We've had lots of questions in response to the posts we've put up recently with little Briar and Nash, who aspirated popcorn and David, who aspirated peanuts.  Some of the questions include 'what is aspiration?' 'How do I know if my little one aspirates?' 'What can my bub aspirate on?' 'What's the difference between choking and aspiration?' 'How can I prevent aspiration?' 'Is aspiration serious?' I've answered them all below:

what is aspiration?

Aspiration is when food, drink or other material accidentally enters the airway tube [trachea] and travels down to the lungs instead of entering the food tube and travelling down to the stomach. Aspiration can happen when a little one [or adult] has trouble swallowing something, has a choking episode, has reflux or has a medical condition that impacts their ability to swallow. It can happen during or after a breast or bottle feed or during or after a meal/ snack. Aspiration can also happen at any time from swallowing saliva [spit] or from reflux or vomit. 

Is it serious + what can my little one aspirate on? 

If your baby is miserable, you can give them paracetamol and/or ibuprofen to ease their discomfort. Always read the label before giving, and record it on your TH medication tracker to avoid overdose. Don't forget, bub must be six weeks or older to receive paracetamol and must be three months or older to receive ibuprofen. 

Signs + symptoms of aspiration

 Signs + symptoms of aspiration in little ones may occur straight away or over time after eating. They may include:  

- Ongoing coughing during or after eating  

 - Difficulty breathing after eating, after trouble swallowing or after a choking episode  

- Complaining of feeling like food is stuck in the throat  

- Voice changes  

- Breathing really fast  

- Noisy or unusual sounding breathing  

- Sucking in at the base of the throat, around the lungs, near the collarbones, or at the base of the chest [chest recessions]  

- Discomfort in the chest or ribs  

- Fever  

- Frequent pneumonia or chest infections   

In some cases, aspiration can be considered 'silent', meaning your little one won't display any immediately obvious signs of aspiration or problems swallowing something, meaning it can be hard to identify. So as general advice, if you're concerned about your little one, see your GP at a minimum. If they're displaying any red flag symptoms [such as not breathing normally, noisy breathing, working hard to breathe, difficult to wake, not responding to you normally etc.], take them to ED immediately if you can transport them safely, or call 000. 

What to do if your little one aspirates

 If your little one has aspirated and is having trouble breathing, or is displaying concerning signs or symptoms, call 000. If you think your bub may have aspirated and you're concerned, but they aren't showing concerning symptoms, monitor them closely, have them medically assessed at a minimum, and escalate to 000 or ED if signs worsen.  If you think your little one frequently aspirates small amounts, take them to your GP or paediatrician to be assessed for medical conditions which may increase the risk of frequent aspiration.  

What's the difference between choking and aspiration? 

Now we know what aspiration is, what's choking? Choking is when there is something stuck in the airway that is either partially or completely blocking the flow of air in and out.  A partial obstruction means that some air is still getting in and out. As a result:  

- Bub will have an effective cough  

- Bub will have some air getting in and out  

- Bub may have red, watery eyes  

- Bub may look panicked  

- Bub may have difficulty or noisy breathing  

- Bub may have a red face  

 A complete obstruction means no air is getting in and out.  As a result, bub:  

-  Is unable to breathe  

- Is unable to cough  

 - Is unable to speak  

 - Has no air getting in or out  

 - May clutch at the throat  

 - Will change colour from red, to pale, to blue  

 - Will go unconscious and need CPR if the obstruction is not cleared quickly  

For the correct choking first aid treatment, have a read of our choking blog and book into our Baby + Child First Aid course so we can teach you the skills you need to save a little life. 

How can you prevent aspiration? 

 In some cases, aspiration may not be prevented. We've all aspirated at some point; think of a time you've drunk some water and accidentally breathed it in, had a big coughing episode and then felt much better. In most of these moments, there's nothing you did, specifically, that caused it; it just happened, and it's the same with our little ones too. However, there are times, such as running around while eating, that can lead to an increased risk of choking or aspirating. To try and prevent both aspirating and choking, we recommend implementing some food rules:

1. No food in the car.

 Instead, I offer the kids food to eat before we leave and, again, after we arrive. That's because if I'm driving down the highway and one of them chokes, I can't stop quickly to deliver life-saving back blows and chest thrusts, or help calm them if they aspirate. To be honest, I may be so focused on the road that I might not even notice, particularly if still rear-facing. You also have to consider that there's not always somewhere safe to pull over. The last thing you want to be doing is travelling at 100km/h while frantically looking for places to pull over because your child is choking or has aspirated in the back. In these situations, seconds count. They might complain that they're hungry, and if it's a long trip, you might consider pulling over for a rest stop. But if it's a short journey, as tempting as it is, keep the food for once you get there and can actively supervise your bub. 

2. We sit at the table when we eat.  

Did you know that if your bub is up and moving around or lying down/ reclined while eating, they are more likely to choke or aspirate? Having your bub sit at the table means that they're seated upright, which is the safest position for bub to be in when eating. Sitting at the table when eating also means that you can closely supervise them at all times because they're not jumping on a trampoline or eating somewhere out of sight while playing hide and seek. This routine is so ingrained in my little ones that as soon as I say 'dinner is ready', they immediately go to the table and wait for me to bring it over. They also know that when they get up, it means that they're finished, and their plates go onto the kitchen bench. If they want more, then it's back to the table. If we're somewhere without a table, such as at a park, we modify the rule to sitting together on our bottoms. If you get up, it means you're finished eating, but if you come back from playing and want more, then we sit back on our bottoms together to eat.  If you implement this rule from the start, your bub won't know any different, and it becomes a normal part of eating. But I can appreciate that it might be tricky to implement with a cheeky toddler if you haven't done this from the start, so my tips are:  

-  Sit at the table with them to eat  

 - Model eating at the table for them to see  

- Hype up sitting at the table [make it exciting]

- Talk to them about why we need to sit at the table [they're smarter than we give them credit for]

 - Be really clear that when they get up, the food goes up until they're sitting at the table again  

 - Perseverance and a lot of patience [they will eventually understand]

 - Remember why you're doing it [to keep them safe] 

3. When the babies are sitting to eat, one of us is sitting with them, distraction-free.

In a complete obstruction, no air can get into the lungs, and no air can get out. Because no air can escape, you can't cough. You can't scream. You can't yell for help. You can't cry. Choking is completely silent. That's why you need to be actively supervising, watching your little one constantly and paying close attention incase they do choke or aspirate.  When our bubs are at the table eating, either I'm sitting at the table with them. While it's not always 100% possible, we always try to have the TV off, phones down and be distraction-free to make sure our focus is on them, but so they're focused on eating as well. It's also a nice time to chat to them about how their day went or something else that's going on, and once you get used to it, it becomes refreshing to have set times each day with your bubs without distractions.  

4. Safe foods only.

If you've been around for a while, then you'd know there are well known choking hazards, particularly for kids under five. Some of the common ones are:  

-  Marshmallows. These sticky treats are a huge choking risk, which is tricky because they're often served with babycinos. Your average marshmallow's size is very similar to that of a little one's [aged 0-3] airway. If swallowed whole, the marshmallow could become easily lodged in the front resulting in a complete obstruction and a choking emergency. When mixed with saliva, the marshmallow's consistency changes from soft and spongy to sticky, which can be challenging for children to swallow properly. This texture also prevents back blows from being effective if a marshmallow was to become lodged in a child's throat. Rip into quarters, and avoid until at least age 3.  

- Popcorn. Popcorn is a big choking risk, but also poses a risk for aspiration [being breathed into the lungs]. Avoid until at least 5. 

-Doritos and corn chips.  

- Grapes + cherry tomatoes. Grapes are the perfect size to block an airway. Chop them into quarters longways, or halve for older kids.  

- Nuts. Did you know that little ones can choke on even half a nut? Instead, grind them down or use a thin slice of nut paste like peanut butter, and avoid whole nuts until at least 5.  

- Unchopped sausages + hotdogs, or chopped into coin-like shapes which easily block an airway. Instead, try long, thin slices.  Chunks of meat. Cook, freeze, and grate into small pieces, or chop well.  

- Chunks of watermelon. Again, chop into long thin slices.  

- Large blueberries. Halve or quarter for extra-large ones.  

 - Chewing gum, lollipops + gumballs.  

 - Raw carrot + apple. Peel + grate, steam, blend or chop well.  

 - Tiny teddies.

5. modify, substitute or distract.

Modify by crushing, blending, steaming, chopping or grating the food item to make it safe for them to eat. This might work for things like raw apple and carrot, meat chunks, sausages, blueberries and cherry tomatoes. Roll slippery foods like avocado in breadcrumbs to add grip - mango rolled in desiccated coconut also works a treat! If the food item can't be modified into a safe and developmentally appropriate form, substitute it for something similar. For example,  swapping popcorn for baby corn puffs, swapping peanut for a thin layer of peanut butter on something, or swapping large squares of chocolate for chocolate custard.  If the food can't be modified, and you can't find an appropriate substitute, distract them with something else and delay introducing the food to them until they are older and developmentally more capable of chewing and swallowing. . 

 At the end of the day, accidents can and do happen. Sometimes no matter how prepared you are, how much research you've done, how much you've modified foods, how many prevention strategies you've implemented, your bub may still choke or aspirate.  Tag your loved ones with little ones in the original post on Facebook or Instagram, and leave a comment with any questions you've got about choking or aspiration. 💗