Baby airway protection during sleep, travel, play and feeding

About airways

Airways are the parts of the body that take air into the lungs. Airways include the nose, mouth, throat and windpipe.

Our airways need to stay open so we can breathe. If our airways become blocked, we might choke, suffocate or be strangled.

We have reflexes that protect our airways and keep them open. These reflexes include swallowing, coughing and gagging. These reflexes also include ‘arousal’ if we’re asleep. Arousal includes things like stirring or shifting position if we roll face first into our pillow, for example. It also includes waking up.

Why babies’ airways need protection

You need to take special care to protect your baby’s airways and make sure they can breathe easily.

This is for several reasons, including the following:

Your baby’s protective reflexes are still developing. These reflexes might not wake your baby or make them move if it’s hard for them to breathe or their airways are blocked.
Your baby’s airways are smaller and softer than airways in older children and adults. This means your baby’s airways are more easily blocked.
Your baby’s head and neck control are still developing, so it’s harder for them to roll or to lift or move their head if their airways become blocked.

Some babies need even more attention to airway protection. This includes babies who are under 4 months, were born premature or small for their gestational age, are unwell or who have been exposed to smoke, vapour or sedating medicines. If these babies are having breathing difficulties, it’s hard for them to move their head or face so they can breathe easily.

How to protect babies’ airways and ensure babies can breathe easily

No matter where your baby is or what they’re doing, baby airway protection is all about positioning your baby so they can breathe easily. Positioning your baby safely also helps reflexes work well if breathing gets difficult.

Here’s how to position your baby to protect their airways:

Nose and mouth are unblocked and uncovered and can’t become blocked or covered.
Chin isn’t tipped onto chest.
Head isn’t tilted back.
Neck can’t get trapped, and there’s nothing that can wrap around it.
Chest and tummy can expand, because there’s nothing pressing down on them.

You can use these principles of airway protection:

in your baby’s sleep environment
in the car
in prams, strollers and baby carriers
during play
when feeding.

When you position your baby, it’s also important to check that your baby is breathing fresh air, rather than air they’ve just breathed out. Rebreathed air contains less oxygen. This is about checking that your baby has plenty of space around their mouth and nose.

Sleep environment and airway protection

A safe sleep environment protects your baby’s airways during sleep and makes it easier for your baby to breathe.

A safe sleep environment involves:

a safe sleep surface – firm, flat and level
a safe sleep space – clear, not too hot, and smoke and vapour free
a safe sleep position – baby on their back.

It’s essential to check your baby’s sleep environment whenever you put them to sleep and wherever they sleep and or are likely to fall asleep. This includes cots, beds, cars, prams and strollers, and baby carriers, slings and backpacks.

Our article on safe sleep environments explains how to make sure that your baby’s sleep surface, space and position are safe. A safe sleep environment reduces the risk of sudden unexpected death in infancy (SUDI) including sudden infant death syndrome (SIDS) and fatal sleep accidents.

Car travel and airway protection

In child car seats, it’s safest for your baby to travel facing the rear and inclined at around a 45-degree angle. But this position can cause your baby’s head to tip forward when they’re asleep, blocking their airways and making it hard for them to breathe.

Therefore it’s best to have your baby’s car seat professionally installed at an authorised installation service. You can ask the professionals to check the following:

Your baby’s head is positioned safely.
The buckle isn’t pressing on your baby’s tummy.
Your baby isn’t slouching.

Whenever you put your baby in their car seat, you can check the following:

Your baby’s chin isn’t tipping onto their chest.
There’s nothing covering your baby’s face.

And when you’re travelling, avoid leaving your baby in the car seat for long periods. This means having regular breaks during long drives. You can lift your baby out of the car seat or adjust their position. Check that your baby:

is breathing easily
shows signs of arousability
isn’t too hot
has normal-looking skin – that is, not flushed, paler than usual or grey around the lips.

Avoid letting your baby sleep unsupervised in their car seat. If your baby is asleep, it’s best to move them to a cot or other safe sleep surface and place them on their back.

You can read more about keeping your baby safe in cars in Child car seats: types of car seats and when to use them and Child car seats: choosing, installing and using safe car seats. If your baby was premature or low birth weight, they might need a specially designed child car seat so that they can breathe easily. You can read more in Going home from hospital: sick or premature babies.

Prams and strollers: airway protection

If your baby is aged under 6 months, airway protection in prams and strollers starts with choosing a pram that allows your baby to lie flat on a level surface if they fall asleep. Upright, non-reclining strollers aren’t safe for babies under 6 months.

For babies of all ages:

Make sure air can get through to your baby. For example, don’t cover the pram with a cloth or blanket.
Ensure that the pram harness is firmly secured to avoid strangulation risks.

When your baby is in the pram, regularly check that your baby:

is breathing easily
shows signs of arousability
isn’t too hot
has normal-looking skin – that is, not flushed, paler than usual or grey around the lips.

If your baby is asleep, it’s best to move them to a cot or other safe sleep surface and place them on their back. If you have to leave your baby in the pram, check regularly that their airways are protected and they’re breathing easily.

If you have a pram with a detachable infant capsule that you can transfer to your car, it’s especially important to check your baby regularly. These capsules are often fixed in inclined positions.

Baby carriers, slings and backpacks: airway protection

You can protect your baby’s airways by choosing a baby carrier, sling or backpack that’s right for your baby’s age and stage of development:

For younger babies and babies who can’t hold up their heads or sit well by themselves, the best choice is a baby sling or baby carrier with baby facing inwards.
For babies who can sit well by themselves and hold their heads steady (usually at 5-6 months), a backpack is a safe choice.

When you’ve chosen something suitable, it’s important to position your baby safely and check their position regularly. You can position your baby safely in a sling or carrier by doing a TICKS check:

Tight: the sling or carrier should be tight, with no loose fabric.
In view: your baby’s face should be in view.
Close enough to kiss: your baby’s head should be close.
Keep your baby’s chin off their chest.
Supported back: your baby’s back should be supported with their tummy and chest against you when they’re facing inwards. If they’re facing outwards, their back should be against you.

If your baby is asleep, it’s best to move them to a cot or other safe sleep surface and place them on their back.

Playtime and airway protection

Here are tips for protecting your baby’s airways and helping them breathe easily during play:

Always use a firm, flat surface when your baby is having tummy time. This means your baby can push up and safely turn their face to protect their airways. Never leave your baby unattended during tummy time.
Always supervise your baby if you use a sitting support, rocker or bouncinette. It’s important to check that your baby doesn’t fall asleep sitting up or get tangled if they try to climb out.
Never leave your baby if they’re sitting in an inclined position, particularly if they’re propped up with cushions or pillows. If your baby is unsupervised, they could roll and suffocate, or their head and chin could tip forward into an unsafe position.

Feeding and airway protection

It can be hard to stay awake while feeding your baby, especially at night. But if you fall asleep while feeding your baby, they might end up in a position that makes it hard for them to breathe.

If you’re falling asleep while feeding, you could plan how to keep yourself awake. For example, you could set a recurring 2-minute alarm on your phone.

And for airway protection during breastfeeding, check your baby’s nose is clear of your breast.

Babies breathe most easily in a smoke-free environment. Exposure to second-hand and third-hand smoke from cigarettes or vapes (even the smell off your clothes) irritates babies lungs. If you want to quit smoking and you’re finding it hard, call Quitline on 137 848. You could also speak to your GP or child and family health nurse.