Miya Pearson
It can be distressing for parents to see their newborn choking in their sleep. While choking is a medical emergency, gagging is a common occurrence in newborns. Newborns may gag in their sleep due to gastroesophageal reflux (GER), which causes them to spit up or vomit. Sleeping on the back is recommended for newborns as it reduces the risk of choking and is also protective against Sudden Infant Death Syndrome (SIDS). If your baby is choking, it is important to perform baby CPR and call emergency services.
| Characteristics | Values |
|---|---|
| Choking causes | Being sick, reflux, sleep apnea, or obstruction in the airway |
| Risk factors | Sleeping position, age, medical history |
| Prevention | Keeping the baby upright after feeding, back sleeping, avoiding swaddling, seeking medical advice |
| Treatment | Baby CPR, calling emergency services |
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What You'll Learn
Choking on spit-up or vomit
It is understandable to be concerned about your newborn choking in their sleep. Gagging and choking are not the same thing. Gagging is a protective reflex that prevents choking. A baby's gag reflex is triggered by spit-up or vomit, which causes them to spit it out or swallow it. Research shows that the risk of choking is low even with babies placed on their backs to sleep. This also applies to babies with reflux.
Healthy babies naturally swallow or cough up fluids. It is a reflex that all people have to keep the airway clear. When a baby is sleeping on their back, the opening of the windpipe sits on top of the opening of the oesophagus. Fluids that come from the stomach have to work against gravity to get into the windpipe and cause choking. When a baby sleeps on their tummy, the oesophagus sits above the baby's upper airways. If a baby regurgitates or vomits milk or fluid, these substances will pool at the opening of the airways and are more likely to be inhaled into the baby's airway and lungs. Hence, choking is less likely when a baby sleeps on their back.
Babies with reflux may spit up more often, which can lead to gagging or coughing. Keeping your baby upright for about 30 minutes after feeding can help reduce reflux symptoms and make them less prone to spit up and gag during sleep. All babies have reflux or "spit up" at some point. This is known as gastroesophageal reflux (GER) and is common in babies under 2 years old. Gastroesophageal reflux disease (GERD) is a more long-term, serious condition where reflux leads to continued symptoms or complications.
If your baby is choking, start baby CPR and call emergency services.
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Gastroesophageal reflux (GER)
GER is common in infants and is considered normal. Most babies outgrow it by the time they are 1 year old. When babies have reflux, they spit up. This often happens after a feeding. Reflux differs from vomiting because vomiting is more forceful. Reflux is spitting up that usually isn't forceful. Sometimes it happens when a baby burps after feeds and liquid comes out of the mouth or nose or both. Babies with reflux usually aren't fussy or uncomfortable.
GER is caused by the relaxation of the ring of muscle (the lower oesophageal sphincter) that separates the oesophagus from the stomach. Reflux symptoms occur if this ring relaxes at the wrong time or doesn't close as it should. The most common symptom of GER is spitting up or vomiting, which can lead to gagging or coughing. Keeping your baby upright for about 30 minutes after feeding can help reduce reflux symptoms and make them less prone to spit up and gag during sleep.
GER can become a more serious condition called gastroesophageal reflux disease (GERD) if it happens frequently, causes problems like poor growth, vomiting, or damage to the oesophagus, or lasts past a baby's first birthday. GERD can make it hard for babies to get proper nutrition. If your baby isn't gaining weight as expected or is losing weight, talk to your doctor right away. Doctors usually diagnose GERD by hearing about the symptoms, doing an exam, and checking a baby's weight.
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Baby sleeping position
It is understandable for new parents to worry about their newborn choking in their sleep. Gagging and choking are not the same thing. Gagging is a protective reflex that prevents choking. Babies usually have a strong gag reflex until they are about six months old, around the time they start solids.
The gag reflex is triggered when an object touches a sensitive area at the back of the throat, causing an automatic muscle contraction that pushes the object out of the mouth. This reflex helps to prevent choking.
The safest sleeping position for a baby is to place them on their back. This position is recommended by the American Academy of Pediatrics (AAP) and is supported by research, which has shown that it saves infant lives and reduces the risk of Sudden Infant Death Syndrome (SIDS). Sleeping on the back is also associated with a reduced risk of choking. This is because, when a baby sleeps on their back, the upper respiratory airways are positioned above the oesophagus. In this position, any regurgitated milk will lie at the lowest level and can be easily swallowed, reducing the risk of choking.
Babies who sleep on their stomachs are at a higher risk of SIDS and choking. This is because the oesophagus sits above the upper airways, so if a baby regurgitates or vomits milk or fluid, it will pool at the opening of the airways and is more likely to be inhaled. Sleeping on the side is also not recommended as babies can easily roll onto their stomachs, which is the most dangerous position for SIDS.
It is important to note that once babies can roll over on their own, they can be left in the position they choose, as long as they start sleeping on their back. It is also recommended to stop swaddling the baby once they start rolling over to reduce the risk of suffocation.
If you have concerns about your baby's sleeping position due to reflux or another medical condition, it is best to talk to your healthcare provider for advice.
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Sleep apnea
There are two main types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA occurs when an infant's throat narrows or closes, resulting in reduced airflow and oxygen intake. This type of sleep apnea is often associated with structural abnormalities in the face or head, particularly in the upper airway or larynx. Gastroesophageal reflux, cleft palate, and neuromuscular disorders such as Down syndrome and cerebral palsy can also increase the risk of OSA. On the other hand, CSA is rarer and is caused by a delay in the signal from the brain telling the body to breathe during sleep. Premature birth and maternal smoking during pregnancy have been linked to an increased risk of CSA in infants.
Certain risk factors can increase the likelihood of a newborn developing sleep apnea. Premature birth is a significant risk factor, with almost all infants born before 28 weeks of pregnancy experiencing apnea. Additionally, infants born with low birth weight are more susceptible to sleep apnea. Other factors, such as brain immaturity, neurological issues, heart disease, and gastrointestinal issues, can also contribute to the development of sleep apnea.
If left untreated, severe sleep apnea during infancy can lead to long-term health complications and even be life-threatening. Therefore, it is crucial for parents and caregivers to be aware of the symptoms and seek medical advice if they suspect their child may have sleep apnea. The American Academy of Sleep Medicine (AASM) recommends an overnight sleep study in a sleep lab, called a polysomnogram, for proper diagnosis. This involves monitoring the child's brain waves, heartbeat, and breathing activity during different sleep stages.
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Baby CPR
If your newborn is choking in their sleep, it could be due to gastroesophageal reflux (GER), a common condition in babies under 2 years old. GER occurs when a baby frequently spits up or has reflux, leading to gagging or coughing. To reduce reflux symptoms, keep your baby upright for about 30 minutes after feeding.
If your baby is choking, it is important to remain calm and follow these steps for Baby CPR, as recommended by the Red Cross:
Step 1: Check the Scene and the Baby
Check around you for any dangers and remove yourself and the baby from harm. Check the baby for responsiveness by tapping them gently, talking loudly, or squeezing their shoulders. Shout their name to get their attention. Check the baby's mouth for any blockages like food, vomit, or blood, and clear them with your little finger, being careful not to put your finger too far back into their throat.
Step 2: Call for Help
If the baby is unresponsive or breathing abnormally, call an ambulance immediately.
Step 3: Place the Baby on a Firm Surface
Place the unresponsive baby on a firm, flat surface, on their back.
Step 4: Chest Compressions
Place two fingers in the centre of the baby's chest, between their nipples. Push down by about one-third of the chest diameter (approximately 4 cm for a baby), using the heel of one hand if you cannot achieve the depth with your fingers. Perform 30 compressions at the rate of 2 compressions per second, allowing the chest to fully rise between compressions.
Step 5: Give Breaths
Take a breath, then seal the baby's mouth and nose with your mouth, or just their nose if you cannot cover both at once. Blow gently for about 1 second, watching for the chest to rise. If the chest does not rise, retilt the head and check for blockages. Repeat the cycle of 30 compressions and 2 breaths until the baby becomes responsive or medical help arrives.
Remember, always seek medical attention as soon as possible if your baby is choking or unresponsive.
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Frequently asked questions
Choking can be caused by an obstruction in the airway. If your newborn is choking, start baby CPR and call 911. To reduce the risk of choking, it is recommended to place your baby on their back to sleep, as this provides airway protection.
Choking can be caused by reflux, also known as gastroesophageal reflux (GER), which can lead to gagging or coughing. It can also be caused by sleep apnea, which is characterised by interruptions in breathing during sleep.
To prevent choking, it is recommended to place your baby on their back to sleep, avoid placing items in the baby's sleeping space to elevate them, and stop swaddling them once they start rolling over on their own. Keeping your baby upright for about 30 minutes after feeding can also help reduce reflux symptoms.
