Colin Snow
It is understandable for new parents to worry about their newborn choking on their own vomit while sleeping. However, according to the American Academy of Pediatrics (AAP), the risk of choking on spit-up or vomit is low, even for babies with reflux, due to their gag reflex. Research shows that sleeping on the back is the safest position for babies, including those with gastroesophageal reflux, as it provides airway protection. This is because the upper respiratory airways are positioned above the oesophagus, allowing regurgitated milk to lie at the lowest level and be easily swallowed.
| Characteristics | Values |
|---|---|
| Risk of choking on vomit | Low, due to the gag reflex |
| Risk of choking on vomit while sleeping on the back | Even lower, due to the positioning of the trachea and oesophagus |
| Risk of choking on vomit while sleeping on the stomach | Higher, as vomit will pool at the opening of the trachea |
| Risk of choking on vomit while sleeping on the side | Higher, as the baby may roll onto their stomach |
| Risk of SIDS | Highest between 1-4 months |
| Safe sleeping position for babies | On the back, for all sleep times, including naps |
| Safe sleeping position for babies with gastroesophageal reflux | On the back |
| Safe sleeping position for babies with birth defects that cause food and liquid to pass into the windpipe | On the stomach or side |
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What You'll Learn
- Babies sleeping on their backs are less likely to choke on vomit
- The risk of choking is low due to the gag reflex
- Babies with reflux may spit up more, leading to gagging or coughing
- Choking is a medical emergency—learn baby CPR
- Babies with certain conditions may choke on vomit due to difficulty clearing their airway
Babies sleeping on their backs are less likely to choke on vomit
It is understandable for parents to worry about their newborn choking on vomit while sleeping. However, according to the American Academy of Pediatrics (AAP), the risk of choking on spit-up or vomit is low for babies due to their gag reflex. This natural reflex causes them to spit out or swallow fluids that enter their mouth.
Additionally, babies tend to sleep more deeply on their stomachs and swallow less frequently, further increasing the risk of choking. By sleeping on their backs, babies can more easily swallow any regurgitated milk or fluid, reducing the risk of choking. This position also provides airway protection and is recommended by doctors as the safest sleeping position for babies, including those with reflux, until they are one year old.
While the risk of choking on vomit is low for babies sleeping on their backs, it is still important for parents and caregivers to be vigilant and learn how to respond in case of choking. It is recommended to ensure that you and your baby's caregivers are trained in baby CPR and know how to respond in a choking emergency.
It is worth noting that in rare cases, babies with certain conditions may be at a higher risk of choking on vomit. If your baby has a birth defect or physical condition that affects their ability to clear their airway, consult with your paediatrician for specific sleeping position recommendations to ensure your baby's safety.
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The risk of choking is low due to the gag reflex
The risk of a newborn choking on vomit while sleeping is low due to the gag reflex. The gag reflex is triggered by spit-up or vomit, causing the baby to spit out or swallow the substance. This reflex is a protective mechanism that prevents choking. It is activated when any object touches a sensitive area at the back of the throat, leading to an automatic muscle contraction that pushes the object out of the mouth.
Healthy babies have a strong gag reflex that helps keep their airway clear. When a baby is sleeping on its back, the upper respiratory airways are positioned above the oesophagus, which carries food and fluids from the mouth to the stomach. In this position, regurgitated milk or fluid lies at the lowest level and can be easily swallowed, reducing the risk of choking.
Additionally, sleeping on the back provides airway protection. The trachea (windpipe) sits on top of the oesophagus, so fluids from the stomach have to work against gravity to enter the windpipe and cause choking. On the other hand, when a baby sleeps on its stomach, the oesophagus sits above the trachea, allowing fluids to pool at the opening of the airways and increasing the risk of inhalation.
While the risk of choking is low, choking is still a medical emergency. It is recommended that parents and caregivers learn baby CPR and keep their baby upright for about 30 minutes after feeding to reduce reflux and minimise spit-up during sleep.
It is important to note that babies with certain conditions may have an increased risk of choking. If a baby has a birth defect, such as a cleft palate or laryngeal cleft, that affects the passage of food and liquid into the windpipe, a paediatrician may advise placing the baby on its stomach or side to sleep. In such cases, parents should follow the recommendations provided by their doctor to ensure the baby's safety during sleep.
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Babies with reflux may spit up more, leading to gagging or coughing
Babies with reflux can be placed on their backs to sleep, as this is the safest position for all babies, including those with reflux, until they are 1 year old. Research shows that the risk of choking is low, even for babies with reflux who sleep on their backs. This is because a baby's gag reflex is triggered by spit-up or vomit, causing them to spit it out or swallow it.
To reduce reflux symptoms and make babies less prone to spit up and gag during sleep, it is recommended to keep your baby upright for about 30 minutes after feeding. However, elevating your baby's head may not prevent reflux symptoms and is not considered safe, as the baby can roll into an unsafe position.
It is important to note that choking is a medical emergency. If your baby is choking, you should start baby CPR and call emergency services. Additionally, if your baby has a birth defect that could cause food and liquid to pass into the windpipe, such as a cleft palate or a laryngeal cleft, consult your baby's paediatrician for specific sleeping position recommendations.
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Choking is a medical emergency—learn baby CPR
It is very unlikely that a newborn will choke on vomit while sleeping. Healthy babies have a gag reflex that is triggered by spit-up or vomit, causing them to spit it out or swallow it. This reflex helps to keep their airway clear. In fact, sleeping on their back lowers the risk of choking compared to sleeping on their stomach or side. This is because, when sleeping on their back, the opening of the oesophagus (food pipe) lies below the upper respiratory airways, making it difficult for fluid to travel up and into the respiratory tract.
However, choking is a medical emergency. If your baby is choking, start baby CPR and call emergency services. Here is a step-by-step guide on how to perform baby CPR:
Step 1: Check the Scene and the Baby
Before starting CPR, check your surroundings for any potential dangers. Remove yourself and the baby from any dangerous situations. Next, check the baby for responsiveness by tapping them, speaking loudly, or gently squeezing their shoulders. Shout their name if you are concerned that they are not responding.
Step 2: Check for Airway Blockages
If the baby is not responding, check their mouth for any blockages, such as food, vomit, or blood. Use your little finger to clear any blockages, but do not put your finger into the back of the baby's throat.
Step 3: Check for Breathing
Look for chest movements, listen for breathing sounds from the baby's mouth and nose, or feel for breath on your cheek.
Step 4: Start CPR
If the baby is not breathing, place them on a firm, flat surface on their back. Give 30 chest compressions at the rate of 100-120 per minute, pushing down about one-third of the chest diameter (4cm for a baby) with two fingers. After 30 compressions, tilt their head, lift their chin, and give two rescue breaths. Seal the baby's mouth and nose with your mouth, blowing gently for one second. Watch for the chest to rise and fall as air goes in and out.
Step 5: Repeat
Continue giving 30 compressions followed by two breaths until medical help arrives. If the baby starts breathing and responding, put them into the recovery position. Keep watching their breathing and regularly check for responses.
Remember, it is important to keep these steps handy and review them often so that you are prepared in case of an emergency. Consider printing out step-by-step guides and placing them in easily accessible locations, such as your car, desk, or kitchen.
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Babies with certain conditions may choke on vomit due to difficulty clearing their airway
While the risk of a baby choking on their own vomit while sleeping is generally considered low, babies with certain conditions may choke due to difficulty clearing their airway.
Healthy babies placed to sleep on their backs are less likely to choke on vomit than those sleeping on their tummies or sides. This is because, when a baby sleeps on their back, the upper respiratory airways are positioned above the oesophagus, which connects the throat to the stomach. As a result, regurgitated milk or fluid from the oesophagus can easily be swallowed, and it is difficult for it to work against gravity and enter the respiratory tract. In contrast, when a baby sleeps on their tummy, the oesophagus sits above the upper airways, and if a baby vomits, the fluid will pool at the opening of the airways and is more likely to be inhaled.
Babies have a gag reflex that is triggered by spit-up or vomit, causing them to spit it out or swallow it. They also have reflexes such as head turning, coughing, and swallowing, which help prevent fluids from entering the airway. However, babies with certain conditions may have difficulty keeping their airway clear. For example, babies with a birth defect such as a cleft palate or a laryngeal cleft may have food and liquid pass into their windpipe, and their paediatrician may recommend they sleep on their stomach or side to prevent choking.
Additionally, babies with gastroesophageal reflux (GER) may spit up more often, leading to gagging or coughing. While research shows that babies with reflux can safely sleep on their backs, parents can keep them upright for about 30 minutes after feeding to reduce reflux symptoms and make them less prone to spit up during sleep. It is important to note that elevating a baby's head may not prevent reflux and is not considered safe, as they can roll into an unsafe position.
In summary, while the risk of choking on vomit is generally low for healthy babies sleeping on their backs, babies with certain conditions, such as birth defects or gastroesophageal reflux, may be at a higher risk due to their difficulty in clearing their airway. It is crucial for parents and caregivers to understand the differences between spitting up, vomiting, gagging, and choking, and to be trained in baby CPR to ensure the baby's safety.
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Frequently asked questions
The risk of choking on vomit while sleeping is low for newborns, due to their gag reflex. Healthy newborns placed to sleep on their backs are less likely to choke on vomit than tummy or side sleepers. This is because, when sleeping on the back, the upper respiratory airways are positioned above the oesophagus, making it difficult for fluid to be pushed up into the respiratory tract.
The gag reflex is triggered by spit up or vomit, which causes the newborn to spit it out or swallow it.
Choking is a medical emergency. If your baby is choking, start baby CPR and call emergency services.
The American Academy of Pediatrics (AAP) recommends placing the baby on their back to sleep, for all sleep times, including naps, to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths.
