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Thread: Coughing, choking, wheezing, major spitting up

  1. #1

    Default Coughing, choking, wheezing, major spitting up

    I am so happy to have found this forum as I need some support and advice. DD is one month and since my milk came in shortly after she was born, she has had issues with at least one massive spit up a day. She will also pull of my breast and cough, choke, have trouble breathing and basically give me a heart attack every time. It terrifies me.

    She cluster feeds (at least I think she does) and will nurse frequently over a 3 or 4 hr period before sleeping for about the same amount of time. Even when I think she must be full, she fusses and cries unless she is nursing. I try to burp her often and keep her upright during and after nursing. But at some point she will pull of my breast as though something has caught in her throat and then cough violently until she expels all of the milk she took in. Sometimes this happens after she's finished nursing. Sometimes she does the choking thing without spitting up (although that seems to be happening less frequently.)

    She is gaining extremely well and does not seem upset after she spits up. In fact, all she wants is to start nursing again. I can handle cleaning up the mess, but I really worry about the choking and wheezing and when it seems like she can't breath. DH is encouraging me to pump and bottle feed her so I can tell how much she's getting and then stop feeding her after a certain amount.

    What am I doing wrong? Is this a nursing issue or something else? How can I help her?

    Thanks so much for any and all advice.

  2. #2
    Join Date
    May 2006
    Posts
    20,643

    Default Re: Coughing, choking, wheezing, major spitting up

    Welcome to the forum and congratulations on the new baby and on making it through the first month of breastfeeding! If you've made it 4 weeks and your biggest concern is spit-up and coughing/gagging/spluttering, then you're doing wonderfully well!

    In the absence of pain or poor weight gain, spit-up is a laundry issue, not a health issue. Spit-up is a normal part of infancy because the muscle sphincters which hold stomach contents down are weak in a new baby, just like all baby's other muscles. But in time, those sphincters are going to get stronger and better at keeping baby's meals down where they belong. Until then, you only need to be patient, to lay in some extra bibs, and to swab out baby's neck folds once a day using water and maybe a little gentle soap. Spit-up can get caught in the chub and cause skin irritation (not to mention a nasty cheesy smell!).

    You definitely do NOT want to pump and bottle-feed, for so many reasons. Your DH might understand why if you handed him the pump and told him that for the next 11 months he will be hooking himself up to it for about 20 minutes every 2-4 hours, round the clock, while also caring for an increasingly active baby who will enjoy doing things like trying to unhook your pump tubes or monkeying with electrical outlets or other hazards while you're pumping. Because that's what pumping and bottle-feeding entails. It sounds simple when you suggest it. Doing it is another matter! And it's NOT your DH who is going to be doing it.

    Now, on to the choking/gagging/gasping. The usual cause for that sort of behavior is a forceful letdown of milk. Imagine drinking from a firehose- you're going to have trouble keeping up! Some things moms with forceful letdown may notice:
    - Mom may feel like she has a lot of milk, frequently feeling "full" or engorged
    - Mom may leak a lot
    - Mom may experience a strong letdown sensation
    - Baby may gain weight very rapidly
    - Baby may produce poops which are frequently or consistently green/greenish
    - Baby may be very gassy
    - Baby may pull off the breast while nursing
    - Baby may choke, cough, gag, splutter, wheeze, or make a clicking/clucking noise while nursing
    - Baby may "slip up" onto the nipple while nursing
    - If baby pulls off the breast while nursing, mom may observe milk squirting or streaming from the breast

    If you're noticing a lot of these issues, let us know. Because managing forceful letdown is definitely possible. Sometimes a mom will have to block feed (i.e. use the same breast for one or more feedings in a row) in order to control oversupply, which is often the root cause of forceful letdowns. That's not something you want to do unless you're SURE you have oversupply. But the first thing a mom can do to manage a FFLD is to adopt reclined nursing positions, which enlist the force of gravity to slow milk flow and make nursing more comfortable for baby.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  3. #3
    Join Date
    Dec 2009
    Posts
    1,056

    Default Re: Coughing, choking, wheezing, major spitting up

    . My daughter did the EXACT same thing for the first few months of her life. Freaky for sure. She eventually quit though. I chalked it up to reflux (though she rarely actually spit up).
    Little SW, Aug '09
    Miss MW, Jan '11
    Sir RW, Oct '12
    3 kids in 38 mos

  4. #4

    Default Re: Coughing, choking, wheezing, major spitting up

    Oh, MommaL, thank you so much -- this list is practically a checklist of what's been happening. I am leaking like crazy, have almost painful letdown and keep spraying the poor baby in the face when she takes a break from nursing. I have to put a towel or cloth diaper on one breast while DD is on the other because it runs like a tap. This is starting to get better, though. Is that part of the process?

    I will read up on block feeding. It seems like my right breast always has more milk than the left...is that normal, too?

    Thanks so much for your reassurance and help -- I am grateful!

  5. #5
    Join Date
    May 2006
    Posts
    20,643

    Default Re: Coughing, choking, wheezing, major spitting up

    One more thing: even though the noises baby is making are scary, she can't actually choke on liquid. Liquid just gets coughed out. It can't block the baby's airway. The choking/coughing is actually protecting baby's lungs, by preventing liquid from getting down into them.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  6. #6

    Default Re: Coughing, choking, wheezing, major spitting up

    Jeno...first few months?? Oh dear. On the one hand, that seems like a long time to deal with such heart-stopping moments. But on the other hand, it's good to know that your LO made it through ok and it's not as life threatening as it seems Thanks!

  7. #7
    Join Date
    May 2006
    Posts
    20,643

    Default Re: Coughing, choking, wheezing, major spitting up

    This is my go-to link on forceful letdown, oversupply, and what to do about them: http://www.aafp.org/afp/2004/0815/p735.html

    Totally normal to have one breast that produces more than the other. Human beings aren't perfectly symmetrical, after all! Differing production between sides is only a problem if it's making you lopsided. If it is, this link covers what to do about it: http://kellymom.com/bf/got-milk/lopsided/

    It is totally normal for forceful letdown to diminish with time. Fast letdowns are usually caused by an oversupply of milk. Most moms start out making too much milk- it's nature's way of ensuring that the baby gets fed while mastering the tricky art of breastfeeding. But eventually supply adjusts to meet demand very precisely. The body doesn't want to be in constant overproduction mode, because it's a waste of energy and increases your risk for nasty things like plugged ducts and mastitis.

    Are you pumping at all in addition to nursing?
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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