Aspiration is what happens when liquid is pulled into the lungs during breathing.
Babies often spit up (or vomit) when they cry, but most of the time they don’t aspirate because of a natural reflex that closes off their airway.
Babies and children with medical conditions or developmental delays are more at risk of aspiration because the reflexes that protect their airways aren’t always effective.
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When a young infant cries hard, the effect can be dramatic. The baby might turn red in the face, hold its breath, and even spit up or vomit. But what happens when a baby tries to breathe while they still have milk or vomit in their mouth?
Although it might be scary to watch, most babies are able to protect their lungs from vomit and other liquids just fine. Keep reading to find out how this works, when it doesn’t work, and what to do if your baby does end up with vomit in their lungs.
Although babies often spit up or vomit when they cry, it’s rare for them to breathe the liquid into their lungs. Normally, babies develop reflexes that protect their airways automatically. This means that even though it might look like a baby is choking on liquid, they aren’t really doing any harm.
That said, in some situations babies do aspirate. Most often babies who breathe liquid into their lungs have other medical problems, such as:
Gastroesophageal reflux disease (GERD)
Physical birth defects, such as a cleft palate or tracheoesophageal fistula
A baby’s body works automatically to protect the airway from liquids. When vomit comes up from the stomach, several things happen at the same time:
The vocal cords squeeze together to block the airway.
Breathing immediately stops for a few seconds.
The throat makes several quick swallowing motions.
Older babies might cough afterward.
These reflexes happen very quickly — so fast you might not even notice them. But here’s the end result: Liquids that start to enter the airway get rerouted into the baby’s stomach.
It’s worth mentioning that sometimes babies regurgitate (or vomit into their mouths) without anyone realizing. In these cases, you might see your baby respond with this reflex even when they haven’t vomited.
If you’re watching your baby closely, it can be alarming to see the reflexes described above. After all, one moment your baby is crying and has a red face, and the next moment they’ve stopped breathing and are swallowing rapidly. It can look like your child is choking.
Fortunately, the reflexes that protect a baby’s lungs from vomit only last a few seconds. In fact, chances are that by the time you realize what’s going on, the baby is back to crying again. If that’s what happened, there’s nothing you need to do.
On the other hand, if your baby is not getting back to normal quickly — for example, if their breathing continues to be difficult or if their cough doesn’t go away — that could be cause for concern. You’ll want to make sure they aren’t choking on something solid like a toy or a chunk of food. And if your baby continues to struggle with their breathing, you should seek a medical evaluation.
If you think vomit has entered your baby’s lungs, don’t panic. As long as the vomit is liquid, inhaling vomit isn’t an emergency. Although the germs and stomach acid in vomit can irritate the insides of the airways, the effects of this show up over time. Your baby isn’t in immediate danger.
That said, it’s important to keep in mind that solid objects, like toys or pieces of food, are a different story. Solid objects — even very small ones — are dangerous because they can block a baby’s breathing entirely.
Aspiration pneumonia is a lung infection that starts when bacteria in food or liquid are sucked into the lungs during breathing.
Not necessarily. Remember, most babies don’t inhale vomit at all — their natural reflexes cause them to swallow it into their stomachs. It’s pretty uncommon for a healthy baby with typical development to get aspiration pneumonia.
That said, babies with neurological conditions or swallowing problems tend to aspirate frequently. These babies are pretty likely to end up with aspiration pneumonia. In fact, aspiration pneumonia can be the first sign that a baby has a swallowing problem or developmental delay.
Fever and cough are the key symptoms of pneumonia, and aspiration pneumonia is no different. If you think your baby might have pneumonia, you should see a healthcare provider right away.
If your baby has had aspiration pneumonia in the past, you’ll want to make sure your provider is aware of it. Babies who have had aspiration pneumonia are at particular risk for getting it again.
A chest X-ray can often recognize aspiration pneumonia. Otherwise healthy babies don’t always need an X-ray when they have pneumonia. But if a baby with pneumonia doesn’t improve as expected during treatment, the cause could be aspiration. In these cases, a chest X-ray can be helpful.
Healthy babies with typical development have reflexes that protect their lungs from vomit. Most of the time, this keeps babies from aspirating.
If your baby has had aspiration pneumonia, and especially if they’ve had it more than once, it’s worth talking to your healthcare provider about the cause. Sometimes a feeding specialist or occupational therapist can help sort out the problem.
With time and careful specialist attention, many babies will outgrow their tendency to aspirate.
Most healthy babies have a strong reflex that protects their airway from liquids when they breathe or cry. Babies with developmental delays or neurological conditions might be missing this protective reflex, which could put them at risk for aspiration pneumonia or other medical problems.
Bowman, O. J., et al. (2020). Identifying aspiration among infants in neonatal intensive care units through occupational therapy feeding evaluations. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association.
Casazza, G. C., et al. (2020). Aspiration in the otherwise healthy infant—Is there a natural course for improvement? The Laryngoscope.
Dodrill, P., et al. (2015). Pediatric dysphagia: Physiology, assessment, and management. Annals of Nutrition and Metabolism.
Jadcherla, S. R., et al. (2010). Physiology and pathophysiology of glottic reflexes and pulmonary aspiration: From neonates to adults. Seminars in Respiratory and Critical Care Medicine.