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Tuesday 25 June 2019
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You can save your baby

Paediatricians: Simple practices can prevent loss of infant life

All babies should be put “back to sleep” or placed on their backs to sleep. Therefore, if they vomit they could simply turn their faces to the side.
All babies should be put “back to sleep” or placed on their backs to sleep. Therefore, if they vomit they could simply turn their faces to the side.

Nothing can be done to prevent babies from aspirating. However, paediatricians say there are a few things that can be done to make it less likely.

According to Dr Vanessa Stewart, the most common form of asphyxiation in babies is aspiration. She explained that asphyxiation meant not getting oxygen into the lungs resulting in unconsciousness or death. This could take into account any number of things including asthma, drowning, or blockage from the presence of foreign materials.

The Medscape website defined aspiration as “entry of a foreign substance, solid or liquid, into the respiratory tract or inhalation of fumes and vapours.” Therefore, aspiration can occur when a person inhales foreign objects into the airways and lungs, usually food, including water or milk in the case of babies, vomit or stomach acid, or saliva.

Stewart said this was probably what happened to six-month-old Zuri Cedeno of El Socorro who died of aspiration on May 9 after being fed and put to bed at an El Socorro daycare centre. Police said staff at the centre found her unconscious and took her to the Barataria Health Centre where she was declared dead. Investigators said she appeared to have died of natural causes.

“It isn’t common but at six months it can occur if a child is ill or has swallowing or reflux issues already. Any human person can aspirate given the right circumstances. If they have a seizure they can vomit and aspirate, or if they have cerebral palsy, or neurological issues, if they are so drunk and depressed neurologically that they just inhale the vomit and die. It’s just having something that interferes with the clearing of stuff from your throat and so you inhale it... like something ‘going down the wrong pipe.’”

Stewart again stressed if a child had neurological problems, or was acutely or chronically unwell, it would be difficult to prevent aspiration.

“It’s a matter of knowing that the child is sick, taking medical measures, and keeping a closer eye on them while sleeping.”

Dr Nisha Maharaj added that it was also possible for a baby to have had nasal secretions which could have entered the lungs. She concurred with Stewart that aspiration was not common in children in general but it was very common in babies with predisposed health conditions.

“Unfortunately some children are predisposed to aspiration based on their pathophysiology. They may have disorders of their brain, they may have disorders of the muscle or gut motility. These children will suffer from recurring aspiration and often aspiration pneumonia.”

The Healthline website stated, “All of these things (food, stomach acid, etc) may carry bacteria that affect your lungs. Healthy lungs can clear up on their own. If they don’t, pneumonia can develop as a complication.

"This is common in older adults, infants, and people who have trouble swallowing or controlling their tongue.”

Maharaj explained that children with cerebral palsy were usually placed under medical management for several reasons but in terms of aspiration, they produced a lot of saliva and have unsafe swallowing practices. In fact she said many would not be fed orally but through a gastrostomy tube and given medication to produce less saliva.

“However it still does not stop them from dying of aspiration or aspiration pneumonia. Children with predisposed conditions, they aspirate. It’s unfortunate but it’s part of the pathology.”

Gut motility, she said, was when the stomach did not work properly so food particles go from the gut into the windpipe. And in the case of muscular weakness she said, “If your muscles aren’t strong you can’t take a deep breath so you can’t expand your airways. And then you’re generally weak so when you’re choking you don’t have the strength to cough it out.”

Maharaj further defined aspiration as the act of particles going into the airways. “When you have particles blocking your airways and if there isn’t someone to remove that obstruction, that is what causes the asphyxia and death.”

All babies should be put “back to sleep” or placed on their backs to sleep. Therefore, if they vomit they could simply turn their faces to the side.

She said if someone could provide basic life support for babies – back and chest thrusts – those maneuvers were the best a person could do while waiting on an ambulance. “I advise all parents to go onto the internet and learn choking maneuvers. But you can’t be too vigorous. If you actually see the baby choking, these are very helpful.... They call them life-saving because it’s simple things anyone can do. You don’t need to be a doctor, you just need to know what to do.”

She suggested not only parents, but people who cared for babies, including staff at daycare centres and pre-schools, visit mottchildren.org and learn to perform basic life support.

WHAT TO DO

However, she said, if one was not present to see an infant or child aspirating, nothing could be done to prevent it from happening. Still she said there were a few things that could be done that might help marginally.

She said if an infant had a cold, or some other condition that produced a lot of mucus, caretakers should clear the baby’s airways, either through suction or saline nose drops, before putting them down to sleep.

In the case of a regular, healthy child, she suggested keeping the child active for approximately 30 minutes after feeding and before putting them to bed. She also said to make sure they are burped after eating as both would aid the baby’s digestion.

All babies, she said, should be put “back to sleep” or placed on their backs to sleep. Therefore, if they vomit they could simply turn their faces to the side. If they were placed face down, they would just inhale the vomit as they might not have enough strength in their necks to tun their faces in that position. However, she acknowledged that between six to nine months old, babies would begin rolling over so parents would have to keep an eye on them.

Lastly, Maharaj gave some general advice. She said babies should have their own space to sleep, not in their parents bed. Remove all toys from the baby’s crib at bedtime as they could fall or the baby could grab them and block the airways. For example a big teddy bear could fall on the baby’s face while it slept and suffocate the child.

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