What To Do If Your Baby Chokes On Milk.

In This Article:

• Introduction
• Choking vs Aspirating
• What to Do
• Summary

Intro:

In another #FirstAidFriday segment, we have a question in from Millie, regarding her baby choking on milk:

“Hi Kat, 

Last week my 3 month old choked when I was feeding her. It was the most frightening situation because she stopped breathing and turned blue. I instinctively began giving her back blows and she started coughing again. I didn’t know you could choke on milk. Was this right? It seemed to work. But now I have anxiety every feed that it will happen again.”

-Millie

This situation that Millie encountered with her baby is actually quite common in both breastfed and bottle-fed infants alike. But before we get into the treatment of what to do, let's chat the difference between aspiration and choking, and what both of these terms mean.

What is the difference between choking and aspirating?

🔸Aspiration is when we have ANY substance enter the airways that should have gone down the food pipe. These substances can be liquids OR solids, and even stomach contents that have come up and gone back down the wrong way.

 🔸If someone aspirates on something solid, and this solid object becomes stuck in the upper or main airway (trachea) before passing down to the lungs, we call this choking.

🔸If the trachea is completely or almost completely blocked, then the person will be unable to speak, cough or breathe effectively, and this could even lead to unconsciousness within minutes. 

But how can my baby choke on milk if it's not a solid??

Aspirating on a runny liquid like milk can can’t really block the main airway or trachea in the same way that a solid object can... BUT... in really little ones, depending on the amount of liquid aspirated, it can start to fill up their airways.  For example, a newborns airway size is literally the same size as a straw. Therefore, if they have too much liquid pass down their throat into their airway, it doesn’t take too much to fill this skinny little airway up, causing breathing issues. Sometimes, the vocal cords will also close over and prevent any more liquid entering the airways, which we call a laryngospasm.

So in either of these situations; be it the airway filling with milk, or the vocal cords closing over, your little baby is not going to breathe effectively or at all for a bit, and this is when you can see that colour change. Hopefully this only lasts a few seconds, but let's go through what to do in a few different situations.

What to do if your baby "chokes" while feeding:

How I want you to manage your baby if they aspirate on their milk is exactly how you would manage choking. If you need a brush up on your choking skills, we have a FREE choking guide, which you can access down below.

If your baby is coughing and gagging:

This is the most common situation you will find yourself in, and your baby will be coughing and spluttering. We'll treat this just as we would for a mild choking or mild obstruction:

1️⃣ Immediately stop feeding your baby.

2️⃣ Sit your baby up, and lean them forward (supporting their head if needed).

3️⃣ Allow them to clear their own airway through coughing and swallowing.

⚠️ Watch your baby closely over the next few days for any signs of a fever or respiratory infection. If any fluid has entered the lungs, even if it’s just breast milk, there’s a chance the lungs can become inflamed or infected. Any signs of trouble breathing or a fever, please chat to your doctor straight away. If you want to learn more on recognising the signs of respiratory distress, click here.

If your baby is NOT coughing, and is silent and/or changing colour:

If your baby has aspirated on milk and they’re not coughing, or they’ve stopped coughing and they’re starting to change colour to a blue (which doesn't resolve after a few seconds), then we'll treat this just as we would for a severe choking or a severe obstruction:

1️⃣ Send for an ambulance.

2️⃣ Administer up to 5 back blows, checking to see if your baby has started breathing yet after each one.

3️⃣ If not, then administer up to 5 chest thrusts, again checking for breathing between each.

Hang on, WHY would we do back blows and chest thrusts for a liquid?

I know that there’s no solid object stuck in the airway, and that’s technically what back blows and chest thrusts are designed for, but I do think that these manoeuvres have a role in this situation.

✅ Instinctively applying back blows and chest thrusts when your child's airways are obstructed is a great skill to fall back on, and if your child is unable to breathe, it is unlikely these manoeuvres will cause any further harm.

✅ If the milk has filled up your little ones airways, laying your baby in these positions will allow gravity to help get the fluid to run back out the airways, instead of seeping further down into them.

✅ The back blows and chests thrusts can also create a pressure to help expel this fluid out as well.

Therefore, the combined effects of gravity and pressure will hopefully help clear your baby's airways, and get them breathing again. 

What if they don't start breathing and become unresponsive? 

This is incredibly rare, but in the event that your baby becomes unconscious, I want you to place them onto a firm, flat surface, and begin CPR. If you haven't already, make sure you call an ambulance.  

Summary:

🔸If your baby aspirates or gags on milk, look at if they are coughing or not. If they’re able to cough,  simply sit them up, lean them forward, and allow them to clear their own airway. And in all honesty, this is all you’ll have to do to the majority of the time. 

🔸If your baby is not coughing, or if they’re changing colour, send for help, then administer the back blows and chest thrusts until their airways clears. And if at any point your baby becomes unresponsive, start CPR.

🔸If this happens more than once, I strongly recommend that you reach out to your family doctor or lactation consultant to work out a potential cause for these episodes