Infants may choke while nursing, since their swallowing skills are not well developed. Choking during breastfeeding could cause harmless coughing. However, sometimes the milk may find its way into the lungs and cause aspiration pneumonia (1).
Seek emergency medical care if your baby has rapid breathing, turns blue, or becomes unconscious due to choking on breast milk. You may also consider consulting a pediatrician if choking incidences are frequent.
Read this post to know more about the causes of choking, remedies, and what to do in such situations.
Why Does A Baby Choke While Breastfeeding?
A baby can choke on breastmilk due to various reasons ranging from normal immature swallowing to feeding problems due to anatomical or functional disorders. It can also be due to maternal factors.
The main causes of choking while breastfeeding can be (2):
- Oversupply of breast milk: Faster milk flow is one of the major causes of choking on breast milk. Infants may not be able to swallow quickly. This may often happen if the mother has an oversupply of breast milk. The baby may bite while breastfeeding due to the overflow of milk, thus making swallowing further difficult.
- Overactive letdown: It is the forceful ejection of milk when your baby is sucking. Let down reflex is controlled by oxytocin hormones. Increased release of breast milk can cause gulping, coughing, or choking in infants.
Infants who have feeding difficulties are associated with a high risk of choking while breastfeeding or bottle-feeding. The following congenital abnormalities may result in feeding problems (3)
- Developmental delay
- Neurological issues such as cerebral palsy
- Down’s syndrome
- Structural anomalies of oral, respiratory, or feeding structures, such as cleft lip and palate and Pierre Robin syndrome
- Gastrointestinal issues, such as tracheoesophageal fistula
- Congenital heart diseases
- Lung and liver diseases
A healthcare provider should examine if there is frequent choking while feeding. Early intervention could reduce the risk of aspiration pneumonia and other complications.
What To Do If A Baby Chokes While Breastfeeding?
Gagging and choking during nursing is common in young babies. Most of the time, babies can protect themselves from aspiration due to hyper-gag reflex.
The following can be done if your baby chokes while nursing (4).
- Stop feeding if the baby chokes on milk.
- Hold the baby in an upright position for a few seconds. This could help babies to manage the problem.
- Provide good head and neck support while holding younger infants in an upright position.
- Patting the baby’s back may help them.
If the baby turns blue or becomes unconscious after choking, seek emergency medical care. You should also contact a pediatrician if choking occurs in bottle-fed infants.
How to Prevent Choking While Breastfeeding?
The following remedies may help reduce or prevent the incidence of choking on breast milk (1).
- Changing the feeding position is the best way to prevent choking while nursing. The laid-back feeding position is recommended for mothers who have an overactive letdown. This may help slow down milk flow due to gravity, and the baby could manage the flow better.
- You may try to take the baby off the breast for a few minutes during the initial letdown after sucking.
- Lying on the side may also reduce choking incidents. This position may allow the baby to let go of the breast and let the milk flow outside their mouth, to avert choking.
- You may also express milk a few minutes before feeding to reduce overflow and help to control let down.
- It is recommended to seek help from international board-certified lactation consultants (IBCLC) to manage overflow and hyperactive letdown issues. A pediatrician may also help to choose the right bottles and positions to prevent choking while formula feeding.
Note: You should be cautious while expressing or pumping milk since doing it for a longer duration may worsen the outcome. Consult a board-certified lactation consultant who can teach you the correct way to express or pump breast milk.
The feeding skills of a baby develop as the age progresses. It is unusual for older babies to choke while nursing. If an infant lacks age-appropriate ability to suck and swallow milk or food, then they may have feeding difficulties. In such cases, you may consult a specialist for evaluation and management.
2. Oversupply; La Leche League International (LLLI)
3. Choking On Milk; My Health; The Government of Malaysia
4. Infant choking while breastfeeding; New Kids-center