Herbie Murray
It is natural for parents to worry about their newborn choking in their sleep. However, research shows that the risk of choking is low even when babies sleep on their backs. In fact, sleeping on the back is recommended as it provides airway protection and reduces the risk of sudden infant death syndrome (SIDS). When a baby sleeps on their back, the opening of the windpipe is on top of the opening of the food pipe, and fluids from the stomach have to work against gravity to get into the windpipe and cause choking. On the other hand, when a baby sleeps on their tummy, the food pipe sits above the windpipe, and fluids can easily pool at the opening of the windpipe, increasing the risk of choking.
| Characteristics | Values |
|---|---|
| Risk of choking when sleeping on the back | Low |
| Risk of choking when sleeping on the side | Medium |
| Risk of choking when sleeping on the stomach | High |
| Risk of choking due to reflux | Low |
| Risk of choking due to gastroesophageal reflux | Low |
| Risk of choking due to spit-up or vomit | Low |
| Risk of choking due to regurgitated milk | High when sleeping on the stomach |
| Risk of choking due to flat spots on the head | Not associated |
| Risk of choking due to swaddling | High |
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What You'll Learn
Babies sleeping on their backs are less likely to choke
It is understandable to worry about newborns choking in their sleep, but it is important to know that the risk of choking is low even with babies placed on their backs to sleep. In fact, babies sleeping on their backs are less likely to choke and are provided with airway protection.
Healthy babies placed to sleep on their backs are less likely to choke on vomit than tummy or side-sleeping infants. When a baby sleeps on its back, the upper respiratory airways are positioned above the oesophagus (the food pipe that carries food from the mouth to the stomach). The oesophagus sits underneath the trachea (windpipe). This means that if a baby vomits or spits up while sleeping on their back, gravity will pull the vomit back down into the oesophagus and then the stomach.
Babies also protect their airways by swallowing. Regurgitated milk from the oesophagus can be easily swallowed, and it is difficult for fluid to work against gravity and be pushed up and into the respiratory tract. On the other hand, when a baby sleeps on their tummy, the oesophagus sits above the upper airways, and vomit will pool at the opening of their trachea, making choking more likely. Additionally, babies sleep more deeply on their tummies and swallow less frequently.
Babies with gastroesophageal reflux (GER), where stomach juices, food, and fluids back up from the stomach into the throat, should still be placed on their backs to sleep. Research shows that raising one end of the crib or crib mattress is ineffective at reducing reflux or its symptoms and is, in fact, dangerous because babies may slide down and have difficulty breathing. Instead, it is recommended to keep babies on a firm, flat, and level sleep surface.
If a baby is choking, it is important to perform baby CPR right away and call emergency services. It is not recommended to place your fingers or any other object in a baby's mouth if they are choking, as this may accidentally push the object further into their throat.
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Risk of choking is low even with reflux
The risk of choking while sleeping is low for newborns, even for those with reflux. This is because healthy babies have a gag reflex that is triggered by spit-up or vomit, causing them to spit out or swallow the fluid. This reflex helps to keep their airway clear. Sleeping on the back further reduces the risk of choking, as the upper respiratory airways are positioned above the oesophagus, allowing regurgitated milk to lie at the lowest level and be easily swallowed. In contrast, sleeping on the tummy increases the risk of choking as the oesophagus sits above the airways, and fluids can more easily be inhaled into the baby's airway and lungs.
It is important to note that the risk of choking is not non-existent, and choking can be a medical emergency. If a baby is choking, it is crucial to perform baby CPR and call emergency services. Additionally, it is recommended to stop swaddling the baby during sleep once they start rolling over to reduce the risk of suffocation, entrapment, and strangulation.
For babies with gastroesophageal reflux, where acidic stomach juices or food and fluids back up from the stomach into the throat, current evidence still recommends placing them on their backs to sleep. Elevating the baby's head or crib mattress is not effective in reducing reflux or its symptoms and may even be dangerous as it can affect their ability to breathe properly. Instead, a firm, flat, and level sleep surface is recommended.
To help prevent or reduce acid reflux and the associated risk of choking, there are several lifestyle changes that can be considered. These include avoiding trigger foods and beverages, maintaining a healthy weight, reducing stress levels, and not eating right before bedtime. It is important to discuss these options with a healthcare provider to develop a suitable treatment plan.
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Choking risk is reduced when the baby sleeps on a firm, flat surface
The risk of choking is reduced when a baby sleeps on a firm, flat surface on their back. This is because, when a baby is sleeping on their back, the upper respiratory airways are positioned above the oesophagus (or food pipe). The oesophagus is the tube that carries food from the mouth to the stomach. When a baby is on their back, fluids that come from the stomach have to work against gravity to get into the windpipe and cause choking.
Healthy babies placed to sleep on their backs are less likely to choke on vomit than tummy or side-sleeping infants. Sleeping on the back provides airway protection. Babies protect their airways by swallowing. Regurgitated milk from the oesophagus lies at the lowest level and can be easily swallowed. It is difficult for the fluid to work against gravity and be pushed up and into the respiratory tract. Hence, the risk of choking is reduced when the baby is sleeping on the back.
When a baby sleeps on their tummy, the oesophagus sits above the baby's upper airways. If a baby vomits milk or fluid when sleeping on their tummy, these substances will pool at the opening of the airways and are more likely to be inhaled. Sleeping on the stomach increases the risk of Sudden Infant Death Syndrome (SIDS) and choking.
Research shows that the risk of choking is low even with babies placed on their backs to sleep. This applies to babies with reflux as well. The American Academy of Pediatrics (AAP) states that the risk of SIDS outweighs the risk of a baby choking on their spit-up or vomit. The AAP does not recommend placing items in a baby's sleeping space to elevate them or prop their heads up. Elevating a baby's head may not prevent reflux symptoms and is not safe as the baby can roll into an unsafe position.
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Babies' gag reflex is triggered by spit-up or vomit
The gag reflex in babies is triggered by spit-up or vomit, causing them to either spit it out or swallow it. This is a protective mechanism to prevent choking. When an object touches the sensitive area at the back of the throat, an automatic muscle contraction occurs, pushing the object out of the mouth. This reflex is present in babies until around six months of age, when they start eating solid foods.
Babies with gastroesophageal reflux (GER) often spit up, which can lead to gagging or coughing. GER is common in infants under two years old. However, placing reflux-prone babies on their backs to sleep is recommended, as it reduces the risk of choking. When sleeping on their backs, the trachea (windpipe) sits above the oesophagus (food pipe), making it difficult for fluids to enter the windpipe and cause choking. This position also allows babies to swallow and clear fluids more effectively.
Additionally, elevating a baby's head is not recommended, as it may not prevent reflux and can be unsafe if the baby rolls into an unsafe position. Instead, keeping babies on a firm, flat, and level sleep surface is advised. For babies with reflux, it is suggested to keep them upright for about 30 minutes after feeding to reduce reflux symptoms and minimise spit-up during sleep.
While gagging is normal, persistent gagging may indicate a more significant issue. Some babies have a very sensitive gag reflex, causing them to gag on textured or lumpy foods. These babies often do well with smooth pureed foods and may benefit from solids that dissolve easily, such as baby crackers or cookies. Brushing their teeth can also help desensitise their gag reflex.
If a baby is choking, it is crucial to act quickly. Choking is a medical emergency where the baby's airway becomes partially or completely blocked, impairing their breathing. In such cases, it is vital to perform baby CPR immediately and call for emergency medical assistance.
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Choking is a quiet emergency
It is natural for parents to worry about their newborn choking in their sleep. However, it is important to know that the risk of choking is low, even with babies placed on their backs to sleep. This is because, when sleeping on their backs, the upper respiratory airways are positioned above the oesophagus, which carries food from the mouth to the stomach. This means that if a baby spits up or vomits, the fluid will flow back down into the stomach due to gravity, and the baby's airway will remain clear. In fact, babies who sleep on their backs might be less likely to choke than babies who sleep on their stomachs or sides.
When a baby sleeps on their stomach, the oesophagus sits above the upper airways. If a baby regurgitates or vomits in this position, the fluid will pool at the opening of the airways and is more likely to be inhaled. Additionally, babies sleep more deeply on their tummies and swallow less frequently, further increasing the risk of choking.
Despite this, it is still possible for a baby to choke on their back, as spit-up or vomit can trigger their gag reflex. Choking is a medical emergency and can be life-threatening. If a baby is choking, it is important to perform baby CPR right away and call emergency services. To prepare for this type of emergency, it is recommended to take a baby CPR class from a reputable organisation.
To reduce the risk of choking, it is important to keep the baby's sleeping environment clear of any items that could pose a hazard. Do not place items in the baby's sleeping space to elevate them or prop their heads up, as this is not safe. Instead, it is recommended to keep the baby on a firm, flat, and level sleep surface. Additionally, stop swaddling the baby during sleep once they start rolling over on their own, as this can reduce the risk of suffocation, entrapment, and strangulation.
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Frequently asked questions
Yes, newborns can choke in their sleep. Choking occurs when the baby's airway is partially or completely blocked, and air cannot get through.
Choking can be caused by spit-up or vomit. When a baby sleeps on their tummy, the oesophagus sits above the upper airways, and fluids can pool at the opening of the airways and be inhaled.
It is recommended that newborns sleep on their backs as this provides airway protection. When a baby is sleeping on its back, the upper respiratory airways are positioned above the oesophagus, and fluids will naturally be swallowed or coughed up.
Choking is a medical emergency. If your baby is choking, perform baby CPR right away and call emergency services.
