Why Does My Baby Cough When Drinking Water?

It is more common for babies to cough with water than with any other food or drink. Keep reading to find out why babies cough when drinking water and if you should be concerned.

The Difference Between Coughing and Choking

Coughing is not necessarily a bad thing. It’s normal to cough sometimes while eating or drinking. Coughing is a protective reflex, it protects us from choking. Coughing and choking are not the same thing.

If you are choking, you cannot breathe because something is lodged in your airway. We cough to prevent this from happening. Anything that prevents us from choking is a good thing! Coughing while eating or drinking is not a red flag unless it is happening often.

They’re Learning a New Skill

If drinking water is a fairly new thing for your baby, it may take them awhile to get the hang of it. Water is very different than what they were used to before. Give them some time to adjust before getting too worried about it. If they don’t improve over the course of 2-3 months, you may want to consider the following possibilities.

Water Has a Low Sensory Load

Water has very little taste and texture. If a child has an under-responsive mouth, they may not be able to feel things in their mouth as much as other people. Under-responsive mouths may need stronger sensory information in order to register it. If this is the case for your child, there are things you can do to increase the sensory load. Keep reading!

Water is a Super Thin Consistency

Water is considered a “super thin” liquid, which means it has an extremely thin consistency, more so than formula or most juice. Breastmilk is also a super thin liquid.

If a child has more subtle oral motor or swallowing dysfunction, it may not be apparent until they begin to drink water. Due to it’s consistency, water is more difficult to hold together in a cohesive bolus. It is more likely for water to slosh around in the mouth than other liquids. Because it’s harder to keep water together in the mouth, it can accidently creep back toward the throat before the child is ready, leading to coughing.

Water is Given in a New Cup

If you start using a new cup that baby isn’t used to when you begin to offer water, baby may need time to adjust to using the cup. If they are used to only drinking from a breast or bottle and are suddenly given an open cup or a straw, this will be a very different way for them to drink liquids.

If you start with a sippy cup, the way they drink will be very similar to how they drink from a bottle. I don’t recommend sippy cups for this reason. If you’re introducing a cup in order to advance your child’s skills, that’s not going to happen with a sippy cup. Read more in our article about the Best Cups for Babies and Toddlers. But even with a sippy cup, the flow rate may be very different from what they are used to.

Sippy cups also often have a valve in them that helps to prevent spills. While convenient for us parents, this valve can make it more challenging for the child to suck and they therefore may suck harder to extract the liquid. This can sometimes lead to them taking in more than they can handle.

How to Reduce Coughing with Water

If your baby is coughing exclusively with water, there are some things you can do to try to reduce coughing.

• Increase the sensory load by offering cool or cold water instead of room temp. You can also offer sparkling water since the bubbles pack a strong tactile punch
• Enhance the taste by adding a splash of juice, formula, or breastmilk
• Slow the flow by offering a slow flow open cup like Grabease spoutless sippy or a slow flow straw cup like the b. box or the Munchkin weighted straw cup.
• Offer a small amount at a time either by pinching the straw every 1 or 2 swallows or offering only 1-2mls at a time in a very small open cup like the EzPz Tiny Cup
• Let them practice drinking water from their bottle if that is something they have already been drinking from

When You Should Be Concerned

I always remember learning in pediatric feeding expert Catherine Shaker’s course years ago a phrase that helps me when considering how big of an issue coughing is when eating or drinking. She said “Once a day, you’re okay. Once a feeding, we need a meeting”. And I think this is a good general rule to follow.

We all cough from time to time. Sometimes I’m distracted and multi-tasking and will cough on whatever I am drinking. If it’s once in a while, it’s not a big deal. If it’s happening often, that’s a problem.

• Coughing frequently with water even after practicing for a few months
• Coughing multiple times per day
• Color changes such as turning pale, blue, or purple
• Breath holding or difficulty breathing
• Coughing with other liquid consistencies or also with food
• Frequent upper respiratory infections without known sick contacts

I know it can be scary if baby coughs while eating or drinking. I highly recommend all parents take a CPR class before baby is 6 months old. By that time they may be able to roll or crawl over to items they find on the floor and they will likely be starting to eat solids and drink water. Having this training will hopefully give you some piece of mind. CPR training can help you to identify when baby is actually choking versus just coughing (they are not the same thing!).

It is actually a good thing that we all cough sometimes when eating or drinking! Coughing is a reflexive protective reaction to prevent airway blockage (choking). It’s much more concerning if a child does not cough if something they eat or drink goes the wrong way. As long as this isn’t happening often, it’s most likely normal!

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