Herbie Murray
The risk of newborns choking in their sleep is a common concern for parents and caregivers. It is important to note that choking is a medical emergency, and if it occurs, one should immediately perform baby CPR and call emergency services. However, it is worth noting that the risk of choking while sleeping is relatively low for babies, even for those with reflux. This is because healthy babies have a strong gag reflex that helps prevent choking, and they also have a natural reflex to swallow or cough up fluids, keeping their airway clear. In fact, sleeping on the back is recommended as it provides airway protection and reduces the risk of choking compared to sleeping on the tummy or side.
| Characteristics | Values |
|---|---|
| Risk of choking | Low |
| Risk of choking on vomit | Higher when sleeping on the tummy or side |
| Risk of choking on spit-up | Possible |
| Safe sleeping position | On the back |
| Safe sleeping duration | Until the baby is 1 year old |
| Safe sleeping location | Crib or bassinet |
| Safe sleeping surface | Firm and flat |
| Safe sleeping environment | Free of items that could block the baby's airway |
| Safe sleeping distance | In the same room as the caregiver |
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What You'll Learn
The safest sleeping position for newborns
It is understandable for new parents to worry about their newborns choking in their sleep. However, it is important to know that healthy babies have a strong gag reflex that helps prevent choking. This reflex is triggered when any object touches a sensitive area in the back of the throat, causing an automatic muscle contraction that pushes the object out of the mouth. This reflex is present in babies until they are about six months old, which is usually when they start eating solid foods.
In addition, newborns are also at a lower risk of choking when placed to sleep on their backs. This is because, in this position, the upper respiratory airways are positioned above the oesophagus (food pipe). Therefore, if a baby regurgitates or vomits milk or fluid, it will lie at the lowest level and can be easily swallowed. It is difficult for the fluid to work against gravity and enter the respiratory tract.
For these reasons, the safest sleeping position for a newborn is on their back. This position is known as the supine position and is recommended for all babies, including those born preterm and those with reflux, until they are one year old. It is recommended that parents place their babies on their backs for every sleep, day or night, as this is one of the best ways to reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related deaths.
Once a baby can roll from their back to their front and back again, they will be able to find their own sleeping position. However, until they reach this stage of development, it is important to always place them on their back to sleep.
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The risk of choking on vomit or spit-up
When a baby sleeps on their back, the upper respiratory airways are positioned above the oesophagus (food pipe). This anatomical arrangement allows babies to protect their airways by swallowing. If a baby regurgitates or spits up milk or fluid while sleeping on their back, gravity helps pull the fluid back down into the oesophagus and eventually into the stomach. This reduces the risk of choking. Additionally, healthy babies have a strong gag reflex that helps prevent choking. The gag reflex is triggered by any object touching a sensitive area in the back of the throat, causing an automatic muscle contraction that pushes the object out of the mouth.
On the other hand, when a baby sleeps on their tummy or side, the oesophagus sits above the upper airways. In this position, if a baby vomits or spits up, the fluid will pool at the opening of the airways and increase the risk of inhalation and choking. Therefore, it is recommended to always place babies on their back to sleep, for naps and at night. This back-sleeping position provides airway protection and reduces the risk of choking compared to tummy or side sleeping.
Babies with gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) may spit up more often, which can lead to gagging or coughing. To reduce reflux symptoms, it is advised to keep the baby upright for about 30 minutes after feeding. However, elevating the baby's head using items in the sleeping space is not recommended as it may not prevent reflux and can be unsafe if the baby rolls into an unstable position.
While the risk of choking on vomit or spit-up is reduced when babies sleep on their back, it is important to monitor them closely. If choking occurs, it is a medical emergency, and infant CPR and immediate medical assistance should be administered.
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The gag reflex and how it helps prevent choking
The gag reflex is a natural, protective, and involuntary response that prevents choking. It is triggered when any object touches a sensitive area at the back of the throat, such as the pharyngeal wall, tonsillar area, tongue base, or the soft palate. This stimulation leads to an automatic muscle contraction that pushes the object out of the mouth, preventing choking. This reflex is particularly important for newborns, who have a strong gag reflex that helps protect them from choking while they sleep.
The gag reflex, also known as the pharyngeal reflex, is a somatic response that helps the body eliminate unwanted agents or foreign objects from the oral cavity. It involves the contraction of pharyngeal muscles and elevation of the soft palate, forcing the glottis to close and preventing substances from entering the airways. This reflex is believed to have evolved as a defence mechanism to prevent the swallowing of foreign objects and to protect the upper respiratory tract.
In newborns, the gag reflex is typically triggered by food that the nucleus tractus solitarius, a brain stem region, deems too large or solid for them to digest. This reflex helps protect newborns from choking on solid foods until they are ready to process them. The gag reflex is usually strong in newborns for about the first six months of their lives, around the time they start eating solid foods.
While the gag reflex is protective, it can also be problematic if it is overly sensitive. Some people experience a hypersensitive gag reflex, which can make it difficult to swallow pills or perform routine dental or medical procedures. In these cases, treatments and interventions such as acupuncture, acupressure, or topical medications may help reduce sensitivity and manage the gag reflex.
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Reflux and how to reduce it
It's natural to worry about newborns choking while sleeping, but it's important to know that healthy babies have a strong gag reflex that helps protect their airways. This reflex keeps their airway clear by triggering coughing or swallowing when they spit up or vomit. In fact, sleeping on their back further reduces the risk of choking as the upper respiratory airways are positioned above the oesophagus, making it difficult for fluids to be pushed up into the respiratory tract.
Now, let's talk about reflux and how to reduce it:
Reflux, or gastroesophageal reflux (GER), occurs when food from the baby's stomach returns to their oesophagus, leading to spitting up or vomiting. This is common among babies in their first year and is usually harmless. It happens because a baby's digestive tract is not yet fully mature. Most babies with GER don't need medication and can be managed by making changes to their feeding routine. Here are some ways to reduce reflux:
- Thickened feedings: Consult your paediatrician about adding a thickening substance to breast milk or formula. This can help reduce the visible symptoms of reflux, but it's important to get advice on the suitability and type of thickener for your baby.
- Feeding pattern changes: Altering the feeding routine can help manage reflux. One suggestion is to keep your baby upright for about 30 minutes after feeding. This can reduce reflux symptoms and make them less prone to spitting up during sleep.
- Medication: In rare cases, where reflux is more severe and persistent, a doctor may recommend medication to reduce acid production in the stomach.
- Surgery: In very rare instances, if other treatments haven't worked or the reflux is severe, surgery may be an option to strengthen the muscles and prevent food from travelling back up.
Remember, it's always best to consult your healthcare provider for tailored advice and treatment options for your baby's reflux.
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What to do if your newborn is choking
It is important to note that newborns are at a high risk of choking and it is a medical emergency. While sleeping, newborns can choke on curdled milk, mucus, or vomit. As they grow older, they might choke on solid foods or small toys.
If your newborn is choking, here is what you can do:
- If you can see an object in your baby's mouth and can remove it safely with your fingertips, do so. However, do not put your fingers or any other object in your baby's mouth if you cannot see anything, as you may accidentally push the object further into their throat.
- Sit, kneel, or stand, supporting the infant's back along your forearm, braced by your thigh. Hold the infant's head cradled in your hand, keeping their head lower than their chest.
- Place your other forearm along the infant's front, supporting their jaw with your thumb and forefinger.
- Turn them into a face-down position, holding them along your forearm. Use your thigh for support and keep their head lower than their body.
- Use the heel of your hand to give five firm back blows between the infant's shoulder blades. The force of the back blows should be enough to cause a vibration in the airway and dislodge the blockage.
- Give chest thrusts if back blows don't help.
- Turn the infant face-up, supporting the head and neck and resting them on your thigh. Keep their head lower than their chest.
- Place two fingers in the center of the chest just below the nipple line.
- If your baby is choking, start baby CPR and call emergency services.
Additionally, to reduce the risk of choking, it is recommended to always place your baby on their back when sleeping, for naps and at night. This position provides airway protection as the upper respiratory airways are positioned above the oesophagus, allowing babies to protect their airways by swallowing.
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Frequently asked questions
The risk of choking while sleeping is low for newborns, even for babies with reflux. When a baby sleeps on their back, the upper respiratory airways are positioned above the oesophagus, which means that if a baby spits up while sleeping on their back, gravity will pull the vomit back down into their stomach. This is not the case when a baby sleeps on their tummy, as the vomit will pool at the opening of their airways and is more likely to be inhaled. Therefore, it is recommended that babies are placed on their back to sleep.
To reduce the risk of choking, it is recommended that babies are placed on their back to sleep, for naps and at night. This is the safest sleep position for all babies, including those born preterm and those with reflux, until they are 1 year old. Once babies can roll from back to stomach and vice versa, you can leave them in the position they choose after starting sleep on their back. It is also important to stop swaddling the baby once they start rolling over to reduce the risk of suffocation, entrapment, and strangulation.
Choking is a medical emergency. If your baby is choking, start baby CPR and call emergency services.
