Starting solids or moving to finger foods is an exciting milestone, but it often comes with a wave of anxiety for many parents. The image of your little one exploring new tastes and textures can quickly turn into a nightmare if you fear they might choke. The truth is, the line between choking and gagging can feel razor-thin, especially when you’re still new to feeding your baby or toddler.
As a parent, your primary instinct is to protect your child from harm, so it’s natural to feel a surge of panic when your baby starts coughing or sputtering after trying a new food. But did you know that gagging is actually a normal and protective reflex? It’s your child’s way of preventing choking. Understanding the difference between these two reactions is key to feeling more confident and relaxed during mealtimes and we’re hoping to ease some of that in this blog post.
When we polled our audience about their top fear when it comes to feeding, here’s what we learned:
Before we get right into all of the nuances of choking, gagging and feeding this blog post we want to take a minute to acknowledge that for many caregivers, maybe even you, feeding feels hard, scary or anxiety provoking. Please know you’re not alone and the intent of this blog post is to support you.
If you’re feeling really overwhelmed by all of this, reach out for support whether it’s connecting with a mental health professional, venting to a friend or connecting with a feeding therapist so you can feed from a place of confidence, and not fear.
What is choking?
Simply put, choking is when an individual’s airway has been obstructed by an object or food. As a result they’re unable to breathe. As you can see, choking is serious and considered an emergency situation since it’s potentially fatal.
What are signs my child is choking?
When you know the signs of choking, you can stay attuned to your child and provide them with the help they need. We also want to take time to let you know that while yes, choking can happen, it’s actually quite rare! A lot of time parents confuse gagging for choking, and so they mistakenly believe choking is happening more often than it actually is. Don’t worry, we’ll get into gagging shortly. In the meantime, get familiar with these common signs of choking:
- Your child might have blue lips or skin, if your baby has dark skin color this may not happen which is why the other signs are really important to look out for, like,
- A blank stare and a pained look on their face
- Lastly, your child will very likely be silent… you will not hear your baby crying… If the airway is blocked by food or an object that means the sound waves from the vocal cords are blocked too. This is why it’s vital to always have your eyes on your child when they’re eating.
What to do when your child is choking?
If you see these signs in your child, stop what you’re doing and administer first aid and CPR. If it’s available to you, call for additional help from trained emergency medical professionals.
We want to stress that it’s a really good idea to take an infant CPR/first aid course so that in the unlikely event that your child does choke on food, you know what to do! There are several offerings online and likely some hands-on education in your local community.
From a personal perspective, before we officially partnered with safety expert Holly, we took her course so we would feel equipped to help our four busy boys in the event of a choking incident. We appreciated it so much that we created a bundled offer for our community–so you get a two-step approach to keeping your child safe:
1. knowledge with how to serve foods safely to minimize the risk of choking and
2. comfort, knowing you can respond appropriately in the event of an emergency.
So with all said, we 100% stand behind the Infant/Child CPR, Choking and Injury Prevention course.
What is gagging?
Gagging is a very common occurrence for a beginner eater. This is a reflex to propel food/objects forward out of the mouth. It’s triggered when something in the mouth goes further back, beyond what the eater’s current oral manipulation skills can handle.
For a newborn baby, this reflex is triggered closer to the front of the mouth. As the baby ages, this trigger point moves further back. Around six months of age, this trigger point is somewhere near the back part of the tongue.
For us adults, something would need to be pretty far back in order for the gag reflex to get triggered. Yes, it’s unpleasant, but we want you to try something right now. Pause your reading and stick your finger to the back of your mouth to elicit your gag reflex. How did that feel? It’s not exactly what you’d call a “fun” experience but it’s not painful either.
This reflex is protective in nature. Gagging actually protects your baby from choking!
What does gagging look like?
So, how can you tell if your baby is gagging? Here are some signs to watch out for:
- Baby’s mouth is wide open with their tongue out
- Baby is likely making some guttural noises
- Baby may cry or vomit
To give you an idea of what it may look like, here is a compilation of babies gagging. Trigger warning: gagging and vomit.
What to do when your baby is gagging?
Above all else, what we want you to remember to do when you see your baby gag is this:
Remain calm!
We’ve been there ourselves and we know it personally – seeing your baby gag can feel frightening. But, hopefully you have now learned that gagging is not harmful and is actually protective. This should help you to project calmness, even if your heart is racing!
Your baby feeds off of your energy so if you freak out, your baby will learn “oh no, this gagging thing must be bad! I shouldn’t do whatever caused me to gag. I was eating solids, so I guess I should just stick to milk from now on!” Essentially, eating solids could be coded in your baby’s brain as a bad event, causing them to refuse solids.
We want to make sure that we’re doing what we can to keep mealtimes a pleasant experience!
Alright, after you remind yourself to remain calm, you can do any of the following, if you’d like:
- Encourage your baby with words like “you got this”
- Model a gag, and mirror back a wide open mouth with your tongue hanging out
- Or… just do nothing, knowing that your baby’s body is simply doing what it knows how to do to keep itself safe
On the flipside, here are a few things we’d recommend against doing while your baby is actively gagging:
- Sweep your finger in their mouth
- Pat them on the back
- Offer water to drink
These things could actually increase the risk that your baby will lose control of the piece of food, causing it to fall to the back of the mouth and obstruct the airway. Which is obviously what we are wanting to avoid!
How often do babies gag?
Each baby is different! When starting solids, some babies gag frequently while others only do so occasionally. When Nita’s second started solids, she eagerly videoed him eating every meal, hoping to catch a gag in action. But it never happened!
Interestingly, in one landmark study that compared the outcomes of starting babies on purées vs a baby led weaning approach, the researchers noted that there were more gagging events when whole pieces of food were introduced, whether that was initially (in the baby led weaning group) or a few months later (in the purée group whose food texture slowly transitioned to whole pieces of food). It appears that when the reflex is “challenged,” that’s the sign for the body to start integrating it further back. The human body is so fascinating!
Will my baby ever stop gagging?
Thankfully, we never 100% outgrow our gag reflex. Remember – it’s there to protect us and we still have it as adults! But, as your baby gets more and more practice with eating, the gagging incidents will decrease.
If you’ve been offering your baby solids for a while and you’ve given your baby lots of practice with different textures and your baby is still gagging at nearly every eating opportunity, then it’s time to reach out for a feeding assessment. This can be done by either an SLP or OT who is trained in infant feeding. The feeding professional can check to see if there are any anatomical or physiological reasons why your baby might be having more challenges learning to eat.
Does baby led weaning result in increased risk of choking?
In this study that compared the incidence of choking between babies offered a baby led weaning approach to starting solids and babies who were offered purées to start, there was no difference in the number of choking events between the two groups.
One important thing to note, however, is that parents were provided with education on how to prepare food to ensure it met the right size, shape, and texture to reduce the risk of choking. We don’t know whether “baby led weaning in the wild” results in the same measure of safety. Which is why we are so happy to offer our e-course Start Solids Confidently. In this course we provide extensive education.
Feel empowered
In a world that preys on our fears and insecurities, our mission here at Happy Healthy Eaters is to empower parents to find joy in feeding their babies and toddlers. We do this by creating content that makes you a confident feeder. It’s our hope that learning about the difference between gagging and choking will allow you to relax and enjoy this transition to solid foods!
