Infant aspiration occurs when substances like food, liquid, saliva, or stomach contents mistakenly enter the windpipe and lungs instead of the esophagus and stomach. This bypasses the body’s protective mechanisms, potentially leading to an obstruction or serious lung injury. Because a baby’s airway is small and their reflexes are still developing, aspiration is a serious medical event requiring immediate attention.
Recognizing the Signs of Aspiration
Aspiration often presents with a sudden, forceful, and persistent cough or choking, especially during or immediately after feeding. The baby may exhibit rapid, strained breathing or wheezing, which is a high-pitched whistling sound caused by air passing through a constricted airway.
Significant airway compromise leads to signs of respiratory distress, such as flaring nostrils, chest retractions, or an inability to make noise or cry. Skin color can change quickly, with the face, lips, or fingernails turning blue or dusky (cyanosis) due to lack of oxygen. A wet or gurgly sound in the voice or breathing following a feed may also indicate liquid has entered the airway.
Immediate First Aid Steps
If the baby is coughing forcefully, allow them to attempt to clear the obstruction on their own, as they are likely moving air. If the baby cannot cough, cry, or make noise, the airway is severely obstructed. Administer up to five back blows to a baby under one year old. Position the baby face-down along your forearm or thigh, ensuring the head is lower than the chest to use gravity to help dislodge the object.
Use the heel of your free hand to deliver five sharp, distinct blows between the baby’s shoulder blades. After the five back blows, quickly turn the baby over onto their back, supporting the head and neck, again keeping the head slightly lower than the rest of the body.
If the obstruction remains, transition to administering chest thrusts. Place two fingers in the center of the baby’s breastbone, just below the nipple line, and deliver up to five quick, downward thrusts. Each thrust should compress the chest about one-third of its depth (roughly 0.5 to 1 inch) at a rate of approximately 120 compressions per minute. Repeat the cycle of five back blows and five chest thrusts until the object is expelled, the baby begins to breathe, or the baby loses consciousness. If alone, perform the maneuvers for two minutes before calling emergency services; if a second person is present, have them call for help immediately.
Follow-up Care and When to Call Emergency Services
Even if the choking maneuver is successful and the baby appears to recover, professional medical evaluation is necessary. Any infant who has received chest thrusts should be seen in a hospital to check for internal injury, such as bruising or trauma to the chest wall. Furthermore, the inhalation of foreign material, even a small amount of liquid, can lead to a secondary condition known as aspiration pneumonia.
Aspiration pneumonia can develop hours or days after the initial event, as foreign material introduces bacteria into the lungs. A persistent cough, fever, or difficulty breathing in the days following the incident warrants an urgent medical visit. Call 911 immediately if the baby becomes unconscious, remains unresponsive, has persistent bluish skin color, or is unable to breathe normally after the obstruction is cleared.
Reducing Aspiration Risk
Implementing specific feeding practices reduces the risk of aspiration in infants. Always hold the baby in an upright position during feeding, elevating the head by at least 30 degrees to direct substances toward the stomach. Avoid feeding the baby while lying flat, as this increases the risk of liquid entering the airway. Pacing the feed is beneficial and can be achieved using slow-flow nipples, allowing the baby time to coordinate their suck, swallow, and breath pattern.
After feeding, keep the baby upright for a minimum of 30 minutes to an hour to minimize gastroesophageal reflux. Reflux occurs when stomach contents travel back up the esophagus and potentially into the airway. Do not feed the baby immediately before being placed down for sleep, as a full stomach increases the risk of reflux and subsequent aspiration.