Milk aspiration occurs when milk enters the airway instead of traveling down the esophagus to the stomach. This causes infants to cough, choke, spit up, experience difficulty breathing, or turn blue. Mild cases may lead to respiratory irritation. Severe instances increase the risk of pneumonia, apnea, and can even be fatal if not promptly managed.

The primary cause of milk aspiration is the underdeveloped suck-swallow-breathe reflex in infants, particularly in premature or frail babies. Incorrect feeding positions, such as lying flat, can also contribute. Other factors include an overly abundant milk supply from breastfeeding or using a bottle nipple with a large hole that allows milk to flow too quickly for the baby to swallow. Distractions during feeding, like crying, coughing, laughing, or feeding while drowsy, can easily lead to milk refluxing into the nasal passages. Infants with neurological abnormalities, hypotonia, congenital heart defects, cleft lip or palate, Down syndrome, or respiratory failure face a higher risk of aspiration.

For exclusively breastfed infants, a rapid and strong milk let-down can cause the baby to swallow hastily and choke. To address this, mothers should lean back instead of forward to reduce milk flow pressure. Gently pinching the nipple with two fingers can help control the amount of milk released. If milk sprays in a stream, pause feeding, express some milk, and allow the baby to rest before resuming. Observing your baby's feeding rhythm and swallowing sounds during a feed allows for proactive adjustments, preventing fear and refusal to feed.

Mothers should feed their babies in a side-lying position, with the head higher than the feet. Photo: Gian Don

If breast milk is insufficient and formula supplementation is necessary, adjust the feeding position and bottle-holding technique to prevent aspiration. Avoid feeding the baby with the bottle while they are lying flat. Instead, keep the baby's head elevated at a 30-degree angle relative to their body. For a 20-day-old infant, prioritize a small nipple size with a slow flow rate to control the milk stream. When feeding, tilt the bottle at a 45-degree angle to ensure the nipple remains full of milk, which helps limit the amount of air swallowed, reducing gas and reflux.

After feeding, hold your baby upright against your shoulder and gently pat their back to burp them for about 10-15 minutes, releasing excess air from their stomach. When placing the baby down after feeding, prioritize a side-lying position or elevate their head and shoulders, avoiding immediate placement on their back.

Dr. Nguyen Minh Thanh Giang, First-Degree Specialist

Neonatal Center

Tam Anh General Hospital Ho Chi Minh City