Choking On Milk

Rapid breathing and turning blue – these are symptoms that may happen to an infant during feeding if they are not able to suck or swallow milk properly. This could lead to choking or coughing episodes during a feeding that may lead to aspiration pneumonia. To learn more on how to avoid this, it’s important to know about how a baby’s feeding skill develops, as sourced from the Ministry of Health.

What are feeding skills?

Feeding is a complex sensorimotor skill that starts from birth and reaches maturity by the age of two.

Newborns are only able to suck and swallow liquids due to limited skills in their feeding development. However, they have innate reflexes that help them to locate, suck and swallow milk. The reflexes are as below:

• Rooting reflex – when the cheek is brushed or stroked, the infant will turn his head towards the stimulus. This reflex helps him locate the milk source and grasp a nipple. It begins since birth and is inhibited by the age of four months.
• Suck-swallow reflex – these reflexes are initiated when the lips or area around the mouth are touched. Suckling and sucking movements begin and the tongue pushes the milk to the back of the mouth to be swallowed. These reflexes begin since birth and are inhibited by the age of four months.
• Tongue-thrust reflex – the tongue moves out the mouth when it is touched. This reflex is present from birth and will last for four to six months. It helps in breastfeeding to bottle feeding transition.
• Gag reflex – the infant will gag when any object is placed way back in the mouth. This reflex helps protect babies from swallowing any objects that could lead to choking. Due to the presence of this reflex, food consistencies other than liquids are only introduced when the infant is four or six months old. This reflex is usually inhibited by the age of four months.

The typical development of feeding skills from birth till 12 months old can be seen in the table below:

Age-appropriate feeding development helps babies ingest food and liquid safely, with an lesser risk of facing feeding difficulties.

How to tell if my baby is experiencing feeding difficulties?

Your child may have feeding difficulties if you notice the following symptoms:

• frequent choking or coughing during or after feeding
• difficulty sucking or swallowing milk/food
• difficulty breathing during feeding
• drooling of saliva or milk during feeding
• takes a longer period of time to finish milk and food
• voice changes after feeding
• frequent milk or food refusal and vomiting
• weight loss or delay in development

Some infants have a higher risk of feeding difficulties than others. Some examples include those who have:

• Abnormality of oral structures, respiratory and swallowing tracts. Example: cleft lip and palate, Pierre Robin Syndrome.
• Global developmental delay
• Neurological problems (Cerebral Palsy, Down’s Syndrome)
• Behavioural issues (picky eater)
• Complex medical problems (congenital heart disease, lungs and liver)
• Gastrointestinal tract problems (tracheoesophageal fistula)

Frequent choking on milk is an indicator of feeding difficulties in infants. It’s important for parents to be observant and diligent when looking out for these symptoms.

Source: MyHealth (Kementerian Kesihatan Malaysia)