Breastfeeding is the most natural and healthy way to feed your baby. But babies choking during a feed can be a very stressful and scary experience for moms.
There are several reasons why this may happen. One of the most common reasons babies choke when breastfeeding specifically is due to an oversupply of breast milk. When there is too much milk flow too quickly your baby may not be able to swallow it all at once, leading to choking or spluttering.
Another reason is your baby’s position during feeding. If you and your baby aren’t in a good breastfeeding position then this can cause the milk to flow too quickly, leading to choking.
Sometimes certain medical conditions, such as reflux or a tongue tie, can also cause a baby to choke while nursing. I have my own personal experience of this with my second baby which I will discuss later.
So, “Why does my baby choke while breastfeeding?”. Let’s find out.
Why Does My Baby Choke While Breastfeeding?
In this section, I will discuss the causes and signs of choking during breastfeeding.
Causes of Choking
Choking occurs when your baby takes more milk into their mouth than they can swallow. Excess milk can spill into the airway and block airflow, leading to choking.
This can happen due to an overactive letdown (also known as a forceful letdown)
Oversupply of milk.
It can also happen if your baby’s mouth is not latched on correctly, or the nursing position is not optimal. This can occur with bottle feeding too.
In some cases, choking can be due to a functional reason, such as a hyper-gag reflex. All healthy babies are born with this exaggerated but protective reflex which is designed to protect their airways.
Transitioning from bottle to breast can be overwhelming if the mother’s milk flow is faster than the bottle’s nipple.
Signs of Choking
It can be frightening for any mother to see her baby coughing and sputtering milk while struggling to breathe. There is a difference between gagging and choking. The signs of a baby choking on milk during breastfeeding include:
- unable to cough
- lips may be blue and face red
milk coming out of their nose or mouth (if choking on milk)
- inability to make much sound or cry
- loss of consciousness or becoming unresponsive
NOTE: A baby that is coughing, crying, breathing or making loud noises is not fully choking. They may be gagging. If your baby is coughing and removing milk from their mouths they are not fully choking but will still need help from you and you must not leave them.
Dealing with a Choking Episode
First Aid for Choking While Breastfeeding
As a paramedic, I have first-hand experience of babies choking both at work and with my own children. The steps to take if you suspect choking in a baby are similar whether you believe it is due to a solid object or liquid. In the context of this article, we will discuss choking when breastfeeding.
1. Act quickly
Prepare yourself by learning the signs to look for (see above). The most likely time your baby will show choking signs during breastfeeding is right at the beginning when first latching.
2. Stay calm
It’s important to stay calm and not panic. Your baby can sense your emotions, so remaining calm can help them feel more secure.
3. Take your baby off the breast
Quickly and efficiently stop feeding and put your baby upright in a leaning forward position with good neck support (you can support their chin with your hand but don’t press on their neck). This repositioning alone may solve the problem or at least prevent further milk from entering their mouth. Allow your baby to cough and splutter while talking in soothing tones. He/she may prefer a more upright position and this is ok too.
4. Check for breathing and shout for help
Check to see if your baby is breathing. A limp and floppy baby or one who is turning red or blue in the face while not making sounds is not breathing. If they are not breathing or having difficulty breathing, shout for help or call the emergency services but do not leave your baby.
5. Perform back blows
If your baby is still choking (little to no sound is coming from their mouths) position your baby so their head is lower than their chest and bottom. Do this by laying your baby across your lap (when you are sitting) with their chest to your thighs and head lower than their body. You can also lay them across your arm. Again this positioning also may be enough to help remove the blockage.
If it does not then perform back blows: using the base of your hand firmly hit between the shoulder blades 5 times. With each blow, you are aiming to remove the blockage. Without moving your baby check to see if this has helped.
6. Perform chest thrusts
After 5 back blows and the blockage is still present perform chest thrusts. Turn your baby over and lay on your lap again or on your arm with their head supported. Place 2 fingers between the nipples and push sharply up to 5 times. Again frequently assess if this has removed the blockage.
Repeat the 5 back blows and 5 chest thrusts until the blockage is removed or professional help takes over.
Although you must be confident when performing back blows and chest thrusts you must carefully observe that your baby is choking and not just coughing.
6. Seek expert medical attention
All babies who have had a choking episode that required back blows or chest thrusts require medical attention immediately.
When to Seek Emergency Care
NOTE: If your baby is choking and is unable to breathe, turns blue, or loses consciousness, call for emergency help immediately.
In addition, if your baby chokes frequently, it’s important to speak with your baby’s pediatrician. They may recommend changes to your breastfeeding routine, such as adjusting your let-down or expressing milk by hand, to prevent future episodes.
How To Prevent Your Baby From Choking When Breastfeeding
Ensure that your baby is latched on correctly.
Use an upright nursing position. You may find a supportive breastfeeding chair helps with this.
Take breaks during feeding to burp your baby.
If you have a milk oversupply or faster milk flow, try pumping before feeding.
If you are bottle feeding your baby, use the appropriate nipple size and feeding position.
If you notice your baby choking frequently, consult with your pediatrician or a lactation consultant.
Ensuring that your baby is latched properly when breastfeeding is crucial to prevent choking. Make sure your baby’s mouth is wide open and covers most of the areola, not just the nipple. This ensures that your baby gets enough milk and reduces the risk of choking.
Using a pacifier can help prevent choking while breastfeeding. Choose pacifiers specifically for breastfed babies as this can help them to strengthen their sucking technique. It can also help soothe your baby and reduce the risk of sudden infant death syndrome (SIDS).
To reduce the chances of your baby choking, consider changing your breastfeeding position. A laid-back position can be quite effective. In this position, the mother lies on her back in her chair slightly propped up, and the baby is placed on her chest. This position allows your baby to control the flow of milk better using their free hand and maintain a good head position, reducing the risk of choking.
This involves feeding your baby from only one breast per feeding or for a few consecutive feedings (a few hours), which can help manage an oversupply. Once your baby settles and seems content, you can switch to the other breast for the next block. If your baby is still hungry after feeding from one breast, you can put them back on the same breast until the next feeding time.
Handling Forceful Letdown
If a forceful let down (also known as overactive letdown or forceful ejection where the milk releases at a fast rate) is the issue, you might want to try expressing some milk before nursing. Hand express or pump just enough milk to alleviate the pressure of too much milk supply for your baby. This can slow down the flow when your baby latches on, preventing choking.
Apply pressure to your breasts using your free hand to help control the flow. This method, known as counter pressure, can be particularly useful during the first few seconds of feeding when the flow is often the fastest.
Aspiration, in medical terms, refers to the inhalation of either solids or liquids into the airway and lungs, which can potentially lead to serious complications such as pneumonia. While aspiration is a concern with any type of liquid or food, breastmilk is generally not harmful if aspirated in small amounts because it’s a natural substance and doesn’t irritate the lungs as much as artificial substances. That said, frequent, severe, or large-volume aspiration can still cause problems, including aspiration pneumonia.
In healthy, full-term babies, the risk of aspiration during breastfeeding is minimal due to their natural reflexes. However, for preterm babies, babies with certain medical conditions, or those with swallowing or feeding difficulties, the risk may be higher. If your baby chokes and aspirates during feedings, it’s essential to speak with a pediatrician or a specialist in feeding issues. They can provide guidance based on your baby’s specific circumstances.
Choking during breastfeeding, though alarming for both baby and parent, is a common issue typically linked to a too-rapid milk flow. Oversupply and overactive let-down are the usual culprits. If choking leads to wheezing or breathing difficulty in your baby, seek immediate medical attention. Sometimes, such episodes may warrant an emergency room visit.
Preventing choking involves finding a comfortable feeding position where your baby’s head is elevated and aligned with their body. If you have an oversupply, consider expressing some milk before feeding or using a breast pump to control the flow.
Choking is preventable with proper techniques, but persistent issues or other complications should be discussed with a healthcare provider. Remember, every mother-baby duo is unique. Patience is key as you discover what works best for you and your baby, whether that’s a different position or regulating an oversupply. Stay open to various methods and remain patient in your journey.
My second child was born with severe laryngomalacia (a problem swallowing). His breathing was noisy and the poor boy couldn’t swallow properly so I was breastfeeding him every hour (exhausting!!). He would often choke and splutter – as a paramedic, I knew what to do but it was still distressing.
He had surgery at 11 weeks old and improved slowly after that (learning to manage a nasogastric tube in a baby is no joke!). Even so, his gag reflex was strong and he was always able to clear his airway with a good few coughs and careful supportive positioning. I always tell every new parent to trust their instincts – if you think something isn’t right then take your baby to a doctor urgently.
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