neurophysiologic, environmental, social, and cultural factors. Most children negotiate the necessary developmental sequence without significant difficulties. An understanding of the development of normal feeding abilities aids the pediatrician in monitoring this remarkable process in his or her normal patients. This understanding also helps equip the pediatrician who is challenged by a child with complex feeding problems. The following statements summarize the major elements of feeding development. 1. Structural integrity is essential to the development of normal feeding and swallowing skills. Infant anatomy differs from adult anatomy. Anatomic changes associated with growth affect feeding function. 2. Normal infant feeding is reflexive, under brainstem control, and does not require suprabulbar input. As feeding development progresses, basic brainstem-mediated responses come under voluntary control through the process of encephalization. 3. The mature swallow consists of a voluntary oral-preparatory phase, a voluntary oral phase, and involuntary pharyngeal and esophageal phases. The infant swallow does not have a voluntary oral-preparatory and oral phase but is otherwise similar. 4. The neurophysiologic control of feeding and swallowing is complex and involves sensory afferent nerve fibers, motor efferent fibers, paired brainstem swallowing centers, and suprabulbar neural input. Close integration of sensory and motor functions is essential to the development of normal feeding skills. 5. Feeding development, although dependent on structural integrity and neurologic maturation, is a learned progression of behaviors. This learning is heavily influenced by oral sensation, fine and gross motor development, and experiential opportunities. 6. The basic physiologic complexity of feeding is compounded by individual temperament, interpersonal relationships, environmental influences, and culture. 7. The main goal of feeding is the acquisition of sufficient nutrients for optimal growth and development. Malnutrition may result directly from feeding problems and may also help perpetuate them. 8. Protection of the airway during swallow is a reflexive, multileveled function consisting of the apposition of the epiglottis and aryepiglottic folds and the adduction of both false and true vocal folds.