It is understandable for parents to feel alarmed when their newborn appears to be choking. These incidents are common and often a normal part of development rather than a serious medical emergency. Understanding the reasons and knowing how to respond can provide reassurance and help ensure a baby’s safety.
Understanding Newborn Choking
Newborn choking is distinct from normal gagging or spitting up. Gagging is a natural reflex preventing foreign objects or excess liquid from entering the airway, often characterized by retching sounds. Spitting up, or reflux, involves the effortless expulsion of small amounts of milk, usually due to an immature digestive system.
True choking occurs when the airway is partially or fully blocked, leading to difficulty breathing. A newborn’s airway is narrow, making them susceptible to blockages from even small amounts of fluid or food. Their swallowing coordination is still developing, meaning the synchronized action of breathing, sucking, and swallowing has not yet fully matured.
Common Reasons for Choking
Immature Swallowing Reflex
A frequent cause of choking in newborns is their immature swallowing reflex and coordination. The developing interplay between the mouth, throat, and esophagus can lead to milk or saliva inadvertently entering the airway. Protective mechanisms, like the epiglottis closing over the trachea, are not always perfectly timed.
Rapid Milk Flow
Rapid milk flow during feeding can overwhelm a newborn’s ability to swallow. From a breast with a strong let-down reflex or a fast-flow bottle nipple, abundant milk can enter the baby’s mouth quicker than they can process it. This leads to gulping, coughing, and choking as the baby struggles to manage the volume.
Gastroesophageal Reflux (GER)
Gastroesophageal reflux (GER) is another common contributor, where stomach contents, including milk and acid, flow back up into the esophagus and sometimes into the throat. This backward flow can irritate the airway or be aspirated, leading to coughing, gagging, and choking episodes, particularly after feeds. The immature lower esophageal sphincter in infants often allows for this reflux.
Excessive Mucus or Saliva and Feeding Position
Excessive mucus or saliva can also challenge a newborn’s small airway. Babies produce significant saliva, and if congested or with more mucus than usual, they may struggle to clear their throats, resulting in gurgling sounds and choking. Additionally, a baby’s feeding position influences choking likelihood. Feeding in a fully reclined position makes it harder for gravity to assist swallowing, increasing the risk of milk entering the airway.
Strategies to Reduce Choking Incidents
Proper Feeding Techniques and Positions
Implementing proper feeding techniques and positions can significantly reduce choking. For bottle-fed infants, paced bottle feeding allows the baby to control milk flow, mimicking breastfeeding pauses. This involves holding the bottle horizontally, allowing the nipple to fill partially, and taking breaks for the baby to swallow and breathe. For breastfed babies, a deep and effective latch helps manage milk flow and prevent gulping. Holding the baby in an upright position, with their head elevated, utilizes gravity to aid swallowing and prevent milk from flowing back up, keeping the airway clear.
Frequent Burping
Frequent burping during and after feeds helps release swallowed air, which can contribute to discomfort and reflux. Burping a baby after every ounce or two of formula, or when switching breasts, can prevent an overly full stomach. This practice helps reduce stomach pressure, lessening the likelihood of milk regurgitation and choking.
Managing Reflux and Nasal Passages
Managing reflux involves keeping the baby upright for at least 20-30 minutes after each feed. Offering smaller, more frequent feeds can also prevent the stomach from becoming overly distended, which can exacerbate reflux symptoms. These measures help keep stomach contents down, reducing the chance of them entering the airway. Ensuring a clear nasal passage, especially before feeds, is also beneficial. Using a saline nasal spray and a bulb syringe can help clear congestion, allowing the baby to breathe more easily through their nose during feeding, which supports coordinated sucking and swallowing.
Immediate Action During a Choking Episode
Recognizing Severe Choking
Recognizing the signs of severe choking is important for a parent. If a newborn is truly choking, they may be unable to cry, cough effectively, or make sounds. Their skin might also begin to take on a bluish tinge, especially around the lips and face, indicating a lack of oxygen. Immediate action is necessary to clear the airway.
Infant First Aid
Basic infant first aid for choking involves back blows and chest thrusts. For infants under one year old, deliver five firm back blows between the shoulder blades with the heel of one hand while supporting the baby’s head and neck. If the obstruction is not cleared, turn the baby over and deliver five chest thrusts using two fingers in the center of the chest, just below the nipple line. Parents should seek hands-on training from a certified instructor in infant CPR and choking first aid, as correct technique is important for effectiveness.
When to Call Emergency Services
If the baby becomes unresponsive or the choking does not resolve, call emergency services immediately. Continuous monitoring of the baby’s breathing and responsiveness is necessary until medical help arrives.
When to Seek Medical Advice
Increased Frequency or Severity
While many choking incidents are benign, certain circumstances warrant medical evaluation. Consult a pediatrician if choking episodes become noticeably more frequent or severe, or consistently interfere with feeding.
Blue Skin or Loss of Consciousness
Immediate medical attention is necessary if a baby turns blue or loses consciousness during a choking episode. These are indicators that the airway obstruction is severe and oxygen deprivation is occurring.
Other Concerning Symptoms
A medical evaluation is also recommended if choking is accompanied by other concerning symptoms, such as persistent difficulty breathing, wheezing, or a chronic cough. These signs might suggest respiratory distress or ongoing aspiration, where milk or food enters the lungs. Poor weight gain or general feeding difficulties, when associated with choking, can also signal a need for professional assessment, as the baby may not be receiving adequate nutrition. Recurrent respiratory infections, like pneumonia, could be a red flag for silent aspiration, where small amounts of fluid are repeatedly entering the lungs without overt choking signs.