Many parents look forward to feeding time with their baby. It’s a chance to bond and also gives you a few minutes of peace and quiet.
But for some, bottle feeding or breastfeeding can lead to gagging or choking sounds, which are alarming if you’re a new parent. Fortunately, there are things you can do to help prevent your baby from choking on milk or formula.
If your baby seems to gag a lot while eating, don’t panic. “Choking and gagging during feeding is common in young infants,” says Robert Hamilton, MD, FAAP, a pediatrician at Providence Saint John’s Health Center in Santa Monica.
Hamilton says babies are born with an exaggerated but protective “hyper-gag reflex,” which can cause gagging while feeding. Plus, babies gag easily due to their own neurologic immaturity.
“Babies are growing and learning new ways to use their body (and mouths) every day,” says Amanda Gorman, CPNP and founder of Nest Collaborative, a collection of International Board Certified Lactation Consultants.
“Often, just stopping the feed and positioning the baby upright with good head and neck support will give them a few seconds to manage the problem.”
Gina Posner, MD, a pediatrician at MemorialCare Orange Coast Medical Center, says if your baby begins to choke, let them stop feeding for a little bit and pat their back. “Typically, if they’re choking on liquids, it will resolve quickly,” she says.
The most common reason a baby chokes during breastfeeding is that milk is coming out faster than your baby can swallow. Usually, this happens when mom has an oversupply of milk.
According to the La Leche League International (LLLI), common signs of oversupply include restlessness at the breast, coughing, choking, or gulping milk, especially at let down, and biting on the nipple to stop the flow of milk, among others.
You might also have an overactive let down, which causes a forceful flow of milk into your baby’s mouth. When your breasts are stimulated by your baby suckling, oxytocin causes the let-down reflex that releases the milk.
If you have an overactive or forceful let down, this release happens too fast for your baby to respond appropriately, causing them to gulp or choke while breastfeeding.
How do I prevent my baby from choking on milk when breastfeeding?
One of the first things you can do to help prevent your baby from choking while eating is to change the feeding position.
“For breastfeeding mothers who appear to have overactive let down, we typically recommend they nurse in a laid-back position, which reverses gravity’s effect and allows baby to have more control,” says Gorman.
Posner recommends pulling your baby off the breast every once in a while to help them catch their breath and slow down. You can also take your baby off the breast for 20 to 30 seconds when your milk first lets down.
In addition to a laid-back position, the LLL recommends lying on your side so your baby can allow milk to dribble out of his mouth when it flows too quickly.
Furthermore, expressing milk for 1 to 2 minutes before bringing your baby to your breast can help. Doing so allows the forceful let down to happen before baby latches. That said, be careful with this technique, as pumping for too long will tell your body to make more milk and worsen the problem.
When your baby gags when drinking from a bottle, it’s often due to the positioning. Lying your baby on their back while bottle feeding will lead to a faster milk flow, making it harder for your baby to control the rate of feeding.
“Tilting the bottom of the bottle higher than the nipple increases the rate of milk flow, as will a nipple with too large of a hole for the infant’s age,” Gorman advises. Tilting the bottle too high can lead to involuntary increases in intake and contribute to problems like reflux.
Instead, when bottle-feeding an infant, try using a technique called paced bottle-feeding. “By keeping the bottle parallel to the ground, the baby remains in control of the milk flow, as they are at the breast,” Gorman says.
This technique allows your baby to actively pull milk out of the bottle using their sucking skills and lets them easily take a break when needed. Otherwise, gravity is in control.
For babies who are bottle-fed by multiple caregivers, Gorman says all of the people who administer feeds should be educated on paced bottle-feeding.
Finally, you should never prop the bottle up to feed your baby and walk away. Since they can’t control the flow of the milk, it will keep coming even if your baby is not ready to swallow.
“The mechanism of swallowing is complicated and requires several muscle groups working together in concert and in the right time sequence,” Hamilton says. Fortunately, gagging usually diminishes as children get older and become better at swallowing.
Still, if you’re a new parent or caregiver, it’s smart to take infant cardiopulmonary resuscitation (CPR). While rare, a choking episode that caused your baby to turn blue or lose consciousness would be an emergency.
If you’re having problems related to breastfeeding, contact a LLL leader or International Board Certified Lactation Consultant (IBCLC). They can help you with your baby’s latch, positioning, oversupply issues, and forceful let-down problems.
If you’re having problems related to bottle feeding, contact your child’s pediatrician. They can help you with bottle and nipple selection, as well as feeding positions that prevent choking on milk or formula.
If your baby continues to choke even after slowing down the rate of feeding, you should contact your pediatrician to rule out any anatomical reasons why swallowing may be challenging.
When you hear your baby gagging or choking during feeding, don’t panic. Take baby off the nipple and prop them up to help them clear their airway.
Often it will take a little time for your baby to learn suckle with ease. In the meantime, try keeping your baby upright during feedings and make the flow of milk slower, if possible. Soon enough, feeding time will be a sweet snuggle session!