Coughing While Breastfeeding: Is It Normal For Newborns?

It can be distressing to hear your baby cough, but it is a common symptom, especially in winter. Coughing is one of the body's most important defences against respiratory tract illness, helping to clear the airways and rid the throat of phlegm. However, it can be tricky to know when to worry about your baby's cough and when to seek medical advice.

Babies can choke while breastfeeding due to an excess of milk or poor feeding positions. An oversupply of milk can lead to a forceful let-down, where milk is released almost explosively, causing the baby to choke or gag. To prevent this, you can try feeding from one breast per feeding, or using the block feeding technique, where the baby feeds from one breast for a few hours before switching. It is also important to ensure your baby is latched properly, as improper latching can cause milk to accumulate in the mouth and lead to choking.

If your baby is choking on milk, it is important to stay calm and remove the baby from the breast to prevent them from inhaling milk. Hold your baby upright, facing down on your forearm, and use your other hand to support their head and neck. You can also try giving them back blows or chest thrusts to open the airways. If your baby doesn't recover and becomes unconscious, seek emergency medical attention immediately.

If your baby is coughing persistently, has difficulty breathing, or shows other signs of distress, contact your doctor.

How to prevent choking

It is normal for newborns to cough while breastfeeding, and it can be distressing for parents to witness. However, there are ways to prevent choking and keep your baby safe.

• Change the feeding position: Try a laid-back position, which reduces the flow of milk due to gravity and gives your baby more control.
• Take your baby off the breast occasionally: This helps them catch their breath and slows down the feeding.
• Lie on your side: This allows your baby to let milk dribble out of their mouth if the flow is too fast.
• Express milk before feeding: Doing so for 1-2 minutes can reduce the force of the let-down. Be careful not to pump for too long, as this will signal your body to produce more milk.
• Ensure a proper latch: Babies who don't latch deeply on the nipple often choke. A firm latch helps them handle the milk flow better.
• Try an uphill nursing position: This position makes the milk work against gravity, reducing the flow.
• Use the down-under position: Lie on your back and place your baby on top, so their tummy touches yours. However, don't do this too often, as it can lead to plugged milk ducts.
• Try the football hold: This is effective and can be used when you're out and about.
• Manage your milk supply: Feed from one breast per feeding to reduce the flow and prevent choking.
• Seek help: Consult a lactation consultant or your paediatrician for guidance on managing milk supply and feeding positions.

General Tips to Prevent Choking

• Keep your baby's head elevated while sleeping: This prevents milk or saliva from blocking their airway.
• Address reflux: If your baby has reflux, speak to your paediatrician for strategies to manage it and reduce the risk of choking.
• Use the right bottle and nipple: For bottle-fed babies, use the right-sized nipple and keep the bottle horizontal during feeding to reduce the milk flow.
• Keep nasal passages clear: Use nasal saline drops and a bulb aspirator to clear congestion, especially before feeds.
• Use a humidifier: This helps moisten airways and reduce coughing caused by post-nasal drip.
• Keep your baby hydrated: Breast milk or formula provides the necessary fluids.
• Consult a doctor: If your baby frequently chokes, has persistent coughing, or shows other distress or feeding difficulties, seek medical advice.

What to do if your baby chokes

While it can be distressing to see your newborn cough while breastfeeding, it is quite common and usually not a cause for concern. Newborns have a "hyper-gag reflex", which can cause gagging or coughing while feeding. This is due to their neurologic immaturity and developing bodies.

If your baby is coughing while breastfeeding, here are some tips to help them:

• Remain Calm: It's natural to feel anxious or scared, but staying calm will help you respond better.
• Remove Baby from the Breast: Take your baby off the breast immediately to prevent them from inhaling milk, which can cause choking or gagging.
• Hold Baby Upright: Hold your baby upright, facing down on your forearm. Support their head and neck with your hand.
• Back Blows: Use the heel of your hand to give five firm but gentle back blows between their shoulder blades, lower than their chest.
• Chest Thrusts: Place your baby on their back and use two or three fingers to perform chest thrusts on the lower half of their breastbone. Support their head with your other hand. Continue until the blockage is cleared.
• Intermittent Back Blows and Taps: Turn your baby upside down and give them intermittent back blows, combined with gentle taps on their back to open the airways.
• Hold Baby in an Upright Position: Hold younger infants in an upright position with good head and neck support for a few seconds. This helps them manage the choking episode.
• Pat Baby's Back: Gently pat your baby's back to help soothe and calm them.

If your baby doesn't recover and becomes unconscious, rush them to the nearest hospital immediately while continuing the dislodging procedure.

Remember, it's always better to be cautious. If you're concerned about your baby's health or have any doubts, don't hesitate to contact your doctor or healthcare provider for guidance and support.

Why your baby might be choking

It is common for babies to choke while breastfeeding. This can be frightening for any mother to witness, but it is important to remain calm and understand how it occurs to prevent it from happening.

Milk Excess

Sometimes, mothers produce more milk than their babies can ingest. This can cause choking when the excess milk spills into the baby's airway and blocks airflow. This is more likely to happen when the baby is not latched on properly, as the milk accumulates in their mouth instead of going straight down their throat.

Forceful Let-Down or Milk Ejection Reflex

Some mothers have an oversupply of milk, which can lead to a forceful let-down. This is when milk is released from the milk ducts forcefully and almost explosively. The baby may try to swallow all the milk, but the flow is too strong, and they end up choking.

Immature Suction

Babies can also choke while breastfeeding due to immature suction. They are still learning how to breastfeed and use their bodies, so they may gag or choke more easily.

Tips to Prevent Choking

Full Drainage

Before starting to feed your baby, express most of the milk from your breasts to reduce the flow during feeding. However, be careful not to pump for too long, as this can signal to your body to produce more milk.

Different Nursing Positions

Try different nursing positions that work against gravity to slow down the flow of milk. For example, you can recline on a surface with the baby in your arms or lie on your back with the baby on top, so their tummy touches yours. You can also try the football hold while leaning backward or sitting the baby in front of you instead of lying them down.

Burp Your Baby Frequently

Burping your baby can help to prevent choking by releasing any air bubbles that may be trapped in their stomach.

Feed Your Baby When They Are Relaxed

When your baby is relaxed, they will suck more gently, and the milk flow will decrease, reducing the risk of choking.

Slow Down Your Milk Supply

To slow down your milk supply, you can try expressing a little milk before feeding or applying cold pads to your breasts between feeds. You can also try feeding from only one breast per feeding to reduce the overall milk supply.

When to Call a Doctor

If your baby is choking and cannot breathe, turns blue, or becomes unconscious, call emergency services immediately. Other signs that you should seek medical attention include persistent coughing, difficulty breathing, distress, refusal to feed, and fever.

When to call for help

While newborn coughing is normal, there are some instances where you should call for medical help.

Call Emergency Services

If your baby is choking and cannot breathe, turns blue, or becomes unconscious, call emergency services immediately.

Contact Your Doctor

• If your baby is coughing persistently or has a persistent cough after choking, contact your doctor.
• If your baby appears distressed, cannot be calmed down, or is inconsolable after choking, call your doctor.
• If your baby refuses to breastfeed or has difficulty latching on after choking, contact your doctor.
• If your baby has a fever after choking, as this may indicate an infection, call your doctor.
• If your baby is coughing within the first few weeks of life, contact your doctor.
• If your baby has a cough with a fever lasting more than five days, call your doctor.
• If your baby has a cough lasting for eight weeks, contact your doctor.
• If your baby's cough is getting worse by the third week, call your doctor.
• If your baby has difficulty breathing or laboured breathing, contact your doctor.
• If your baby has night sweats, weight loss, or is coughing up blood, call your doctor.
• If your baby has a wet or dry hacking cough without wheezing or fast breathing, day or night, contact your doctor.
• If your baby's cough and stuffy nose persist for more than 10 days without improving, call your doctor. Your baby could have acid reflux, allergies, asthma, or enlarged adenoids.
• If your baby is coughing terribly in the winter, it could be respiratory syncytial virus (RSV), a dangerous viral infection for infants. Contact your doctor immediately.
• If your baby is under 3 months of age, or when the cough is accompanied by a high fever or signs of breathing difficulty, call your doctor.
• If your baby has a cough with a runny nose but no fever that lasts more than five to seven days, call your doctor.
• If your baby has coughs for more than 10 to 14 days, contact your doctor.
• If your baby has a fever for more than three days, call your doctor. Babies under 2 months should be seen immediately for any fever over 100.4°F (38°C).
• If your baby is coughing frequently during the night, call your doctor.
• If your baby is coughing persistently after eating, contact your doctor.
• If your baby has noisy breathing, such as rattling or whistling, call your doctor.
• If your baby has a dry or wet cough with a cold and a fever of 100°F (37.8°C) or more, contact your doctor.
• If your baby has mild, light wheezing, call your doctor.
• If your baby is experiencing skin retractions at the neck and chest area while breathing, call your doctor.
• If your baby has dizziness, excessive sleepiness, refusal to eat or drink, or trouble crying, contact your doctor.
• If your baby has a cough that sounds like barking or "whooping", call your doctor.
• If your baby is unable to catch their breath, call your doctor.
• If your baby is rapidly retracting and expanding their stomach, contact your doctor.

How to change feeding position

It is normal for newborns to cough while breastfeeding, and it can be caused by excess milk or poor feeding positions. Here are some tips to change the feeding position and make it more comfortable for both you and your baby:

The Cradle Hold

This is the most popular breastfeeding position. Sit in a comfortable chair with armrests or on a bed surrounded by cushions or pillows. Place your baby across your lap, facing you, with their nose towards your nipple. Their lower arm should be under yours, and their ear, shoulder, and hip should be in a straight line. To avoid backache, rest your feet on a stool or small table.

Lying on Your Side

This position is suitable if you've had a caesarean or difficult delivery or if you're breastfeeding during the night. Lie on your side comfortably, with your baby facing you, tummy to tummy, ensuring their ear, shoulder, and hip are in a straight line. Place cushions or pillows behind you for support, and remember to remove them after feeding. Use your free arm to support and guide your baby's head to your breast.

Laid-back Nursing

For laid-back breastfeeding, also known as biological nursing, lie back in a comfortable semi-reclined position on a sofa or bed. If you've had a caesarean, your baby can lie across you, away from the incision. Prop yourself up with cushions or pillows for back, shoulder, and neck support. Place your baby on your front, with their tummy resting on yours. If this is uncomfortable, lay them on their side. Ensure you are upright enough to maintain eye contact with your baby.

The Rugby Hold

The rugby hold is excellent for caesarean babies as it doesn't put pressure on the tummy or scar area. It's also useful for twins, as you can feed them simultaneously. Sit in a chair with a cushion or pillow along your side. Position your baby at your side, under your arm, with their hips close to your hips and their nose level with your nipple. Support their neck with your palm and gently guide them to your nipple.

Upright Breastfeeding or Koala Hold

In this position, your baby sits on your thigh or hip, with their spine and head upright while feeding. You can do this with a newborn if you provide enough support, and it's also convenient for older babies who can sit unaided. This hold is often the most comfortable for babies with reflux or ear infections, and it can also work for babies with tongue-tie or low muscle tone.

Side-lying Position

The side-lying position is ideal for relaxed night feeds and breastfeeding in bed or on the sofa. Lie on your side, and place your baby on their side, facing you, with their head at your breast. Support your back with pillows, and ensure your baby's nose is clear.

Reclining Position

If your baby has difficulty latching or is restless and crying, try the reclining position. Prop yourself up with pillows and lean back enough so that your baby is fully supported on your reclined body but not completely flat. Place your naked baby prone on your chest for skin-to-skin contact, which stimulates digestion and an interest in feeding.

Remember, the most important thing is to ensure your baby can feed well and that you are both comfortable. Don't be afraid to try out different positions until you find the ones that work best for you and your baby.

Frequently asked questions