For which reason would the nurse perform nasal and oral suctioning of a newborn immediately after birth?

Your child may need to have his/her mouth and nose suctioned with a bulb syringe or with a suction catheter. Parents and all hospital caregivers can use a bulb syringe. We will teach you to use a bulb syringe before you go home. A nurse, doctor or respiratory therapist will suction the back of the nose and throat to reach mucus that is too far back in the throat to be removed with the bulb syringe or a plastic tipped suction catheter.

Why does my child need to be suctioned?

A stuffy nose can make it difficult for your child to breathe. This can make your child fussy, especially when he/she tries to eat or sleep. Suctioning is necessary when an illness causes the body to make too much mucus. Some examples of illnesses that cause the body to make excess mucus are:

• A common cold
• Respiratory Syncytial Virus (RSV)
• Bronchiolitis
• Pneumonia
• Influenza

Suctioning is also necessary when cough reflexes are not strong enough to get rid of mucus, saliva or vomit.

• Cough reflexes are not fully developed in some infants, especially preemies.
• Illnesses or injuries that affect the nerves or the brain can affect the ability to cough. Excess mucus can accumulate in the back of the throat, nose and mouth.
• Deep coughing to clear mucus can be difficult after some types of surgeries.  

How to make salt water solution for bulb suctioning:

Mucus can be thick. A salt water solution can be used to help thin the mucus and make it easier to remove. A salt water solution (saline) can be bought in the drug store or you can make your own at home using the steps below. Use salt water solution up to 4 times a day for suctioning.

• 1. Mix 1/4 teaspoon table salt and 1 cup boiled water.
• 2. Allow to cool to room temperature.
• 3. Store in a clean, covered jar or bottle. Label with the date it was made.
• 4. Throw away after 3 days. If you need more, make a new mixture.

Suctioning with a bulb syringe

Your baby cannot blow his/her nose, so you need to use a bulb syringe to remove excess mucus. A bulb syringe (or suction bulb) is a small rubber object with a long tip at the end of a bulb.  

Have a bowl of tap water ready to clean the bulb between suctioning attempts.

There are several ways to position your child so he/she does not push you away or wiggle out of your arms. Your child’s nurse will help you find the best position for your child.

If both the mouth and nose need to be suctioned, suction the mouth first. When suctioning the mouth, place the tip of the bulb syringe towards the inside of your child’s cheek.

Wash your hands before and after suctioning.  

1. Hold the tip of the bulb between your middle finger and forefinger. The bulb should touch the palm of your hand. Before inserting the tip into your baby’s nose, use your thumb to push out the air. If the mucus is thick, put 2-3 drops of salt water solution in your child’s nose before inserting the bulb syringe in your child’s nose.
2. Insert the tip of the bulb into either the mouth or the nose and slowly release your thumb. Suction is created as your thumb releases pressure on the bulb. This will remove the mucus or fluid from your child’s nose or mouth. 
3. If the bulb does not reinflate, this is usually caused by the tip being against the cheek or lining of the nose, or because the tip is blocked by thick mucus. If pulling back on the bulb does not reinflate the bulb, remove and clean the bulb syringe.
4. Remove the bulb syringe from your child’s mouth or nose. Use your thumb to push mucus or fluids out of the bulb syringe onto a tissue or paper towel.  
5. Repeat as needed. Allow your child to recover and breathe between each suction attempt. Gently wipe your child’s nose with a tissue as needed.
6. When finished, clean the bulb syringe using a bowl of soapy water, pulling the soapy water into the bulb and squeezing it out. Let the bulb syringe air dry.
7. When finished, clean the bulb syringe using a bowl of soapy water, pulling the soapy water into the bulb and squeezing it out. Let the bulb syringe air dry. With your thumb compressing the bulb, place the tip into the bowl of warm water and then release your thumb to pull the water into the bulb syringe. Push the bulb with your thumb to push out the dirty water into the sink or another bowl. Do not push out the dirty water into the clean water.
8. Use a separate bulb syringe for each of your children. Discard bulb syringes after 7 days.

When should I suction my child’s nose or mouth?

• Any time your child is having difficulty breathing or is having noisy breathing due to excess mucus.
• Before feeding or nursing if his/her nose is stuffy. Your child will eat better if his/her nose is cleared. Suctioning too soon after eating or drinking may cause vomiting.
• If your child is having difficulty breathing after he/she vomits or “spits up.” Try to limit suctioning to two to three times a day. Suctioning more often may cause the inside of the nose to dry out, get sore and bleed.

Try to limit suctioning to two to three times a day. Suctioning more often may cause the inside of the nose to dry out, get sore and bleed.

Nasopharyngeal (NP) suctioning

A nurse, doctor or respiratory therapist may decide to use NP suctioning if:

• Mucus cannot be removed with a bulb syringe or rigid plastic-tipped catheter (Yankeur).
• They hear abnormal breath sounds when they listen to your child’s chest.
• Your child needs oxygen or more oxygen than usual.
• Your child is working too hard to breathe, breathing too fast, or has difficulty breathing and eating at the same time.

A small suction tube is connected to a suction device. Salt water solution may be used to thin and loosen the mucus and to moisten the inside of the nose. The tube will be gently placed in your child’s nose until it touches the back of his/her throat. This makes most children cough. The coughing will help bring up the mucus to the back of throat where it can be removed. The tube will be gently and slowly pulled out of your child’s nose while suction is applied to get rid of the mucus. This may need to be done several times in each side of the nose. After your child’s nose is clear, another suction tube may be used to suction his/her mouth.

Are there any problems with NP suctioning?

The inside of your child’s nose may become swollen if he/she needs frequent NP suctioning. Also, your child may have a mild nosebleed. If this happens a smaller suction tube or a different tool called a “neosucker” can be used until the bleeding or swelling is gone.

If your child has to be suctioned within 30 minutes after eating, he/she may vomit.

NP suctioning is only done when it is necessary. Although suctioning may upset your child for a few minutes, he/she will feel better and breathe easier once the excess mucus is cleared.

If you have questions or concerns, please speak with the nurse, doctor or respiratory therapist.

Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 09/2018

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