Baby stops breathing when feeding

Brief resolved unexplained event - BRUE: MedlinePlus Medical Encyclopedia

A brief resolved unexplained event (BRUE) is when an infant younger than one year stops breathing, has a change in muscle tone, turns pale or blue in color, or is unresponsive. The event occurs suddenly, lasts less than 30 to 60 seconds, and is frightening to the person caring for the infant.

BRUE is present only when there is no explanation for the event after a thorough history and exam. An older name used for these types of events is an apparent life-threatening event (ALTE).

It is unclear how often these events occur.

BRUE is NOT the same as sudden infant death syndrome (SIDS). It is also NOT the same as older terms such as "near-miss SIDS" or "aborted crib deaths," which are no longer used.

Events that involve a change in an infant's breathing, color, muscle tone, or behavior may be caused by an underlying medical problem. But these events would then NOT be considered a BRUE. Some of the causes for events that are not a BRUE include:

Reflux after eating
Severe infections (such as bronchiolitis, whooping cough)
Birth defects that involve the face, throat, or neck
Birth defects of the heart or lungs
Allergic reactions
A brain, nerve, or muscle disorder
Child abuse
Certain uncommon genetic disorders

A specific cause of the event is found about half the time. In healthy children who only have one event, the cause is rarely identified.

The main risk factors for BRUE are:

A prior episode when the child stopped breathing, turned pale, or had blue coloring
Feeding problems
Recent head cold or bronchitis
Age younger than 10 weeks

Low birth weight, being born early, or secondhand smoke exposure also may be risk factors.

These events are more likely to occur during the first two months of life and between 8 a.m. and 8 p.m.

A BRUE includes one or more of the following:

Breathing changes -- either no effort at breathing, breathing with great difficulty, or decreased breathing
Color change -- most often blue or pale (many infants turn red, when crying for example, so this does not indicate a BRUE)
Change in muscle tone -- most often they are limp, but they may become rigid
Change in level of responsiveness

Choking or gagging means the event was likely not a BRUE. These symptoms are more likely caused by reflux.

The health care provider will ask you to describe what occurred during the event. The provider will also ask about:

Other events like this one in the past
Other known medical problems
Medicines, herbs, or extra vitamins the infant may be taking
Other medicines at home the child could have taken
Complications during pregnancy and labor, or at birth, or being born early
Siblings or children in the household who also had this type of event
Illegal drugs or heavy alcohol use in the house
Prior reports of abuse

When deciding if more testing is needed, the provider will consider:

The type of event that occurred
How severe the symptoms were
What was going on right before the event
Other health problems that are present or that are found on physical exam

A thorough physical exam will be done, checking for:

Signs of infection, trauma, or abuse
Low oxygen level
Abnormal heart sounds
Signs of birth defects that involve the face, throat, or neck that may cause breathing problems
Signs of abnormal brain function

If there are no findings to suggest a high-risk BRUE, lab tests and imaging tests are often not needed. If choking or gasping occurred during feeding and the infant recovered quickly, more testing will often not be needed.

Factors that suggest a higher risk for recurrence or the presence of a serious cause include:

Infants under 2 months of age
Being born at 32 weeks or earlier
More than 1 event
Episodes lasting longer than 1 minute
CPR by a trained provider was needed
Signs of child abuse

If risk factors are present, testing that may be done includes:

A complete blood count (CBC) to look for signs of infection or anemia.
A metabolic profile to look for problems with how the kidneys and liver are working. Abnormal levels of calcium, protein, blood sugar, magnesium, sodium, and potassium may also be found.
Urine or blood screen to look for drugs or toxins.
Chest x-ray.
Holter monitoring or echocardiogram for heart problems.
CT or MRI of the brain.
Laryngoscopy or bronchoscopy.
Tests to evaluate the heart.
Test for pertussis.
Sleep study.
X-rays of the bones looking for prior trauma.
Screening for different genetic disorders.

If the event was brief, included no signs of breathing or heart problems, and corrected on its own, your child will likely not need to stay in the hospital.

Reasons your child may be admitted overnight include:

The event included symptoms that indicate a more serious cause.
Suspected trauma or neglect.
Suspected poisoning.
The child appears unwell or is not thriving well.
Need to monitor or observe while feeding.
Concern over ability of parents to care for child.

If admitted, your child's heart rate and breathing will be monitored.

The provider may recommend that you and other caregivers:

Place your infant on his back when sleeping or napping. His face should be free.
Avoid soft bedding materials. Babies should be placed on a firm, tight-fitting crib mattress without loose bedding. Use a light sheet to cover the baby. Do not use pillows, comforters, or quilts.
Avoid exposure to secondhand smoke.
Consider saline nose drops or using a nasal bulb if the nose is congested.
Learn proper techniques to respond to any future events. This includes NOT shaking the infant. Your provider can instruct you.
Avoid overfeeding, perform frequent burping during feedings, and hold the infant upright after feeding.
Talk to your provider before thickening your child's feedings or using medicines that reduce acid and reflux.

Although not common, home monitoring devices may be recommended.

Most often, these events are harmless and not a sign of more serious health problems or death.

BRUE is unlikely to be a risk for sudden infant death syndrome (SIDS). Most victims of SIDS do not have any types of events beforehand.

A child with risk factors for BRUE may have a higher risk for recurrence or the presence of a serious cause.

Call the provider right away if child abuse is suspected. Possible signs of abuse include:

Poisoning or head injury that are not caused by an accident
Bruising or other signs of a prior injury
When events occur only in the presence of a single caretaker when no health problems are found as the cause for these events

Apparent life-threatening event; ALTE

Marcdante KJ, Kliegman RM. Control of breathing. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 134.

Tieder JS, Bonkowsky JL, Etzel RA, et al; Subcommittee on Apparent Life Threatening Events. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics. 2016;137(5). PMID: 27244835 pubmed.ncbi.nlm.nih.gov/27244835/.

Updated by: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What to Expect and What You Can Do to Prevent Complications

Nationwide Children’s Hospital

Full-term means your baby was born after 39 weeks of pregnancy. Normally, the brain controls breathing automatically. During sleep, when the brain is less active, breathing and how fast the heart beats (heart rate) slow down. It’s normal for infants to have short pauses in breathing. In infant apnea (ap-nee-uh), these pauses are too long, and the heart slows down too much. This is more common in premature babies born before 37 weeks.

Apnea is a pause in breathing. It can happen quickly, without warning. Apnea has one or more of these signs:

Not breathing for 20 seconds or longer
Skin color becomes blue or very pale (cyanosis)
The heart beats more slowly, less than 80 times in a minute. This is called bradycardia (bray-duh-kaar-dee-uh). Bradycardia often follows apnea.

Most infants outgrow apnea by the time they are 1 year old.

Apnea should not be confused with or linked to sudden infant death syndrome (SIDS). Unlike apnea, doctors cannot predict or know why a baby will have SIDS. With apnea, sometimes the doctor can find out why it happens and can recommend a treatment.

Cause

There are many different reasons a baby may have apnea.

Brain immaturity – The brain does not send the right signals to the body to breathe when it should. The brain needs to grow more.
A heart problem – The heart doesn’t pump enough blood to the brain to trigger it to send a signal to breathe.
Infection – There is a urinary infection or an infection in the lungs or brain.
Acid reflux – The baby’s food and stomach juices keep coming back up into their esophagus (the tube leading from the mouth to the stomach).
Other medical problems like lung disease, anemia (low oxygen in the blood), or a genetic (born with) problem.
Sometimes, the doctor cannot find a reason for the apnea.

Diagnosis

Your child will be admitted to the hospital.

The doctor and health care providers will watch their breathing to learn what happens before, during, and after the apnea occurs.
A pulse oximeter will be put on their hand or foot. This device monitors the amount of oxygen in their blood and their heart rate.
Their blood and pee (urine) will be tested.

Treatment

Even if the cause of your baby’s apnea can’t be found, there are some things that can help.

Give medicines that help your baby breathe and increase their heart rate.
Give your baby oxygen through little tubes called cannulas that are placed in the nose.
Pre-term babies might need a machine that breathes for them (a ventilator).

FDA Warning for Medical Device Tubing

The medical device tubing can get wrapped around a child’s neck. This can lead to choking (strangulation) or death.
DO NOT leave the medical device tubing where infants or children can get tangled
up in it.
Talk to your child’s doctor or health care provider:
- If your child has been tangled in their tubing before.
- To learn steps you can take to help make sure the tubing does not get wrapped around your child’s neck, such as keeping the tubing away from the child as much
  as possible.
- Any other concerns you may have about the risk of strangulation from medical
  device tubing.
If your child is injured by the medical device tubing, please report the event to the FDA. Your report can provide information that helps improve patient safety. The FDA website to make a report is: https://www.accessdata. fda.gov/scripts/medwatch/index.cfm?action=reporting.home

Going Home

Apnea in infants is usually temporary. Most babies outgrow it in a year. If your child is sent home with any medical devices, they can help prevent complications, but they will not make your child’s apnea go away any faster.

Your child may be sent home with a pulse oximeter. The health care team will teach you what to do if the alarm rings.
Your child may need to get oxygen through a nasal cannula (See FDA Warning).
The health care team will teach you how to make your baby’s home environment as safe as possible.

Do not let anyone smoke in your home, car, or anywhere near your baby.
Follow the ABC's of safe sleep.
- Alone - Babies must sleep alone. It is okay for them to sleep in the same room as you or others as long as they sleep in their own sleep space like a crib or bassinet.
- Back - Always place your baby on their back to sleep (Picture 1). This is the safest position.
- Crib - The crib must be empty. Do not put bumper pads, pillows, blankets, stuffed animals, toys, or supplies like diapers and diaper wipes in their crib.
If your baby can use a pacifier, it might reduce the risk of apnea.
You may need to learn infant CPR if your baby stops breathing at home.

How to get rid of sleep apnea while feeding a child?

Home→Articles → Patients→Topical topics→Apnea while feeding a baby: how to make the baby breathe normally?

Apnea is the most common breathing control problem in infants. There are many reasons for this state of affairs. Most often, the nervous system or pathological diseases are not sufficiently formed.

New mothers often complain that the baby stops breathing during feeding. Moreover, when breastfeeding, this happens much less often than when feeding from a bottle. When the baby eats with "greed", begins to choke, the breath disappears, then he turns blue, clears his throat in a moment and continues to eat. nine0003

The simplest thing pediatricians advise is bottle feeding in a position close to vertical. The head should be slightly tilted forward. In this position, the chances of choking are much less. Also:

The bottle can be taken out periodically to let the baby catch his breath.
To avoid problems with breathing, it is recommended to feed in a crib on your side.

What causes such apnea, the treatment of which also requires a serious approach? Doctors in most cases attribute this to prematurity. The shorter the gestation period, the more frequent the occurrence of apnea during feeding. In addition, more children with low weight suffer from this disease. nine0003

Apnea during feeding of a premature baby

There are many reasons for such apnea. Premature babies, as a rule, have an immature respiratory center, which means that the mechanism that regulates breathing is imperfect. As for the feeding reflexes, we are talking about swallowing, sucking, they are also not quite active. Their activities are poorly coordinated.

In addition, in premature babies, the work of the muscle fibers of the soft palate, as well as nearby tissues, is disrupted. They sag when feeding on the back and apnea is clearly manifested. When feeding on the side, the baby suffers less from breathing problems, or there are no problems at all. nine0003

This is important!

Statistics show that babies born before 29 weeks can suffer from apnea during feeding in 80% of cases, half of babies born at 30-31 weeks and 10% of babies born after 32 weeks .

The baby may choke on milk with strong pressure. If the baby is breastfed, you can first express a little milk, and if he is bottle-fed, reducing the hole in the nipple helps.

What should a mother do if her baby has an apnea attack? First, stop feeding and try to "stir up" the child. If at the same time breathing is not restored, then you need to do artificial respiration. nine0003

In severe cases, go to chest compressions. For such young children, it is done by means of the thumbs, placing the rest of the fingers on the back of the child. Pushes should be carried out often, after every 5 pushes, mouth-to-mouth breathing should be done.

Remember that feeding apnea requires systematic medical prevention of seizures. To do this, oxygen is given to a premature baby before and after feeding. And, of course, in case of apnea in infants, it is always worth consulting a doctor once again. nine0003

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Breathe to eat?!

08/15/2016

The topic of breastfeeding is very relevant both for those who are just preparing to become a mother, and for those who are already clutching their first child to their breasts. Mother's milk is truly the best food that can only be offered to a child up to a year old. It helps the baby grow healthy and strengthens his immunity. That is why it is especially necessary for a child in the first six months of life. Breast milk contains all the necessary nutrients for the baby, and in the optimal ratio and form, adapted to the characteristics of the digestive system of the newborn. In addition, it is rich in vitamins, enzymes, minerals and contributes to the creation of the necessary conditions for the formation of the "correct" intestinal microbial biocenosis. nine0003

In addition, during breastfeeding there is direct communication between mother and child, which contributes to the formation of a positive emotional bond between them. The very act of sucking is extremely important for the baby. Sucking for an infant is a need and a pleasure that is not directly related to the feeling of hunger. Thanks to sucking, the baby develops the jaw apparatus, muscles of the mouth and tongue, which is especially important in the future, for example, in the development of speech.

But sometimes the process of feeding may not go as smoothly as a mother would like. One of the most common reasons a baby refuses to breastfeed is difficulty in breathing through the nose. A significant role in the development of this condition is given to the physiological characteristics of the nasal mucosa of the newborn, as well as the anatomical features of the child's nose. In an infant, the nasal passages are much wider and shorter, the mucous lining the nasal cavity is thickened and rich in a dense network of blood vessels, while the number of glands that produce mucus is not yet large. Even a small swelling of the mucosa can block nasal breathing. During breastfeeding, the baby has to suck and breathe at the same time, and if the nose is clogged, it is simply impossible to combine these processes. If the baby does not breathe through the nose, feeding turns into torment - the baby cannot suckle without interruption, because he is suffocating. nine0003

The child constantly has to let go of the chest in order to breathe in air through the mouth. This is repeated several times, and as a result, the baby drops the breast. In addition, swallowing air through the mouth contributes to its entry into the stomach, followed by regurgitation of its contents. Frequent regurgitation, in turn, contributes to irritation of the nasal mucosa and nasopharynx with gastric contents and the development of inflammation - rhinitis, which is manifested by prolonged difficulty in nasal breathing.

That is why it is so important for newborns to pay close attention to nasal hygiene to ensure and maintain free nasal breathing. On the Internet, you can find recommendations advising mothers to instill vasoconstrictors for babies in the nose of babies before feeding. Such advice can be useful only if the child has a runny nose, in all other cases, one should be aware of side effects and the inadmissibility of long-term use of such drugs, as well as the need to consult a doctor. nine0003

For daily care and cleansing of the nasal mucosa, special products based on natural sea water have been developed. One of these products is the RINOSTOP® AQUA product line.

RINOSTOP® AQUA contains 100% natural sea water, widely known for its beneficial properties. No preservatives, stabilizers or other chemicals that can cause irritation of the nasal mucosa are used in the process of production and purification of water; preserved macro- and microelements of natural sea water (K, Mg, Na, Ca, Cl). nine0003

The products of the line are available in bottles of different sizes; equipped with nozzles that take into account the anatomical structure of the nose and provide a continuous spray of water of different intensity - in the form of a jet, shower or soft shower.
The special design of the "BAG-ON-VALVE" bottles allows the use of funds in any position of the bottles with a full consumption of the contents without residue.

RINOSTOP® AQUA BABY is perfect for daily hygiene and moisturizing of little noses from birth. It contains sea water in an isotonic concentration close in its physiological characteristics to human plasma. Micro-diffusion water supply in the form of a soft shower provides:

gentle care for the delicate nasal mucosa of babies;
uniform irrigation of the entire surface of the mucosa by spraying sea water in the form of tiny particles mixed with air - "water vapor"; it is this spray that minimizes the risk of getting into the middle ear cavity;
cleansing of mucus, crusts, dust and small foreign particles;
maintaining the normal physiological state of the mucous membrane of the nasal cavity and facilitating nasal breathing of babies, contributing to the normalization of good sleep and optimizing the process of breastfeeding; nine0012
moisturizing the nasal mucosa of infants, incl. with excessive dryness of the air;
increased local immunity, stimulation of the protective function of the ciliated epithelium of the nasal mucosa of infants.

Comfortable, taking into account the anatomy of a child's nose, the spray nozzle RINOSTOP® AQUA BABY has a special restrictive ring that determines the depth of its insertion in order to avoid injury to the sensitive nasal mucosa of the crumbs.