When a baby makes unusual sounds during breastfeeding, it can cause alarm for parents. True “wheezing” is a high-pitched, musical, whistling sound that originates from a narrowing in the lower airways, specifically the lungs, and is usually heard when breathing out. Many common infant sounds during feeding are often mistaken for this true wheezing, requiring careful observation to determine the source of the noise.
Distinguishing Normal Feeding Noises from True Wheezing
Infants frequently produce a variety of sounds while feeding that are normal and do not indicate a respiratory issue. Sounds such as snorting, clicking, gurgling, and squeaking are common due to the small size of a baby’s nasal passages and the coordination required for sucking, swallowing, and breathing. Gurgling noises often result from saliva or milk pooling in the back of the throat or the upper airway.
True wheezing is a tight, musical sound heard primarily during exhalation, indicating constriction deeper in the chest’s bronchial tubes. A different sound, called stridor, is a harsh, high-pitched noise heard when the baby inhales, suggesting an obstruction in the upper airway, such as the larynx. Since infants coordinate breathing and feeding simultaneously, any noise is often amplified because the baby is actively using their mouth and throat muscles.
Feeding Technique and Milk Flow Issues
Many noisy feeding events are mechanical problems related to the breastfeeding process, rather than internal medical issues. An improper or shallow latch, where the baby does not take enough breast tissue into the mouth, often causes a distinct clicking or smacking sound. This occurs because the baby repeatedly breaks the suction seal while attempting to draw milk, which can also lead to gulping air.
A forceful milk letdown, also known as an overactive milk ejection reflex, can overwhelm an infant and mimic distress. When the milk flows out quickly due to the mother’s supply, the baby may gasp, choke, or gulp rapidly as they struggle to manage the volume. This intake of air and milk can produce a sound that parents mistake for wheezing as the baby attempts to coordinate the suck-swallow-breathe pattern.
If a forceful letdown is suspected, immediate adjustments can help the baby manage the flow. Trying a laid-back nursing position, where the mother reclines and the baby lies tummy-to-tummy, uses gravity to slow the milk flow. Hand-expressing milk before latching can release the initial, most forceful flow, allowing the baby to start feeding once the rate has moderated. These changes help the baby control the pace and reduce the gulping that causes noisy breathing.
Congestion and Airway Related Causes
Internal physiological factors can contribute to noisy breathing during breastfeeding. Newborns are obligate nose-breathers, meaning they instinctively breathe only through their noses for the first few months of life, especially when feeding. Even a small amount of dried milk or mucus can partially block their narrow nasal passages, leading to a snorting or rattling sound, known as stertor, that is often loudest during feeding.
Nasal congestion caused by a common cold, dry air, or mild allergies forces the baby to work harder to breathe while trying to breastfeed. This increased effort in the upper airway can create sounds that are misinterpreted as wheezing. Using saline drops and gentle nasal suction before a feed can clear these minor obstructions, improving the baby’s ability to breathe smoothly.
A structural condition called laryngomalacia is a common cause of high-pitched, squeaky breathing, or stridor, in infants. This occurs because the cartilage of the larynx is softer than usual and partially collapses inward when the baby inhales. Laryngomalacia is a benign, self-limiting condition that tends to worsen when the baby is agitated, feeding, or lying on their back. Although it sounds alarming, it resolves on its own as the larynx strengthens, usually by 12 to 18 months of age, but it does warrant a diagnosis by a medical provider.
Critical Signs Requiring Immediate Medical Attention
While most noisy feeding sounds are harmless, certain accompanying signs indicate true respiratory distress that requires immediate medical evaluation. One primary red flag is cyanosis, a bluish or grayish color appearing around the lips, tongue, or nail beds, signaling low oxygen levels. Any change in skin color during a feeding is a serious concern.
Increased work of breathing is a clear sign of an emergency and can manifest in several ways. Look for visible retractions, where the skin pulls inward between the ribs, below the ribcage, or at the notch above the collarbone with each breath. Flaring of the nostrils and an increased breathing rate, known as tachypnea, show that the baby is struggling to get enough air. If noisy breathing is accompanied by lethargy, difficulty waking, or an inability to stay latched and feed, seek immediate medical attention.