Audible swallows

What if I don't hear swallowing?

It is normal to hear a baby swallowing at the start of a feed, but it doesn’t mean the baby is getting enough milk. Mothers will hear swallows even if there is not enough milk. As babies grow, they swallow less frequently and get better at handling the let-down, so swallowing becomes harder to hear. One tool related to audible swallows used by health-care providers is the suck-swallow ratio, the number of sucks for each swallow. The expectation is about one swallow for each suck, but studies have found that the ratio changes within the first month and even varies within a feed, so it’s hard to tell what is an abnormal ratio. There are better ways to assess milk intake.

A) Audible swallows

It is normal to hear your baby swallow (audible swallows) at the start of the feed with the larger let-downs. You may also hear gulping and heavy breathing. Some babies will choke at the start of the feed. These are all signs that the baby is taking in a lot of milk.

It is also possible to see a baby swallow: the underside of the chin and upper throat will temporarily fill. This becomes harder as the baby becomes chubbier and the neck fills in.

B) Using audible swallows to gauge milk intake

Some mothers are told to listen for their baby’s swallows to ensure that their baby is breastfeeding effectively and taking in enough milk. However, there are better ways of assessing milk intake. Audible swallows is a good sign but not a very reliable way to assess whether your baby is getting enough milk.

That’s because:

  • You will hear swallows even if there is not enough milk.
  • The baby’s swallows become harder to hear as the feeding progresses.
  • As babies grow:
    • They can handle the let-downs better, so swallows become harder to hear.
    • Swallows become fewer (Qureshi et 2002).

C) Suck-swallow ratios

Another tool used by some health-care providers is the suck-swallow ratio, the number of sucks for each swallow. Their expectation is that there should be about one swallow for each suck:

  • A 1:1 ratio means one suck for every swallow.
  • A 3:1 ratio means three sucks for every swallow.

However, one study found that suck-swallow ratios change from 1:1 to 2:1 and 3:1 within one month after birth (Qureshi 2002). Another showed that suck-swallow ratios vary widely even during one feed (Sakalidis 2013) so it can be hard to tell a normal feed from an abnormal one.

If you do use suck-swallow ratios, it is best to use them only in the first few weeks of your baby’s life and combine this with other ways of ensuring that your baby is taking in enough milk and growing well.

References

Qureshi MA, Vice FL, Taciak VL, et al. Changes in rhythmic suckle feeding patterns in term infants in the first month of life. Dev Med Child Neurol. 2002 Jan;44(1):34-9
 
Sakalidis VS, Kent JC, Garbin CP, et al. Longitudinal changes in suck-swallow-breathe, oxygen saturation, and heart rate patterns in term breastfeeding infants. J Hum Lact. 2013;29(2):236-245