Managing Choking and Nasal Issues in Infants During Feeding

Choking on milk?

Hello Dr.
Chen,
I have a four-month-old infant who, when drinking milk, initially takes large and rapid gulps, accompanied by loud gulping sounds during swallowing.
This causes the baby to turn red in the face, lean backward, and cry loudly.
Sometimes, milk even comes out of the nose.
After about five or six gulps, the baby is able to drink smoothly.
After feeding, there is also nasal congestion.
The baby is usually held while feeding, and the head is not positioned too low.
I am unsure how to improve this situation.
If milk enters the trachea, is there a way to help expel it? Additionally, my child will be flying soon, and I would like to know what precautions to take.
Thank you for your time in responding!

Xin Ma, 30~39 year old female. Ask Date: 2004/04/01

Dr. Chen Qianyi reply Pediatrics

There are many reasons why young children may choke on milk, such as congenital gastrointestinal structural issues, a nipple hole that is too large, or a more impatient temperament.
Based on the situation you described, since your child can successfully drink milk after a few more sips, it seems that they may have been drinking too quickly at the beginning.
For babies with this temperament, it's best not to let them go too long without feeding, as this can help reduce such occurrences.
Some mothers mistakenly believe that they must wait three to four hours before feeding, which is actually a misconception.
Every baby is different, and daily circumstances can vary; feeding should not be timed like a stopwatch.
Regarding traveling with a baby on an airplane, safety considerations must be taken into account.
Therefore, it is essential to confirm with the airline that you will be traveling with a baby to arrange seating appropriately.
If the baby has any pre-existing health issues, it is important to consult with a physician to determine if flying is suitable.
During takeoff and landing, changes in air pressure can cause discomfort, so allowing the baby to suck on a pacifier, or feeding them milk or water can help alleviate this discomfort.
Additionally, the air on airplanes tends to be drier, so it's important to ensure adequate hydration during long flights.

Reply Date: 2004/04/01

More Info

Managing feeding issues in infants, particularly those related to choking and nasal congestion, can be a significant concern for parents. Your description of your four-month-old child experiencing loud swallowing sounds, turning red, and occasionally having milk come out of the nose suggests that there may be a few factors at play. Here’s a comprehensive approach to understanding and managing these issues.

Understanding the Symptoms
1. Choking and Gulping Sounds: The loud swallowing sounds and the redness you observe could indicate that your baby is drinking too quickly or is overwhelmed by the flow of milk. This can happen if the nipple of the bottle is too large or if the baby is very hungry and eager to feed.
2. Nasal Congestion: Milk coming out of the nose can occur if the baby is swallowing too fast, leading to improper coordination between swallowing and breathing. This can also cause nasal congestion as milk may irritate the nasal passages.

3. Crying and Discomfort: The crying and turning red during feeding may be a sign of discomfort, possibly due to gas or reflux. Babies often cry when they are frustrated or uncomfortable, which can further complicate feeding.

Strategies for Improvement
1. Feeding Position: Ensure that your baby is in an upright position while feeding. This can help reduce the risk of choking and allow for better swallowing. Holding the baby at a slight incline can also facilitate easier breathing.

2. Nipple Size: Consider using a slower-flow nipple. If the nipple is too large, it can cause the milk to flow too quickly, overwhelming your baby. A slower flow allows your baby to control the intake better.

3. Pacing the Feed: Allow your baby to take breaks during feeding. If you notice signs of distress, gently pull the bottle away and give your baby a moment to breathe and calm down before resuming.

4. Burping: Frequent burping during feeds can help alleviate gas and discomfort. Try to burp your baby after every 1-2 ounces of milk.

5. Monitor for Reflux: If your baby frequently spits up or seems uncomfortable after feeding, it may be worth discussing with your pediatrician about potential reflux issues.

Addressing Choking
If you suspect that milk has entered the airway, it’s essential to remain calm. Here are steps to take:
1. Positioning: If your baby is choking, hold them face down on your forearm, supporting their head and neck. Use the heel of your hand to give firm back blows between the shoulder blades.

2. Seek Help: If your baby is unable to breathe or is turning blue, seek emergency medical help immediately.

Traveling with Infants
When flying with an infant, consider the following:
1. Feeding During Takeoff and Landing: The change in cabin pressure can be uncomfortable for infants. Feeding your baby during takeoff and landing can help equalize ear pressure.

2. Hydration: Ensure your baby stays hydrated, especially on long flights. Bring enough formula or breast milk to last the trip.

3. Comfort Items: Bring familiar items like a blanket or toy to help soothe your baby during the flight.

4. Consult Your Pediatrician: If your baby has any underlying health issues, consult your pediatrician before flying to ensure it’s safe.

Conclusion
Managing feeding challenges in infants requires patience and observation. By adjusting feeding techniques, monitoring your baby's reactions, and ensuring a comfortable feeding environment, you can help alleviate choking and nasal issues. If problems persist, or if you have concerns about your baby's health, it’s always best to consult with your pediatrician for tailored advice and support.

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