Choking at the breast

Why does my baby choke while breastfeeding?

Choking while breastfeeding is normal, especially in the first few months, and shows that the mother has a good milk supply. It usually happens near the beginning of a feed or at the first morning feed, when milk is flowing quickly. Some babies show signs they are about to choke. They may look panicked, wave their arms, and gulp or breathe quickly. They let go of the breast, cough, and seem a little angry, but within a minute most show hunger signs again and can be re-latched. Babies have coping strategies for choking. They may clamp down on the breast or pull back. Older babies usually release the breast and wait a few minutes for the let-down to pass before re-latching. Eventually they will no longer choke. If your baby chokes more than a few times during the feed, is not growing well, is generally unhappy, or struggles to breathe through most of the feed, see your health-care providers.

A) Reason why normal breastfeeding babies choke

Most babies occasionally choke while breastfeeding. Some mothers find this upsetting, but it is normal and shows that the mother has a good milk supply. The mother’s let-down brings a lot of milk into the baby’s mouth. Babies of mothers with a large milk supply tend to choke several times during each feed.

B) Behaviour before and during choking

1) When choking is likely to occur

Choking usually happens toward the start of the feed and often at the first morning feed when the milk is flowing quickly.

Other babies may be at the end of the feed and not actively sucking, when the mother has a let-down, resulting in the baby choking. They will immediately let go and not resume breastfeeding. This is more common when the mother has a large milk supply.

Choking is also more common in the first months after delivery and occurs less over time.

2) Signs the baby is about to choke

At the start of breastfeeding or with larger let-downs, some babies give signs that they are about to choke:

  • They will have a look of panic with big eyes and frowning eyebrows.
  • They may wave their arms frantically.
  • They may gulp quickly.
  • They may pant or breathe very quickly.

3) A baby’s behaviour when choking

A choking baby will:

  1. Make a sound like a squeak or an odd swallow.
  2. Quickly let go of the breast and pull away.
  3. May stop breathing for a few seconds.
  4. Cough to clear the milk from the throat.
  5. Settle down.
  6. Get a little angry at you.

Within a minute after choking and coming off the breast, most babies give hunger signs. Wait to see the signs before re-latching the baby. Babies can get quite angry if they are forced onto the breast and when they can’t breathe from choking or are no longer hungry.

C) How babies cope with choking

Babies have several coping strategies to deal with the let-down. They tend to progress through the following as they mature. 

1) Choking in the first few weeks

In the first few weeks, the baby is still figuring out how the breast works and will choke at many or most feeds. The frequency of choking decreases as the baby grows.

2) Clamping and tugging

Babies don't like choking and quickly learn to clamp down with their mouth while breastfeeding to slow the milk flow. They can also pull back (tug) on the breast when the let-down is too much.

3) Releasing the breast

An older baby generally releases the breast to catch a breath when too much milk is coming. The baby waits for the let-down to pass before re-latching.

4) Riding the wave

When a large let-down occurs, an older baby will remain latched but:

  • Have wide eyes.
  • Breathe heavily or pant.
  • Flail the arms.
  • Generally look a little stressed.

They remain latched but breastfeeding can be a little stressful for a few minutes. We call this riding the wave.

5) Adapting to the let-down

Finally, the baby will breastfeed through the let-down with minimal difficulty.

D) How to prevent and manage choking

1) Preventing choking

The laid-back breastfeeding hold is very effective at reducing choking as the baby is placed face down on the breast. The worst hold for a baby who chokes frequently is the under-arm hold in which babies are on their backs. The milk will be pulled by gravity towards the throat. 

Babies like to be able to come on and off the breast as they need to manage milk flow and choking. The cradle and side-lying holds can provide this.

If you see signs that the baby is about to choke and is really struggling to feed or is causing you pain by tugging and clamping, you can take the baby off the breast, wait for the let-down to slow or pass, and allow the baby to settle. This usually takes 5 to 15 seconds. Once the baby gives hunger signs, you can resume breastfeeding.

Premature, sleepy newborn, or sick babies may have trouble re-latching. If you take the baby off the breast, ensure that this does not reduce the amount of milk a baby takes in. 

2) Managing choking

If the baby chokes, let the baby roll away from the breast for a few minutes. Watch the baby’s face. This lets you see any hunger signs and how the baby is doing.

Some mothers panic, sling the baby over their shoulder, and start forcefully patting the baby on the back. This is only necessary when the baby can’t stop choking or coughing. Most babies are very able to deal with choking and only need a little time to recover.

E) Abnormal choking

Rarely, choking is caused by an abnormality in the throat, breathing tube (trachea), or swallowing tube (esophagus). Consult your health-care providers if your baby:

  • Chokes more than a few times during the feed.
  • Is not growing well.
  • Is generally unhappy.
  • Struggles to breathe through most of the feed.
  • Has unusual sounds while feeding.
  • Develops a blue-tinged area around the mouth while feeding.