Colin Snow
Choking is a common occurrence in young children, and it can be a scary experience for both the child and the caregiver. Choking happens when a baby's airway becomes partially or completely blocked, and it can be caused by various factors such as regurgitation of milk, foreign objects, or fluids. Sleep disordered breathing (SDB) can also cause choking in children, affecting their ability to inhale enough air while asleep. In this article, we will discuss the reasons why a 2-month-old baby may be choking in their sleep and provide guidelines on how to respond to and prevent such incidents. We will also explore the differences between choking and gagging, highlighting the importance of understanding the unique dynamics of infant choking to ensure the safety and well-being of young children.
| Characteristics | Values |
|---|---|
| Choking | Occurs when the airway is either partially or completely blocked |
| Reasons | Milk regurgitation during sleep, gastroesophageal reflux (GER), or Gastroesophageal reflux disease (GERD) |
| Prevention | Keep the baby upright for 30 minutes after feeding, lay the baby on their right side while sleeping |
| First Aid | Place the baby on a flat surface, look for an object in the mouth and remove it if visible, apply chest compressions, tilt the head back and lift the chin to open the airway, give rescue breaths |
| Sleep Disordered Breathing (SDB) | A child struggles to inhale enough air while asleep, lying on the back makes it worse, the throat closes completely and the child may stop breathing for more than 10 seconds |
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What You'll Learn
Regurgitation of milk during sleep
It is important to understand that choking is when a baby is unable to cry or cough, and they cannot make any noise or breathe because their airway is completely obstructed. If your baby is coughing or gagging, and is able to breathe, they are not choking. If your baby is choking, you should place them on a flat, firm surface, and look for an object in their mouth. If you can see it and it is easy to grasp, remove it. If not, follow the steps for infant CPR, which includes 30 chest compressions and 2 rescue breaths. Call 911 or your local emergency services immediately.
Now, moving on to the specific topic of regurgitation of milk during sleep in 2-month-old babies. This may be due to the regurgitation of milk or Gastro-esophageal reflux (GER). During feeding, if your baby is choking, it could be due to too much milk flowing into their mouth, so squeeze out a little milk before feeding. To prevent regurgitation during sleep, nurse the baby with the head-end raised and let them sleep on their right side with a small pillow under their head so that their head is above the level of the stomach.
If the problem persists, consult a pediatrician to rule out GER. They may recommend feeding pattern changes, such as feeding your baby more often with smaller amounts of milk each time. They may also suggest thickened feedings, where you add a substance to breast milk or formula to make it thicker, but this should only be done under medical supervision.
Additionally, it is important to note that reflux usually begins at 2 to 3 weeks and peaks at 4 to 5 months. It should fully go away by 9 to 12 months. If symptoms appear before the baby is 1 week old or after they are 6 months old, it may indicate Gastroesophageal Reflux Disease (GERD) or another condition.
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Gastro-oesophageal reflux
Choking in a 2-month-old baby could be due to Gastro-oesophageal reflux, also known as GERD (gastroesophageal reflux disease). This is when food from the baby's stomach returns to the oesophagus, which may lead to spitting up or vomiting. It is a more serious and long-lasting type of reflux. In babies with GERD, the sphincter muscle that acts as a valve between the oesophagus and stomach is weak or relaxes when it shouldn't, allowing stomach contents to flow back into the oesophagus. This can cause the baby to regurgitate milk during sleep.
GERD is common in younger infants, with many 4-month-olds having the condition. However, by their first birthday, only about 10% of babies still have GERD. The main symptom of reflux and GERD in babies is spitting up, but other symptoms may include arching of the back, often during or right after eating, and colic (crying that lasts for more than 3 hours a day with no medical cause). It is important to note that reflux is usually harmless and may not require treatment. However, if your baby has GERD, there are treatments available.
If your baby is choking, it is important to remain calm and follow these steps:
- Place your baby on a flat, firm surface, such as the ground.
- Look for any objects in your baby's mouth and remove them if they are visible and easy to grasp.
- Perform infant CPR: place two fingers on your baby's breastbone and apply pressure to compress the chest by about one-third at a rhythm of around 100 to 120 compressions per minute. Complete 30 chest compressions in all.
- Tilt your baby's head back and lift their chin to open the airway.
- Give two rescue breaths by creating a seal around the baby's mouth and nose and blowing in for 1 full second each.
- Repeat this process until help arrives.
If you suspect that your baby is choking due to Gastro-oesophageal reflux, there are some measures you can take to help manage the condition:
- Burp your baby during and after feedings to release excess gas in their tummy, which can cause them to spit up.
- Keep your baby upright for about 30 minutes after feedings to prevent reflux.
- Add rice cereal to your baby's bottle of formula or breast milk to thicken the feed. Consult your doctor about the appropriate amount to add.
- If the mixture becomes too thick, you can change the nipple size or make a small cut in the nipple to enlarge the opening.
- Avoid overfeeding; give your baby the recommended amount of formula or breast milk.
If these measures do not help and your baby continues to experience choking episodes, consult a paediatric gastroenterologist or your healthcare provider. They may recommend further tests, such as an upper gastrointestinal (GI) endoscopy and biopsy, to evaluate the extent of reflux and GERD. In rare cases, surgery may be considered if your baby has severe breathing problems or physical complications that contribute to GERD symptoms.
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Sleep-disordered breathing
The most obvious symptom of SDB is loud snoring that occurs on most nights. Other symptoms include irritability, daytime sleepiness, difficulty concentrating, hyperactivity, bedwetting, and slow growth. If left untreated, SDB can lead to neurological and cardiovascular problems, including attention deficit disorders. It can also cause the child to eat more, leading to weight gain and insulin resistance, which increases the risk of diabetes.
Obstructive sleep apnea (OSA) is the most common form of SDB. It occurs when something blocks the upper airway, such as enlarged tonsils, adenoids, or a misaligned jaw. OSA can be dangerous and lead to complications such as behavioural, heart, and lung problems. In rare instances, it can be life-threatening. Central sleep apnea (CSA) is another form of SDB that occurs when the part of the brain in charge of breathing doesn't work properly. It is most often found in infants.
If you suspect your child has SDB, you should seek medical advice immediately. A doctor will ask about your family history of sleep apnea and perform a physical examination to look for obstructions that might cause breathing difficulties, such as enlarged tonsils or narrow airways. They may recommend a sleep study or polysomnography (PSG) to monitor your child's brain waves, muscle tension, eye movement, breathing, and blood oxygen levels during sleep. Treatment for SDB aims to keep the child's airway open while they sleep, and mouthpieces can help with this by aligning the jaw.
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Blocked airways
Foreign Objects
Small objects, such as toys, food, or any other item that a baby might put in their mouth, can easily obstruct their airway. Even some common foods can pose a choking hazard to young children, such as grapes. It is important to ensure that any foods given to a baby are age-appropriate and cut into small pieces to reduce the risk of choking.
Fluids
Young babies can choke on liquids such as breast milk, formula, or even their own spit-up or mucus. Their airways are small and can easily become obstructed. Keeping your baby upright for about 30 minutes after feeding can help reduce reflux symptoms and make them less prone to spitting up or gagging during sleep.
Sleep-Disordered Breathing (SDB)
SDB occurs when a child struggles to inhale enough air while asleep. This condition can be exacerbated when the child lies on their back, as gravity causes the throat to narrow further. Children with SDB may arch their necks and open their mouths wide to try to get more air, leading to loud snoring. In severe cases, SDB can progress to Obstructive Sleep Apnea (OSA), where the throat closes completely, resulting in apnea or cessation of breathing for more than 10 seconds.
Gastroesophageal Reflux (GER)
GER, also known as reflux, is common in babies under 2 years old. It can cause regurgitation of milk during sleep, leading to choking. To prevent this, it is recommended to nurse the baby with their head-end raised or on their right side.
If you suspect your baby is choking due to a blocked airway, it is important to act quickly. Choking can be life-threatening, and a baby's inability to cough or cry is a sign of a completely blocked airway. In such cases, follow emergency procedures, such as those outlined by the Red Cross, and seek immediate medical attention.
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First aid and CPR
If your 2-month-old baby is choking in their sleep, it may be due to the regurgitation of milk during sleep. It is recommended to nurse the baby with their head-end raised and to let them sleep on their right side. During feeding, if milk is flowing too quickly, squeeze off a little milk before feeding. If the problem persists, consult a doctor to rule out gastro-oesophageal reflux (GER).
If your baby is choking, remain calm and follow these steps:
Step 1: Check the Baby's Mouth
- Place the baby on a flat, firm surface, such as the ground.
- Look for any visible objects in the baby's mouth.
- If you see an object, remove it only if it is easy to grasp. Do not waste time trying to remove an object that is not easily removable.
Step 2: Back Blows
- Position the baby face-down along your forearm, using your thigh for support. Keep the baby's head lower than their body.
- Give five firm back blows between the baby's shoulder blades with the heel of your hand.
Step 3: Abdominal Thrusts
- Turn the baby over so they are facing upwards.
- Place two fingers in the middle of the baby's chest, just below the nipples.
- Perform up to five sharp chest thrusts, pushing straight down about 1.5-2 inches and then letting the chest return to its normal position.
Step 4: Call for Help
- If the baby is still choking after performing back blows and abdominal thrusts, call 911 or your local emergency number.
- Explain the situation to the operator and provide updates. Inform them if the baby becomes unconscious at any point.
Step 5: CPR
- Place the baby on a flat, firm surface.
- Tilt the baby's head back and lift their chin to open the airway.
- Give two rescue breaths by making a seal around the baby's mouth and nose, and blow each breath in for 1 full second.
- Place two fingers on the baby's breastbone and perform 30 chest compressions at a rate of 100-120 compressions per minute.
- Continue this cycle of two rescue breaths followed by 30 chest compressions until help arrives.
It is important to note that choking can be a scary and stressful situation. If you are alone with the baby, provide about two minutes of care, and then call for emergency services. If you have access to a friend or family member, ask them to call for help while you focus on the baby.
Additionally, consider enrolling in a first aid or CPR course specifically designed for infants and children, such as those offered by the Red Cross. These courses can provide you with the skills and confidence to effectively respond to choking emergencies.
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Frequently asked questions
This may be due to regurgitation of milk during sleep. Try nursing the baby with their head-end raised and let them sleep on their right side. During feeding, if there is too much milk flow, squeeze some out before nursing the baby.
Choking is when a baby is unable to cry or cough. They won't be able to make any noise or breathe because their airway is completely obstructed. Gagging is not the same as choking. If your baby is gagging, they may make coughing or gargling sounds.
If your baby is choking, you should place them on a flat, firm surface. Look for any objects in their mouth and remove them if they are easy to grasp. Then, place two fingers on the baby's breastbone and apply pressure with a rhythm of 100-120 compressions per minute. Tilt their head back and lift their chin to open the airway. Give two rescue breaths by making a seal around their mouth and nose and blowing for 1 second each time. Repeat this until help arrives.
