Last week, a child choked on its mother’s milk while being breastfed in Attappadi, the sixth such death in this region of Kerala’s Palakkad district this year. This is called aspiration, and is caused by the accidental entry of food or drink into the windpipe rather than into the food pipe, the oesophagus. The person then chokes; in extreme cases it can lead to death by completely cutting off air supply. This is more common when a baby is being fed than in other circumstances.
Why it happens
Normally, when a person eats or drinks, a small flat strip called the epiglottis closes off the larynx to prevent food going down the wrong way. In babies, this can often turn severe, especially if the baby is unwell. Infants cannot burp on their own, which is why doctors recommend that after breastfeeding, the mother should try and induce a burp. She is advised to hold the baby upright after feeding, facing her chest with its head resting on her shoulder. To prevent milk blocking the airway, the mother has to tap the baby’s back until she hears a burp. Mothers are advised to keep the baby in an upright position during feeding, too.
Aspiration can happen even in adults when they are suffering from an infection such as pneumonia. It can also happen if there is a disease that affects the ability of a baby or an adult to swallow properly, a condition known as dysphagia.
Whether aspiration will cause a small bout of coughing, or lead to more severe or even fatal consequences, depends on the amount of food or drink that has gone down the wrong way. For example if a baby aspires just a small amount of liquid, say its own saliva, which often happens during sleep, it will be jolted out of its slumber by a bout of coughing. If a large amount of milk goes the wrong way, on the other hand, the chances of choking to death are higher.
While milk aspiration is not a leading cause of infant death compared to other reasons such as congenital anomalies or low birth weight, it has been responsible for six of Attappadi region’s 11 infant deaths this year. In 2012, it had caused 18 of 110 infant deaths; last year, this came down to two out of 14 infant deaths following various interventions.
The risk has been widely associated with an age-old tribal custom in Attappadi, the state’s only tribal region. For 28 days after delivery, a mother and her baby are not allowed to enter their house but are confined in a hut. This is often a dilapidated structure with very little facilities for care, thus exposing the mother and child to the possibility of infection as well as extreme weather. A few of the deaths due to milk aspiration have happened inside such shelters.
Attappadi has strong network of health workers, at grassroots level. They have been campaigning among pregnant women about safe breastfeeding practices. The deaths, however, indicate, that not all of them have learnt these lessons.
Selvi, who works as a tribal animator, describes the risks arising out of the tribal practice of mothers and newborns being kept in a hut, away from others. “The mother would be sleeping on the floor, on a mat. The child may be deprived of the required care and temperature. Not all children may survive this situation,” Selvi says