When you begin breastfeeding your newborn, you're probably worried about many things. Are they getting enough to eat? Are they latched properly? Is my baby part vampire? But you're probably not prepared for them to choke on your milk as they're breastfeeding. You might be concerned — why is my baby gagging while breastfeeding? It would scare anyone, but there's actually a pretty good explanation.
Babies are developing quickly from the word go. Certain things, however, like sucking and swallowing, take a bit of practice. This is especially true of preemies, according to the Annals of Nutrition and Metabolism. Neonates not only have to focus on the action of sucking and swallowing, their little epiglottis, the flap of cartilage over the larynx that acts as a barrier between the esophagus and the breathing mechanisms in the deep throat, is brand new and not fully conditioned to its job just yet.
I know that I wanted to assume that my kids would spill out of my vagina ready to take on the world. (I mean, my son did come out fist first like Superman.) But it's difficult to anticipate the fact that something as utterly evolutionarily based as breastfeeding could make him choke and turn blue, yet it did. Don't worry, he's totally fine and definitely trying to find a way to sneak in reading a Rick Riordan book during the school assembly as I write.
So, why is your baby gagging while breastfeeding? There are several possible causes according to International Board Certified Lactation Consultant (IBCLC) Alicia Rivera. In an interview with Romper, she says, "It could be a problem with baby's frenulum or epiglottis, but that's rare, and is usually the last thing we look for. But, provided your baby is getting a good latch, and the beginning of the feed goes well, it's most likely due to forceful let-down or flow issue. It could be oversupply, or it could just be the mechanics of the breast," she says. Rivera explained that an overfull breast really has some gas behind it when let-down happens, and also, some women just have a more severe let-down than others.
Rivera notes that the first and easiest thing you can do is to change the position your baby feeds in. Make sure your baby's head is above the level of the breast, so the milk is working against gravity. You can recline and hold baby to the breast with a lot of pillow support, notes Rivera, or hold baby in a semi-seated position, lying atop your breast, or a side cradle where the baby can just let the excess drip out of his or her mouth. These usually help quite a bit, and Rivera notes that flow issues have a tendency to resolve themselves in a few weeks or months, so the awkward positioning is probably not going to last forever.
However, if it is due to oversupply (the most reliable way to determine this is by baby's weight), there are strategies to help. Imagine you have two balloons and they're both the same size. You fill one to the point where the color of the latex changes, you fill the other to just nicely rounded. If you pierce them both, the flow will be very different — this is the same in breasts. When that happens, it's just too much for your baby to swallow all at once. Don't worry, though, there are some methods that can help. Rivera notes that it's very important to remember that, "no matter what, if you're concerned with how your baby is swallowing or eating, always talk to your pediatrician and a certified lactation consultant first. They are there to help you."
According to Rivera, your healthcare providers might employ a method called block feeding. This is when you feed from only one breast for a block of time before switching to the other breast. This decreases supply over time, and should lessen the flow. Rivera notes this is not something that should be long term, because it can severely inhibit production overall. "Really, no longer than a week," Rivera tells Romper.
Another strategy is to pump your breasts until they feel much emptier and then nurse, which should also help with the flow. (And give you quite the back stock of breast milk.) But this only helps with flow — not supply.
Rivera says you can also try switching sides frequently (noting that you should have great nursing pads, and that you may spray on dismount), and encourage your child to slow their nursing by stroking their cheek as they breastfeed. Rivera says there's no real science behind the cheek stroking, but she's seen it work enough that it's worth the try.
Then there's the old "cabbage leaves in the bra" trick. "It really does work," says Rivera, "but sometimes it works too well, so watch out. It also smells terribly bad."
Rivera tells Romper that while all these are well and good, it's important to watch baby's weight to make sure they're still growing and thriving, and to employ the aid of your pediatrician and lactation consultant if you feel you need to. Just remember, you're doing everything you can to make your baby safe, thriving, and happy, even if it feels like they're gagging on your breast milk.