Why your baby is coughing during bottle feeding and how to help

As a parent, you may wonder why your little one occasionally coughs while taking a bottle or breast feeding. It's important to remember what an incredible motion the swallow reflex is! Newborns and infants must suck, swallow, and breathe in perfect synchrony. It's no wonder that some little ones occasionally struggle to coordinate the task. But what about when coughing happens more frequently? And what can you do as a parent to help them?

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Why do babies cough while feeding?

Coughing is your body's natural response to airway invasion. In other words, when your brain senses food or liquid traveling down "the wrong pipe", it elicits a coughing reflex to forcefully expel whatever it is that is trying to invade the airway. Having a cough reflex is a good thing! Without it, we would be much more susceptible to upper respiratory infections and severe illnesses like pneumonia. Although your baby's cough reflex is a protective mechanism, it is good to note how frequently coughing occurs during bottle and breast feeding and how your baby responds to it.

A little or a lot? How much is too much?

It is not uncommon for babies to occasionally lose coordination while feeding and cough. These coughing behaviors should be brief and infrequent (no more than a couple times a week) and should not be accompanied by the following symptoms:

- Color changes (blue or dusky coloration around the forehead, bridge of nose, or lips)

- Coughing fits that are persistent and resemble choking

- Lethargy or extreme drowsiness following coughing fit

- Increase in core body temperature following coughing

- Refusal to resume breast or bottle feeding

- Frequent arching, head turning, or pulling away from the bottle

- Coughing that leads to vomiting

- Gasping for air

- High pitched squeaking-like noise when baby inhales (called inspiratory stridor)

- Rapid breathing, tugging observed in the chest when child inhales

If any of these symptoms accompany coughing, speak with your healthcare provider immediately about obtaining a referral for a swallow study or feeding therapy evaluation.

Don't want to wait for a referral? If you have concerns about your child's feeding and would like immediate support, TeleBites offers same day and next day appointments to provide immediate support for your child. Don't see a time that meets your needs? Call or text us at (719) 640-7854 for booking assistance.

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What can I do to help my baby if they are coughing while feeding?

There are a few techniques that can address some of the reasons that babies cough while feeding. The most common reason for coughing is loss of coordination. These strategies can improve coordination and offer better airway protection.

1. Positioning:

2. If baby is coughing while being fed in a reclined or cradled position, try positioning them on their side for feeding in a position referred to as sidelying

3. Be sure that overall alignment is still developmentally supportive. Ears, shoulders, hips, and feet should all line up.

4. Swaddling a baby during feeding is a great way to promote stability and organization. Many parents mistake baby kicking or pushing out against the swaddle as an attempt to free themselves from being wrapped, but it is just the opposite. Babies push out with their arms and legs to seek stability and find boundaries. Swaddling them for feeding helps them find a boundary to stabilize their body so they can focus on feeding.

5. Pacing:

6. Myth: a bottle nipple must be completely full of milk so baby doesn't swallow too much air.

7. Fact: Babies generally swallow too much air when gulping down a bottle, which happens more frequently when they extract too much milk too quickly from a bottle. While you want to ensure baby is able to extract some milk from the bottle, a small pocket of air at the widest part of the nipple ensures gravity isn't acting to increase the flow rate of the bottle. Think of it like the bubble on a level. It indicates horizontal positioning of the bottle and ensures that baby won't be getting milk passively. It promotes active feeding rather than reactive swallowing.

8. Flow rate modification

9. Appropriate flow rate is one of the most important factors in safe feeding for infants. Unfortunately many commercial bottle manufacturers market relatively fast flowing bottles to newborns. It's extremely common for infants from birth to three months to struggle with flow rate management on level 1 bottle nipples. This contributes to a host of long term feeding difficulties because your baby's rapidly developing brain is mapping reactive and uncoordinated feeding patterns instead of mature suck, swallow, breathe pattern which will support feeding development for years to come.

10. If you have a preferred bottle system, you can search on Amazon or other online retailers for 0 flow or slow flow (sometimes labeled preemie flow) nipples for that bottle. Although they are not always carried in stores, a good selection of appropriate flow rate bottles are available to be ordered online. Need help finding the right flow rate for your baby? TeleBites recommends a 30 minute therapy session to analyze your baby's feeding patterns and provide recommendations based on your preferences and the needs of your little one.