Infant feeding commonly involves occasional spitting up or regurgitation, where milk flows back up the esophagus. A true choking emergency, however, is a distinct and serious situation where the airway is partially or completely blocked, often by aspirated milk. Understanding the difference between these common feeding issues and a sudden airway obstruction is paramount for any caregiver. This knowledge allows for a calm and immediate response during an emergency.
Recognizing the Difference Between Gagging and Choking
The distinction between a gagging infant and a choking infant lies in the presence of sound and the effectiveness of their cough. Gagging is a natural, protective reflex that is often loud, involving coughing, sputtering, or retching sounds. The baby’s face may turn red as they work to clear the obstruction. This indicates the airway is only partially blocked, and the baby is actively attempting to clear it without intervention.
Choking is generally a silent emergency because the airway is fully or severely blocked, preventing air movement required for coughing or crying. A baby who is truly choking will be unable to make any sound, and their attempts to breathe may be quiet or non-existent. Their skin color may quickly change to blue or pale, especially around the lips, signaling oxygen deprivation. Immediate intervention is required when the baby cannot cough, cry, or breathe effectively.
Emergency Response: Step-by-Step First Aid
If the infant is choking—meaning they cannot cough, cry, or breathe—immediately begin a sequence of five back blows and five chest thrusts. Shout for help and ensure emergency medical services are being called. Position the infant face-down along your forearm, using your thigh as support. Ensure the baby’s head is lower than their chest to utilize gravity.
Deliver five distinct, firm back blows using the heel of your hand between the infant’s shoulder blades. The goal is to create a sharp jolt of pressure to dislodge the milk or object. After the back blows, use one hand to support the back of the baby’s head and neck, sandwiching the baby between your forearms, and turn them over to a face-up position.
Once face-up, the infant should be resting on your thigh with their head still lower than their body. Place two fingers in the center of the breastbone, just below the nipple line. Deliver five rapid chest thrusts, compressing the chest about one-third to one-half the depth of the chest (approximately 1.5 inches deep).
Continue alternating between five back blows and five chest thrusts until the blockage is cleared or the infant begins to cough, cry, or breathe effectively. Only attempt to remove milk or an object from the baby’s mouth if you can clearly see it. Blindly sweeping the mouth with a finger can accidentally push the obstruction further into the airway. If the infant becomes unresponsive, the first aid protocol shifts immediately to CPR.
Post-Emergency Care and Medical Follow-Up
Once the baby is breathing, crying, or moving, the immediate emergency has passed, but professional medical attention remains necessary. Even if first aid successfully cleared the airway and the baby appears fine, seek medical evaluation immediately. The forceful nature of the back blows and chest thrusts, while life-saving, carries a risk of internal injury to the chest or abdomen that requires assessment.
If you administered first aid alone, call emergency services immediately after two minutes of intervention or once the baby is breathing again. There is a risk of aspiration pneumonitis or pneumonia following the event, even if the baby is breathing normally, due to milk entering the lungs. A medical professional can assess for any residual lung complications and ensure the baby is stable after the traumatic event.
If the infant becomes unresponsive during the process, immediately begin CPR. Shout for help and then start chest compressions and rescue breaths. Use a cell phone on speaker mode to call 911 while simultaneously providing care. Do not stop CPR until an emergency responder takes over, the baby shows signs of life, or you are too exhausted to continue.
Strategies for Preventing Milk Aspiration
Preventative strategies focus on controlling the flow of milk and optimizing the baby’s feeding position. Always hold the infant in a semi-upright or upright position during feeding, ensuring their head is elevated above their stomach. This position allows gravity to assist in directing milk down the esophagus and helps prevent reflux that can cause aspiration.
For bottle-fed infants, using a paced feeding technique is highly effective. This involves holding the bottle horizontally to allow the baby to control the flow and coordinate sucking, swallowing, and breathing. Ensure the bottle nipple has a slow flow rate, as a hole that is too large can overwhelm the infant and increase the chance of aspiration. Frequent burping during and after a feed helps to release trapped air, which contributes to regurgitation and potential aspiration.
After feeding, keep the baby upright for at least 15 to 30 minutes before laying them down. If the baby consistently struggles with managing the milk flow, shows signs of excessive reflux, or has chronic coughing during feeds, visit the pediatrician. These signs may indicate a swallowing dysfunction or severe reflux that may require specialized interventions, such as feed thickening or a referral to a feeding therapist.