New Barrier for Mothers: Don’t Feed Baby on the Bus

Update: See clarification below.

The head of Beterem, the Israeli organization for child safety, has issued a warning that will strike fear into any young mother who relies on public transportation:  Breastfeeding while riding on a bus puts your baby in danger. And bottle-feeding will likely to be next (or will it?).

In a tragic incident, a Jerusalem baby suffered brain damage after choking while breastfeeding on a bus. The report seems odd but there has been no further information. (Update: The baby apparently suffocated.)

Haaretz interviewed the director of Beterem, Orli Silvinger, about parents who forget children in cars. At the end, they ask Silvinger about the bus incident.

 

Here is Haaretz’s English translation of the relevant question (this did not appear in my original post):

A baby of a month and a half is now in hospital in very serious condition after choking while his mother nursed him on a bus. Is it dangerous to nurse a baby when traveling?
Absolutely. Parents must know that it is forbidden to nurse babies during traveling. The baby’s windpipe is only the size of the small finger on a hand. Very few things can pass through there with ease. Secondly, the cough reflex that exists in a child or adult does not exist in the same way in a baby. A baby that has drunk too large an amount of liquid cannot bring it up and he chokes. Also, the movement during traveling causes liquids to go into the windpipe. Just as we do not read while traveling, or get dressed while traveling, we must not nurse while traveling. It’s better to hear the baby cry with hunger for a short while than to nurse him while traveling. It’s in our hands.
(The line about reading and getting dressed did not appear in the original Hebrew. I get nauseous from reading on a bus, but I’ve never been on one that didn’t contain at least one person reading.)

I asked Dr. Lisa Amir, medical director of the Department of Emergency Medicine at  the Schneider Children’s Medical Center of Israel, whether caution is warranted. She said, “In 20 years of practice I’ve never seen a healthy child suffering any neurologic injury or severe damage as a result of having choked on a liquid, whether it be breastmilk or formula.”

Which feeding practices do cause hospital admissions? Dr. Amir added: “However, I have seen a number of children who were severely injured or who died after having choked on hotdogs, deflated balloons, and sunflower seeds.”

I wonder whether Silvinger’s experience is different. How many babies have been hospitalized during the last year because they choked while breastfeeding, whether on the bus or at home? Some breastfed babies “choke” or splutter when the flow of milk is strong, but they always recover immediately.

Silvinger says it’s better to let a baby cry than to nurse him on the bus. I’m guessing she’s never taken a baby on a bus, or listened to one screaming for 45 minutes.  But there are a few other issues besides crying.

  1. Would Silvinger would apply the rule to bottle-feeding? It would seem that the risk is similar. And what about solid foods? Breastfeeding is one thing, but who can imagine a bus ride without Bamba?
  2. I guess that during long trips, Silvinger would require the whole family to get off the bus for the baby’s feeding, then get on the next bus.
  3. A hungry or unhappy baby will do much more than cry. She will most likely start flailing around, requiring the parent or parents to make a superhuman effort to prevent the child from bumping her head or worse. And any other children won’t get the attention they need.
  4. Small babies can get dehydrated very quickly.

Families who rely on public transport have enough challenges already. Traveling with a nursing baby is hard, but easier than with a bottle-fed baby. Or worse, one who is not allowed to eat at all.

For the record the safety of babies riding unrestrained on a bus or car is not the issue, but whether feeding  in a moving vehicle increases the risk of choking. I’ve written to Beterem and am curious to read their response.

Clarification: My daughter points out that the Hebrew word chenek, used both in the original news reports on the incident and in the interview, can mean both suffocation and choking. The baby probably suffocated while being nursed under a blanket, as Erika mentions below. But Silvinger assumed the baby choked on the milk, which is highly unlikely. So this may turn about to be a story about hyper-tzniut, or excess modesty. I also removed the title of Dr. as Silvinger is not listed as such on Beterem’s website.

Check out the 2016 fashions at Hydrochic modest swimwear.

Comments

  1. I wonder if we are getting the full story of what he said. Something seems really odd- yes an infant’s trachea is small but even a relatively strong let-down doesn’t deliver THAT much milk. Besides what about being on a bus would make this more of an issue?

  2. It sounds like he said during ANY travel. I’ll admit that when I read the story and again seeing his reply, the first thought that came to mind is that when someone is traveling it can be very bumpy (and I would think buses are worse, but that’s just another point). I think anyone who’s ever been on a bus (or in a car) while trying to drink is familiar with that “choke” feeling you get when hitting a bump right as you’re trying to swallow, though sitting up usually lets that feeling pass quickly. I would *think* this could be harder on a baby lying against its mother (and not much better for a baby with a bottle, though you’re more likely to notice it and they aren’t as compressed).

    • Ezzie, I hear your point, but is it really dangerous? Especially in light of Dr. Amir’s comment? (For the record, Silvinger is a she.)

      • It’s possible to choke and get an injury even according to Dr. Amir, she just doesn’t know that it’s possible with a liquid (and seems to think not). Either a) it is possible with a liquid; b) somehow either the baby swallowed something else (tiny bit of fabric?) at the same time; c) the breast milk was very thick (?); d) some combination of b/c compounded by the way a baby is situated during a breastfeeding; or e) this is just a purely random coincidence that happened.

        Personally I’m guessing b or d, which would make the advice wise even if it is more of a freak accident than a “true” danger.

        • Ezzie: if a), then a freak accident and not a reason for a blanket recommendation. You don’t make rules because of some bizarre theoretical possibility. Babies (and adults) can choke on any object but we don’t forbid all solid foods. b) Not fabric, but some other foreign object? I personally suspect that the baby suffocated under a blanket but the news report said choking. I hope we will find out the real story. C) Sometimes the milk is thick during an infection but I still don’t think this is at all likely. d) like I suggested under (b) . e) if so, bad advice again
          The advice is bad because of the terrible hardship it causes to parents everywhere.

        • From what Dr. Amir says, it could also be an issue of a child with an undiagnosed issue. Notice what she said? “I have never seen a HEALTHY child suffer…”

          • Observer–Dr. Amir made that clear on the phone. A baby with neurological problems can have swallowing issues that affect feeding liquids as well. But as I clarified, it’s almost certain that this baby suffocated.

  3. I was told that the mother was trying to breastfeed modestly with the baby under her shirt and the baby suffocated.

    No matter where a mother feeds her baby or by what method, you need to pay attention to your baby… their color, their movement. It’s extremely rare for a baby to choke to death on breast milk or suffocate at his mother’s breast. This is a “freak accident” story… very sad and tragic but equally tragic if the media frenzy afterwards causes women to stop breastfeeding.

  4. Considering the number of babies and children who are bottlefed/breastfed/given real food on buses and the number of incidents of choking on buses, I think that it’s just not that risky. I believe statistics and they just don’t work for this.

  5. Honestly, I think the danger is more for parents who think it’s ok to take their kids out of carseats while in cars to feed them, because “THE BABY IS CRYING!!!!!”. I remember stopping on the side of the highway to feed my oldest, even while we were stopped in a traffic jam, because I refused to take her out of the carseat with the possibility that we would start moving shortly. OTOH, my SIL thinks nothing of taking her kids out to nurse in a moving car, because one should never wait to feed a baby. Personally, I’m ok with my baby crying occasionally if it’s not possible to stop the car or what i’m doing the second she starts crying.

    • Yes, it is dangerous to take the baby out of the carseat to nurse. Buses are safer than cars because of their size, but keeping them restrained is of course safest in case of accident.

  6. I have always wondered about the safety of breastfeeding under a cover or under a shirt, where the mother cannot see her baby’s face throughout the feed. When feeding in a sling, I believe that the advice is to ways be able to see the baby’s face; I wonder how this translates to feeding under a cover or a shirt? Just musing out loud, given that we don’t know if this relate in this case. However, it seems to me that nursing under a cover certainly would have the potential to be dangerous in some situations. Must add that in the UK, where I live, virtually nobody uses covers, at least atm, so I have very little experience or knowledge about them.

    • Emily, I don’t believe the mother needs to see the baby’s face. Most of us nurse at night in the dark, and blind mothers nurse too. The mother is usually immediately aware if her baby is having problems breathing as the first thing the baby will do is stop nursing. The mother may have been very distracted or upset.

      • Sorry, you are right, I don’t think I communicated that very well – I have certainly spent the last number of years nursing at night, in the dark! I guess I meant more in a situation where the baby’s face is covered up, as well as not being able to see the baby. So, nursing at night or a blind mother seems like a very different situation to that of a baby covered by material, perhaps in hot weather and unseen by the mother. I agree that the baby would stop nursing, however if a baby had already fallen asleep, might it be less obvious, especially, if as you say, the mother was also distracted or upset?

        In case I am not being clear, I am totally not suggesting women don’t feed on buses, my worry is more regarding nursing covers, if that makes sense.

  7. Eegadz, I breastfed on a train just this morning and if I had to do the same route by bus I would have fed there too despite the drivers glares or warnings from busybodies that read this interview and now know breastfeeding on buses can be deadly.

    I would consider whether having a child of that size flung across my lap is dangerous while speeding down the road (perhaps a neck or head trauma would be the most likely to happen from a sudden stop or swerve). But I doubt, as everyone else seems to doubt, whether traveling and feeding was the danger as opposed to a freak accident where a child choked on or was suffocated by something else. But for Erika, I can’t imagine any Israeli woman who needs to feed their baby while stuck on the bus will give this interview a second thought.

  8. Sounds like irrational hysteria to me, but I find that pretty common in parenting in general and in Israeli parenting in particular. Just in the last couple of months I’ve been told that it’s dangerous to let my baby crawl on the floor of the public library (there could be nails on the floor!!!) and to let him climb up an open staircase with me right behind him (he could fall through the slats!!!)… I don’t think “he could choke while nursing” is any more batty than that. Certainly more harmful, though. I wonder if she’d extend her concerns to flying and expect babies to fast through transatlantic flights.

    • Channa, I think that kind of hysteria is even more common in the US these days.

      • Maybe it’s just that people in the US mind their own business more, but I don’t ever remember being harrassed with my older son in the US the way I am with my younger son in Israel.

        • Kol Yisrael arevim ze l’ze and all the more when it comes to someone elses children. A crying baby on the bus is clearly due to all of the things everyone else will tell you IE The air conditioning bothers him, he needs to drink water, he doesn’t like his baby harness, he’s not getting enough air, he doesn’t like the way you hold him… all of those things aside from the fact that your baby wakes up hungry and then wails his head off. Mothers forget your instincts, other people know your child better.

  9. This type of response is a product of people in power solving problems in a unilateral way. The ban is only one solution which addresses the problem of safety , but it ignores the concerns of the mother for other aspects of her child’s health – the need to eat and in a manner appropriate for the mom and child
    People die from cancer from breathing air -s o should we ban breathing !

    Allan

    • This is not about “solving problems” in a unilateral way or otherwise. Nor does it address any issue of safety. I don’t know if the baby actually choked or suffocated, but in neither case does that indicate a safety issue with nursing on a bus. This is also, by the way, not about “people in power” doing anything or banning anything. The head of B’Terem does not have the power to ban anything (fortunately!) and no one else seems to be interested in taking this up as a cause (fortunately!)

  10. I added this clarification to the post: My daughter points out that the Hebrew word chenek, used in the original news report and the interview, can mean both suffocation and choking. The baby probably suffocated while being nursed under a blanket, as Erika mentions. But Dr. Silvinger assumed the baby choked on the milk, which is highly unlikely. So this story may turn out to be about hyper-tzniut.

  11. That is too weird. I think the danger of nursing is far less than bottle feeding. It’s very rare for a nursing baby to choke because the milk stops when they stop sucking. There are far worse dangers… holding your baby on your lap on the bus, cars w/out PROPERLY INSTALLED carseats, nursing while smoking or near smokers, snacks at innapropriate ages, bottle feeding while not paying attention to the baby… need I continue? This won’t last. Try taking a crying baby on a bus and see how many people tell you that your baby’s hungry or ask “don’t you have a pacifier?” Then see how many busy bodies complain about you nursing.

  12. That’s one strange ruling based on such a freak/rare accident that I have no doubt that it’s mistaken.
    Good thing they aren’t applying it retroactively or I’d be one of those arrested.

  13. sylvia_rachel says:

    Well, I should totally be in jail, then 😛 My 9-year-old, as a nursling, spent vast amounts of time being trundled around by bus, streetcar, and subway (she still does, she just isn’t nursing anymore ;), and believe me, she wasn’t fasting the entire time. In fact, for a while after I went back to work and she was adjusting to daycare (so, maybe from age 13-18 months?), she was nursing on the bus practically every afternoon.

    Suffocating under a cover definitely seems more plausible. A lot of babies seem to really dislike nursing covers, blankets, etc.; maybe they know something adults don’t …

  14. With a small baby, it’s very difficult to be on the bus for an hour straight and not nurse (you have to take into account the time you wait for the bus and the time you get to your destination afterwards). This is totally irrational. Choking on Bamba would seem a far more likely possibility to me.

  15. Silvinger tried to reach me yesterday–her secretary left a message that Silvinger is going on vacation and will try again in a week and a half.

  16. And my husband doesn’t understand why I’m really not happy with the idea of using a nursing cover when breastfeeding our little one…

    • Nursing covers are not dangerous (if you are paying attention, which you should be anyway). The fact is that we really don’t know exactly what happened, nor what the child was covered with – if it certain (as opposed to “probable”) that the child suffocated.

      Whatever happened, this is clearly a freak accident. I don’t think you can come to any conclusions based on this story.

  17. I’d have thought that if you are holding a baby tightly to you, and the bus jerks forward, the baby was simply caught between its mother and the seat in front, (so squashed or suffocated).

  18. Haaretz has an English translation up of the article and I added it to the post.
    Link: http://www.haaretz.com/print-edition/features/kids-safety-expert-orly-silvinger-why-are-children-hurt-particularly-in-summer-1.377915

    “A baby of a month and a half is now in hospital in very serious condition after choking while his mother nursed him on a bus. Is it dangerous to nurse a baby when traveling?

    Absolutely. Parents must know that it is forbidden to nurse babies during traveling. The baby’s windpipe is only the size of the small finger on a hand. Very few things can pass through there with ease. Secondly, the cough reflex that exists in a child or adult does not exist in the same way in a baby. A baby that has drunk too large an amount of liquid cannot bring it up and he chokes. Also, the movement during traveling causes liquids to go into the windpipe. Just as we do not read while traveling, or get dressed while traveling, we must not nurse while traveling. It’s better to hear the baby cry with hunger for a short while than to nurse him while traveling. It’s in our hands.”

    For the record, the line about reading or dressing does not appear in the original Hebrew. It sounds like Silvinger has never ridden a bus. I get sick while reading on a bus but it seems to be a popular activity.

    • Huh? “we don’t read on a bus”? Really? It’s also kind of odd to read that the reason to nurse a child is to keep from “hearing the child cry” rather than the fact that the child is crying because s/he needs food and / or liquid.

      Another thing, according to what she is saying bottle feeding should be even MORE dangerous than nursing on the bus, but it doesn’t even get mentioned. What’s that all about? It certainly doesn’t add any credibility to to this proclamation.

  19. this seems strange – why the distinction between nursing and any other form of eating or drinking? have there been other cases where kids have choked on food or drink (bottle feeding?) on a bus? was it smothering/blanket issue, and if yes, have there been other cases of kids sleeping with blankets or other items (stuffed animals?) on buses?
    the blanket warning seems strange given so many questions.
    and yes, people read on the bus all the time.

    • I don’t have answers for you but I hope to talk to Silvinger next week.

      • Please do ask her why such a stringent warning on nursing but no mention of a bottle, which is far more likely to give an infant too much liquid? Also, what is one supposed to do on a long trip, where the issue is NOT the inconvenience of the the parent who has to listen to a child crying but the fact that a child NEEDS nutrition on a fairly frequent basis?

  20. It is really unlikely to drown on breastmilk! Like other posters said, much more likely to happen from a bottle. Even tiny babies reflexively cough. It’s virtually impossible to drown while nursing.

    My 8 hour old baby, born at home, (later to find out she had Down syndrome) had a “breathing issue” at 8 hours old. She vomited up what I assume was amniotic fluid, and CHOKED on it. she was asleep on the bed, deeply asleep, but woke up and COUGHED LIKE CRAZY. A baby whose brain stem is intact will cough instinctively. Something else is going on here. Didn’t they do an autopsy? They can easily distinguish between drowning (because choking would be a blocked airpipe, which doesn’t happen from liquid) and suffocation.

    And, what is the vaccine schedule in Israel? Because 100 bucks says that baby had some sudden neurological reaction to something toxic: a vaccine most likely, a new medicine, or even serious fumes on the bus, etc.

    I know that sudden choking, caused by brain damage and neurological problems swallowing can happen as a vaccine adverse event. It is one of the standard serious reactions (rare, but I have heard it often enough for it to register)

    Sally Clark, the lawyer in the UK – her sons had similar symptoms. She is the one who was sent to prison for “killing” her two sons, both of which had various things wrong with them (one was for sure a vaccine reaction, the other had a viral infection of the lungs and stopped breathing, choking on his own frothing mouth) . Her sentence was overturned but she was not allowed to breastfeed or visit her baby girl, their third child. She was released in the end, but literally her world was shattered. Her husband stood unflaggingly beside her, but she had lost two sons, her baby, and her prestige among her colleagues was only restored after the final verdict reversal. The book is Stolen Innocence, The story of Sally Clark . by John Batt.

    Liora

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