My Baby Is Choking In Her Sleep!

A frantic mom rushes up to the Triage window in the Emergency Department, her eyes wild.  “My baby is choking!” she cries.  The staff scramble to get the baby in back and assessed.

Yet in the mom’s arms is a pink, calm infant.  After a few moments of reassurance by the triage nurse, the mom begins to breathe normally.  Thus begins a common evening visit to the ED.

Many moms lie awake at night listening to their babies breathe.  Most worry: what if she stops?  Then when baby gets her first cold, mom worries that her worst fear is about to come true.  Mucus in the baby’s nose runs to the back of her throat as she lies flat in bed.  The baby gags, then coughs, then splutters, then gives a single sharp cry, gags and coughs and splutters again.

By this time mom is on her feet and baby in her arms in one panic-driven motion.  Baby continues to gag.  Mom’ mind races between suctioning baby’s mouth with the bulb syringe, giving back blows, or giving mouth-to-mouth breaths.  Maybe she calls the ambulance, sometimes calls a nurse or paramedic friend who lives nearby.  Eventually mom and baby end up at the triage window and baby is back to normal.

What mom has witnessed is a normal event in many little babies’ lives.  Despite mom’s fears, the episode is not life-threatening.  It is not the beginning of Sudden Infant Death Syndrome (SIDS), also called “crib death.”  Baby will not choke to death on mucus or vomit lying on her back in the middle of the night.  The coughing and gagging and spluttering and vigorous swallowing baby does are the normal reflexes babies use to clear her airway. 

The fear that baby will choke to death is made worse by the stories of so many rock-and-roll stars dying of lying on their backs and vomiting.   The problem with theses music icons is that their normal cough and gag reflexes have been numbed by drugs and alcohol so that they can not cough and gag and clear their airways like babies do.  Thus they drown on the little pool of vomit in their throats.

Thus the recommendation by the American Academy of Pediatrics holds true- but babies to sleep on their backs.  SIDS happens twice as often to babies put to sleep on their stomachs because they are more likely to smother in thick bedclothes. 

So what should mom’s do to make babies with colds sleep better?  One thing to try is to put baby to sleep in a car seat, swing, or bouncer.  When baby is upright, the mucus does not hit the back of the throat and cause coughing and gagging.  Strap baby in!  Do not put baby on a pillow, which greatly increases the risk of SIDS.

A second thing to try is a vaporizer at the bedside- indoor air at night is dry, and it dries out mucus so that it is thicker and harder to clear, and airways get more dry and irritated.  A vaporizer putting out mist may moisten baby’s throat and thin the mucus.  Finally, it is okay to give baby tylenol for pain before bedtime- baby may have some sore throat and other pain from the virus that she cannot tell us about.

Next time your baby gets a cold, don’t panic.  Try the car seat for bed, try the vaporizer, try tylenol.  And if baby gags in bed, sure, go ahead and call your doctor or your medical neighbor.  But if baby recovers on her own in a few minutes, take a deep breath yourself- baby is okay!

25 thoughts on “My Baby Is Choking In Her Sleep!

  1. Thanks for the info. Just to let you know, nurses in my area suggest not allowing a baby to sleep in a car seat for more than 2 hours. Their breathing can be interrupted by their chin being folded over.

    • I have re-researched the recommendations on sleeping, cold care, and car seats. There is nothing suggesting infants are at increased risk of breathing problems in car seats. There are no case reports of well babies having breathing problems in car seats. Given the widespread use of car seats, one would think that we would know of such a problem by now.
      The only precautions mentioned is that babies should not spend excessive time in car seats because this might contribute to plagiocephaly, which is when babies develop flatness at the back of their heads from sleeping on their backs so much. However, “excessive time” means months of time either flat or in a car seat. A few nights in the car seat while enduring a cold virus will not make this a problem.
      My suggestion is that the nurses you mention also research their recommendation and discuss it with their pediatricians. If they learn something more than the above, please let me know!

  2. pretty sure that Kristin is right. i’m not about to just put my infant in a carseat and go to bed. the thought of this is ridiculis. a swing that may be reclined to a laid back position maybe, for a few hours, but not all night. this will potentially create a hard to break bedtime habit. learn your job as a parent and and stay at your child’s side, when coughing starts, get up and take care of it! it’s that simple.

  3. This is in a response to Liz. Remember the three-day rule wihen it comes to infants and toddlers. Almost any behavior, whether good or bad, can be modified in a young child over the course of only three days. It normally takes three days to develop a bad habit with a child, and normally only three days to break it. Often, when we have sick children, the most important thing is to keep them comfortable. Especially with a virus or other common childhood illness, there’s not much we as parents can do but “let it run its course” and comfort our kids with an extra dose of love. For instance, you might only allow your child to watch an hour of cartoons on a normal day but will allow them to cuddle on the couch with a pillow, blanket, and sippie cup all day watching Dora the Explorer when he/she is running fever. Same thing with putting your baby to sleep in a carseat or swing if they are sick. As I’m sure Dr. Hamilton would agree, it’s much better to prevent the coughing and gagging of an infant than to get up all night to tend to it. Not only will the baby receive the much needed rest its body needs to fight off the infection, you as a parent will be able to refuel for another long day of tending to a sick child. It is not hard to retrain your child to sleep in a crib again – the carseat/swing is a temporary modification used to handle a break from routine that occurs when your baby is sick. Following this advice in no way means you’re not be a responsible mother or father.

  4. Okay, here’s my question to Liz and Kristen. If it’s dangerous to have your child in a car seat for over 2 hours, does that mean you’re not supposed to take any car trips which are longer than 2 hours with a baby? Somehow, I didn’t read that anywhere in my car seat information, and I got one that’s top rated for safety.

    Nobody’s saying don’t take care of your child. It’s simply saying that it’s an aid you can use to help your child sleep a little better. While I loved our nurses in the NICU, we caught them out several times on information that we later found was incorrect – for example, they used a rolled-up blanket as a positioner, yet when we researched it, we found that was an absolute no-no. Later, we went back for a visit and one of our favorite nurses told us they’d just had a ‘back to sleep’ training seminar…and they weren’t using the blanket positioners any more.

    Just an FYI.

  5. my son is 16 mths & chokes sometime’s when he is eating.. is that bad? he eat’s fine and enjoys his food but sometimes he will choke!

    • Your 16 month chokes sometimes while he is eating? Me too! Seriously though, that he eats fine tells us that his swallowing mechanism is ok. We all have times when a bit of food or drink gets into our “windpipe” and we cough and gag to clear it, but that is ok. You do bring up a good point though about what foods to give toddlers.
      Parents need to be careful not to feed toddlers foods that require lots of chewing. Those kinds of foods can lead to a life-threatening choking. Hot dogs are particularly risky about getting a big piece swallowed and blocking the airway. Other high risk foods at toddler age are popcorn, peanuts, hard candies, gum, gooey candies like toffees or tootsie rolls, and other meat chunks like hotdogs or steak or seafoods. Any meat or hot dog should be cut up into pieces as small as a green pea.

  6. and what does one do when the child exhibits these symptoms but also chokes on very thick plugs of mucus to the point of changing colour and losing consciousness? my baby actually stops breathing and we have to hook out these thick plugs from nostrils and throat to clear his airway, when there are no signs of life for 20-30 seconds I take action. if we’re lucky we have time to suction if not we use first aid for choking techniques to help clear him or drain him, sometimes we’re lucky and he responds with a breath, other times …it becomes necessary to use CPR and actually resuscitate.My boy is 16 months old and doctors are at a loss to explain it..currently he is being tested for cystic fibrosis.

    • You obviously have a worse problem than most! Just reading your story, I would guess that your baby has an exaggerated gag/valsalva reflex. Some people, when they gag, trigger a reflex called valsalva, where they pass out and drop their blood pressure. This is like a worse-than-usual fainting spell, but patients self-recover. Babies and toddlers who have “breath-holding” spells do the same thing- cry so hard that they turn blue and pass out, and then wake up within a minute just fine. These things look scary, but again are usually not at all life-threatening. If your doctors are looking into things like cystic fibrosis, it sounds like they are on the ball.
      The other question is why your child has so much congestion. Long standing congestion could be from allergies and I am sure your doctors have looked into treating that. But if your child is in day care, you should take him out. You should be also be very careful about exposing him to people with colds, and make sure anyone who touches him has washed their hands first. Better to prevent the colds than deal with his awful episodes of congestion.

  7. In repy to Dr.Hamilton, thank you for replying . My boy has been like this since birth, he was also born with Atresia/Microtia (missing ear and ear canal) I do wonder if drainage and/or missed infection could be part of the problem.
    He doesn’t cry before an episode or hold his breath, sometimes he doesn’t make a noise or gag but simply doesn’t respond or breathe when he’s sleeping . He doesn’t attend any form of childcare, only hearing and speech clinics, we try to control the incidence of exposure to other sick children and we are very careful with hygiene out and about or at home. He doesn’t always have obvious signs of cold or congestion and has been diagnosed with a cold only twice so the episodes are surprising.
    Medical Opinions have ranged from Reflux to Apnoea, to Coeliac disease and Thyroid issues, He’s had x-rays, scans and ECG’s for seizural episodes , …has been admitted to respiratory clinic prior where a Bronchoscopy found stridor wheeze and an immature thorax/problem with tubes closing opening at wrong time but failed to explain the asphyxiating mucous issue.
    Dietician clinic came next to learn to swallow and properly chew and tolerate textures, which we had hoped would lessen the incidence of choking.
    Early feb he will be hooked up to Intensive Tube Feeding because despite fleshing out his meals with oils, cream, butters, eggs etc there is no sustainable weight gain. . He’s still filling in with breastmilk at 18 months because he refuses to take milk , and has days where he refuses to swallow or show interest in food. The hospital nutitional formulas have been a dismal failure. His body just isn’t taking up nutrients for some reason, any weight gain is minimal and lost again within a matter of weeks.
    He is also scheduled for a visit to a geneticist for any underlying conditions. I’m looking at the whole package and feel the issues he has could be linked.
    No-ones looked into allergies nor do I think they’ve ever mentioned the vasalva reflex , so I’ll be passing your tips by his medical team in case your onto something, anything’s possible I’ll keep you posted .

    • Wow. You certainly have a much, much worse case than most. But you also are pursuing all the right specialists and taking on the issues, which is very complex and thorny. I wish I could offer more comfort other than to say that you sound like you doing a great job not panicking and methodically tackling the problem- hats off to you!

  8. Well, I have to agree with Dr. Hamilton in diagnosing the symptoms of worried moms. I have a five months old baby and she was diagnosed with RSV. The symptoms are now disappearing except for the mucus which is my main concern. She wakes up several times because she is unable to breathe properly from her nose and I feel I am going to have a heart attack for not breathing too. Do you think Doctor it’s safe to use Mucosolvan in such a case? I have little faith in our doctors in Lebanon (MEA) and I was wondering if you can advice…

    • I do not know Mucosalvin by name. It sounds like an over-the-counter medicine for cough and congestion symptoms. If this is so, science has shown that NO cough and cold medicine has ever been helpful. In fact, those medicines are not certain to be safe in infants. Best to stick with vaporizers and tylenol for comfort.

  9. Hi everyone, I’m a new parent and I’m trying to get my three month daughter to sleep longer during night. Currently I am fortunate to have three hours rest a night. Regards

  10. I’ve also heard about the no leaving infants in car seats to sleep. Their chins hang down against their upper chest area causing restricted breathing. Driving in a car seat and baby sleeps is a different story. It’s not in the position that it would be in if it was just sitting there. Most car seats lay back more so the baby is more on the back when put in the car. Rather than when it’s out of the car it’s more inclined and chin droops down.
    Doctors have also advised this as a no no. Infant deaths in day cares have been on news in recent months due to this

    • Yes, there are case reports of new infants (too young to hold their heads up), slumping in car seats and closing their airways. Car seats should not be positioned so newborns are sitting up too much. And the recommendation of having rear-facing car seats in the back seat makes it hard to watch the baby. You can buy mirrors that hang on the backseat to see your baby’s face. But best to just take short drives with newborns-no cross country road trips!

  11. I’d take this article with a grain of salt. I don’t think this women has seen a baby choking in the middle of the night. In ten years, they’ll be back to telling us to put babies on their stomachs again.

  12. I agree I wouldn’t allow baby to sleep in car seat. There was a story on the news where the babysitter put baby in car seat to sleep because she had a cold and thought it would help but the baby head was bent like fell forward and the airway was clogged and the baby died. So I wouldn’t risk the car seat.

    • Yes, there have been case reports and new information that new babies, under at least 2 months old, can have their head fall forward and kink their airway. In fact, hospital nurseries are now doing “car seat studies” which examine how babies breathe in their car seats before baby is discharged home. I no longer recommend babies under 2 months old sleep in car seats, swings, or bouncers. However, when babies start to have good head control, then this is safer.

  13. Baby’s can choke on mucus. My son who has asthma(also had meconium aspiration when born and trachealmalacia) was 4 months old with another upper respiratory infection. Breathing treatments were keeping him comfortable. One night, we just got home from the in laws, when I gave my son to my mom for a breathing treatment while I got the other kids ready for bed. Not 20 seconds after I walked away my mother was screaming for me and when I got over there my son had stopped breathing. His chest was not moving at all but his heart was beating and his eyes were open. For what seemed like two minutes we were on the phone with 911 frantically asking for an ambulance. I finally put him on the floor, head back I blew into his mouth(I know it’s the wrong thing to do now) his chest didn’t rise and mucous came out his nose and suddenly he started coughing, sputtering the breathing and crying. The doctors sent him home the same night? The paramedics never witnessed it nor the docs. I often wonder what would have happened had this happened in his crib. I shudder at the thought, he was quiet and would have died I know. Doctors called it a mucous plug, that’s all I know.

  14. I understand that this article is a little old but it does make me feel a teeny bit better but for the most part I am still terrified. Right now, it’s 5:15a and I am up to ‘watch’ my baby sleep and make sure she’s breathing. I was congested last week and seem to have passed it to my daughter. She turned 4months old on Thursday 3/30 and that’s when her congestion symptoms began to show. Friday night (3/31) we put her down for bed like normal – we bed share – and sometime a few hours later woke me with a coughing spell that also felt like she wasn’t breathing right. I scooped her up and into my arms and began hitting her on her back until her breathing returned to normal… it did and the whole thing maybe took about 20 to 30 seconds. Well tonight, we put her to bed and again she had another choking episode that was much much worse. I scooped her into my arms when I was awoken by her persistent cough hit her on the back and waited for the ‘gasp’ of air that never came, I continued to hit her until I heard a wheezing and realized that the mucus or saliva was still there blocking her airway. I stuck my finger in her mouth and tried to pull / hook it out and nothing. She still wasn’t breathing correctly and instead was taking short shallow breaths and to make matters worse, both my ears are clogged so I can’t hear that well but just knew this isn’t right, this isn’t normal breathing. I woke my husband who rushed over and tried to get her to breathe and in the process officially woke her up which really seemed to help the situation. Now, terrified and haven’t been able to go back to sleep since. She gave her 3ml of Zarbee’s cough syrup before bed and now after reading the article know that I need to stick with Tylenol which is what we were using before we tried this since it said ‘cough’ on it…
    anyway, what I’m asking is that her two episodes are totally and completely normal and she would’ve been fine and returned to ‘normal’ on her own without me intervening?

    • As is stated at the intro to this blog, we cannot comment on individual children’s cases, as we have not seen them as patients. This is a question for your child’s provider.

  15. I’m a nurse anesthetist – I do airway protection all day long. Chin flexion can block the airway but it takes hours to get to the point where o2 supply goes down from extended chin tucking (in normal cercumstancrs) – you’re likely taking them out or feeding them long before they could have problems. Even at night, lower the angle of the seat so as not to promote extreme fkexion (tucking) of chin from the seat being too vertical. Lower it to 45 degrees to Get the therapeutic benefit from the car seat draining the airway gook out while preventing chin talking.

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