Instructions for timely and safe first aid for children choking on milk

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Phan Ngoc Toan - Emergency Medicine Doctor - Emergency Department - Vinmec Danang International Hospital.
Choking on milk is a common accident in pediatrics and very dangerous. When milk spills into the baby's airway, it will make it difficult for the baby to breathe, even lead to respiratory failure and worse, cardiac arrest, apnea, death. Therefore, parents need to know how to give first aid to infants choking on milk.

1. Overview

Choking milk is a phenomenon where milk overflows into the airways, causing the baby to choke, have difficulty breathing, turn purple, and may stop breathing. If not treated quickly and promptly, the child can die.
Causes of milk choking:
Babies suck, eat in the wrong position; Breastfeeding too full Feeding babies when they're crying or coughing Too much breast milk makes them unable to swallow Nipples with too large holes, causing milk to flow a lot Premature babies should have poor sucking-swallowing reflexes Children with birth defects birth in the oropharynx such as cleft lip, cleft palate...

Signs of a baby choking on milk: When a baby is sucking or after feeding, suddenly coughs, spits milk through his nose, mouth, chokes, turns pale, panics, screams, his body is soft or stiff, etc. may progress to respiratory arrest, cardiac arrest, and death.

2. First aid choking infant milk

When a child begins to show signs of choking such as coughing, choking, immediately parents or caregivers need to be very calm to give first aid according to the following steps, applicable to situations of foreign bodies in the airways including: even choke on milk.

2.1. If the child is awake

Step 1: Immediately call for support from relatives, medical emergency (make a phone call, turn on speakerphone mode and follow the instructions). The rescuer can sit or kneel depending on the condition.
Step 2: If it is convenient to take off the child's shirt to expose the chest
Step 3: Have the child lie on his or her stomach so that the head is lower than the chest on the inside of the forearm resting on the thigh. Keep the baby's head and chin in an upright position. Avoid putting pressure on the pharyngeal soft tissues
Step 4: Use the heel of the hand BACK 5 TIMES between the child's shoulders in a top to bottom to front direction
Step 5: After patting the back, use the other forearm Place your hand on the child's back, holding the head and neck with your hands.
Step 6: Turn the baby over carefully (hold the head and neck firmly), hold the baby on his or her back on the inside of the forearm against the thigh. Keep your head lower than your body.
Step 7: Press the chest 5 times at the position 1⁄2 below the sternum, just below the breast line. Push the chest for about 1 second, try to apply enough pressure to expel the foreign body
Step 8: Repeat the cycle of 5 back pats and 5 chest compressions until the foreign body is removed or the child does not respond.

2.2. If the child is unconscious

Step 1: Immediately call for support from relatives, medical emergency (make a phone call, turn on speakerphone mode and follow the instructions). The rescuer can sit or kneel depending on the condition.
Step 2: Immediately give CPR – Support the baby's respiration with 2 finger technique (see picture below) with the requirements:
Frequency:
30 chest compressions – 2 breaths (If only 1 ) 15 chest compressions – 2 breaths (If there are 2 rescuers) Depth of chest compressions: 4cm or 1/3 of the anteroposterior diameter of the thorax
Each time you prepare to give breaths, check the oropharynx If the child finds a foreign body that can be easily removed, use his/her hand to remove the foreign body, do not use your hand to blindly hook it in the child's mouth, it may cause the foreign body to fall deeper.
+ If no foreign body is seen or uncertain, continue to give first aid
Step 3: After about 2 minutes of chest compressions, call 911 if no one has helped.

2.3 Breathing techniques Mouth – Mouth and Nose for young children

Step 1: Keep airway open with proper head position by Tilting - Chin Lifting technique
Step 2: Mouth - Nose: Take 1 normal breath, cover and close the rescuer's mouth over the rescuer's mouth and nose. young.
Mouth - Mouth: Take 1 normal breath, cover and close the rescuer's mouth over the child's mouth. Clamp the nose with thumb and index finger, palm resting on the child's forehead
Step 3: Inhale for 1 second, paying attention to watch the child's chest rise. Repeat 2 times.
Step 4: If the chest does not rise, repeat the movement of lifting the head to raise the chin, adjust the position of the head up.
Step 5: If the chest still does not inflate, switch to mouth breathing technique (Step 2)

3. Measures to prevent choking milk in children

Baby choking is quite common. If the mother is careful and knows how to take care of the baby properly, this phenomenon can be prevented. Some important notes are:
When breastfeeding: Hold the baby in a high position when feeding, breastfeed slowly, without haste, especially with premature babies. Observe the baby while suckling, see the baby swallow after sucking. If the baby does not want to eat, milk is still in the mouth or when the child coughs or cries, stop feeding, if feeding with a spoon, do not continue to pour. Parents should not force children to eat; For bottle-fed babies: The nipple hole should not be too wide, only 1-2 holes should be punched with the tip of a needle on the nipple side. When feeding, the bottle should be tilted about 45 degrees so that the milk fills the vent, the child does not suck a lot of air leading to spitting up milk after eating; After feeding: Should hold the baby lying on the mother's shoulder or chest for 15-20 minutes, pat the baby's back to burp less gas in the stomach, avoid bloating, which will stimulate choking. When detecting that the child spits up, immediately put the child to one side and wipe the milk from the child's mouth; Note: Do not breastfeed while lying down, crying or coughing; Do not play with the baby while breastfeeding because it is easy to make the baby laugh, leading to choking on milk. For children who often vomit, it is recommended to reduce the amount of milk per meal and increase the number of meals;... Correctly handling infant choking will help children quickly get out of dangerous situations. . And if the child has been handled in the above ways, but the child still shows signs of coughing, cyanosis, apnea, ... the parents need to immediately take the child to the nearest hospital for timely emergency.
Master Phan Ngoc Toan used to work as a Internal Medicine Doctor at Quang Tri General Hospital, Emergency and Intensive Care Doctor - Hoan My Da Nang Hospital before working at Vinmec International General Hospital. Da Nang as it is today. Doctor Math has a lot of experience in the treatment of Resuscitation – Adult Emergency, Pediatric Emergency.

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