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I have a 5 week old daughter. She spits up after feeding sometimes (especially if she feeds too much in one sitting). We have been worried about her choking on the spit-up. Especially in the night while we are sleeping.

We have been trying to minimize the spit up by feeding her less in one sitting and keeping her upright after feeding for half an hour, and she sleeps on a slight incline on her back, and watching her for a while after she's asleep to make sure she's OK, but we are really exhausted too. Do we need to worry about her choking so much? What if she spits up while we are sleeping?

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    Please remember that comments are for clarification, not answers. Thanks.
    – anongoodnurse
    Commented Jun 25, 2018 at 23:17
  • Not an answer, but I wanted to stress that the worry is normal for first-time parents, and the best thing you can do for your self and your newborn is learn to take a deep breath and let it go. We humans (even as infants) are pretty damn resilient. I don't mean to say to seek harm, but first-time parents are often so scared when they just don't need to be. Try finding some "Positive Parenting" classes in your community, and don't be afraid to join groups of parents. That 1-2 hours a week will save you countless hours of worry.
    – coteyr
    Commented Jun 27, 2018 at 7:48

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According to NICHD: No.

Myth: Babies who sleep on their backs will choke if they spit up or vomit during sleep.

Fact: Babies automatically cough up or swallow fluid that they spit up or vomit—it’s a reflex to keep the airway clear. Studies show no increase in the number of deaths from choking among babies who sleep on their backs. In fact, babies who sleep on their backs might clear these fluids better because of the way the body is built.

You also should visit the website and learn as much as you can.

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    Welcome to the site, and thanks for this well-sourced answer!
    – anongoodnurse
    Commented Jun 25, 2018 at 17:14
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    Perfect, thank you for updating the answer! (You also could've flagged your original answer for undeleting by one of us mods, but this is a fine solution given you clearly fixed the problem.)
    – Joe
    Commented Jun 25, 2018 at 18:03
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    I do like that the answer suggests learning as much as you can. I would caution that you make sure the sources you read are reputable and official. My wife started reading everything she could for our first child, and upon reflection found much of it to be more harm than good: various blogs and mom groups that have wildly subjective (and often uneducated) "advice." Reading NIH, AAP (American Academy of Pediatrics) and other reliable sources is a wonderful thing. Just don't be tempted by "wow that seems logical, thanks random-mommy-blog-dot-com!"
    – corsiKa
    Commented Jun 25, 2018 at 20:04
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    I'd be tempted to add that the myth likely comes from the fact that adults suffer this problem after drinking - so we assume that babies are liable to it. The difference is of course, that babies aren't drunk and don't have their nervous system suppressed by drugs.
    – UKMonkey
    Commented Jun 26, 2018 at 2:13
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    @corsiKa that's one of the reasons I've asked this question. There is so much conflicting information online and it's really confusing to read and decipher what is legit and what is not.
    – user30275
    Commented Jun 26, 2018 at 10:15
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I think CF13's answer is spot on. I just want to add a little bit of information to support/expand on it.

I assume by "choke", you mean a significant event, like death or aspiration pneumonia, not merely coughing or gagging. The latter are actually ways to clear the throat (kind of the opposite of choking.)

Without going into too much detail, there are reflexes which work very well to keep us alive. Coughing out and/or swallowing vomitus to keep the airway clear is one of those.

People who die from choking on vomit are those who are neurologically impaired in some way. For example, heroin use, heavy intoxication, unconsciousness (not the same as sleep!), a stroke, or prematurity (born before those reflexes are perfected) can dull that reflex, and that's why that kind of death can happen in those populations.

Babies who are neurologically intact will clear their airway, even of copious amounts of vomit, very well.

Cases of fatal choking are very rare except when related to a medical condition. The number of fatal choking deaths has not increased since back sleeping recommendations began. In most of the few reported cases of fatal choking, an infant was sleeping on his or her stomach.

So to answer your questions directly,

Can an infant choke on spit-up?

Yes, in the same way that it's possible for your spouse (let's say they have gastroesophageal reflux) to do so.

Do we need to worry about her choking so much?

No. If you're not worried about your spouse choking in their sleep, you needn't worry about your baby, though worrying about babies is very common, normal, and natural.

What if she spits up while we are sleeping?

Usually when babies spit up in their sleep, they simply swallow it or it ends up on the bedsheet/child's collar, etc. No one even wakes up. But if she's having a rough time of it for some reason, her cough/distress should wake you up. If you're sleeping in a different room (not recommended practice according to the American Academy of Pediatrics), please use a monitor set on 'loud' to detect distress of any kind. Room sharing done correctly is the recommendation.

Study: More Research is Needed About Room Sharing Effects On Infant Sleep, Sids Prevention

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