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Choking On Milk

Rapid breathing! Infant turning blue! Parents will feel very worried if their infant showed any of these symptoms during feeding. This usually happens when the infant could not suck and swallow milk properly. It can lead to choking and coughing episodes during feeding, and may cause aspiration pneumonia. It is closely related to infant feeding skill development.

Feeding skills

Feeding is a complex sensorimotor skill. This skill starts from birth and reaches maturity gradually at the age of two. Feeding development depends on neurological development of the child and it will continue to develope through experience.

Infant and bottle feeding
(resource: fawwaznuha.com)

After birth, infants are only able to suck and swallow liquids. This is due to limited skills in their feeding development. Reflexes related to feeding development help infant 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 infant to locate 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. 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 – tongue moves out the mouth when it is touched. This reflex is present  since birth and will last for four to six months. It helps in breastfeeding to bottle feeding transition.

  • Gag reflex – Infant will gag when any object is placed way back in the mouth. This reflex helps protect infant 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 able below shows typical development of feeding skills from birth till 12 months old.

Age

Reflexes and mouth movements

Feeding skill

0 to 5 months

  • Suck/ swallow reflex

  • Tongue-thrust reflex

  • Rooting reflex

  • Gag reflex

  • Able to swallow liquids

  • Able to coordinate suck-swallow-breath pattern during feeding

  • Tongue moves forward and backward for sucking

4 to 6 months

  • Up and down chewing movements

  • Able to move food from front to back of tongue to be swallowed.

  • Tongue-thrust and rooting reflexes start to inhibit.

  • Able to accept and swallow puree consistency without choking.

  • Start drinking from cup with help.

5 to 9 months

  • Begin to control food in mouth

  • Move food to between jaws for chewing

  • Begins to accept mashed food

  • Eating from spoon

  • Drinking from cup without help

  • Begins to feed self with hands

8 to 11 months

  • Moves food from side to side in mouth

  • Begins to use jaws and tongue to mash food

  • Rotary chewing pattern begins

  • Begins to eat ground, finely chopped and soft food

  • Prefers to use hands to feed self and begins to use spoon

10 to 12 months

  • Rotary chewing improves

  • Begins to eat chopped and soft cooked food

  • Feed self by spoon with help

  • Bites and munch a variety of textures

Infant should follow the normal feeding development as stated in the table above. Age-appropriate feeding development helps infant ingest food and liquid safely. If feeding development is not age appropriate, infant may have feeding difficulties.

Feeding difficulties

An infant may demonstrate feeding difficulties when he is unable to suck, gather, munch and swallow milk or food in the mouth. Symptoms of feeding difficulties are as below:

  • frequent choking or coughing during or after feeding

  • difficulty to suck and swallow milk and food

  • breathing difficulty 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

Infants at high risk of having feeding difficulties

Some of infants who are at high risk of having feeding difficulties are as below:

  • 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. Parents should pay attention and always look out for any symptoms of feeding difficulties during feeding especially for those who are in the high risk.

References

1. Morris, S.E., & Klein, M.D. (2000). Pre-feeding Skills (2nd Ed.). Unites States: Therapy Skill Builders.

2. Hall, K.D. (2001). Peadiatric Dysphagia: Resource Guide. Canada: Singular.

3. Leonberg, B. Infant Nutrition And Feeding. Retrieved from http://www.nal.usda.gov/wicworks/Topics/FG/CompleteIFG.pdf

Last Reviewed : 08 Oktober 2014
Writer / Translator : Rozila bt. Sumardi
Accreditor : Yong Ennie