What to Know About Baby Gagging vs. Choking
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So you just started solid foods with your 6-month-old baby… but it feels like every time you feed them, they gag! It can be scary to watch your baby gag, but gagging is actually a natural, normal part of the process of learning to eat solid foods. Choking, however, is very different.
Most parents and caregivers I talk to tell me that their greatest source of stress about feeding their children is fear of choking. In fact, I’m often told that fear of choking is the biggest barrier preventing them from starting their babies on solid foods using a baby-led weaning approach.
When feeding a baby, concerns about gagging and choking can create anxiety and uncertainty. Understanding the differences between gagging and choking, what causes each, and how to respond appropriately is the best way to reduce stress around feeding.
Instead of avoiding finger foods out of fear, learn how to feed your baby confidently and safely while offering a wide variety of foods. In this post, my goal is to resolve confusion about why babies gag and the differences between gagging and choking in order to help parents feel confident and knowledgeable during feeding.
Why is my baby gagging?
Gagging is a natural reflex that helps protect infants from choking. It occurs when an object or a portion of food in the mouth touches a sensitive area, triggering the gag reflex. Gagging is a normal developmental process as infants explore new textures and learn to manage solid food.
Early in infancy, the gag reflex is strong and far forward in baby’s mouth, toward the front of the tongue. That strong gag reflex in early infancy is especially protective of a baby’s airway while babies are starting solids and learning how to eat. As your baby grows, the gag reflex moves further back into the mouth until it is in a similar location to an adult's (usually by around 9-10 months of age.) For most babies, frequent gagging subsides as they grow.
Some babies and kids have a more sensitive gag reflex than others, which can occasionally cause them to vomit. Do not be alarmed if this occurs periodically (if your baby vomits frequently throughout the day or at every meal, consult your pediatrician). To help prevent a gag from leading to vomiting during meals, make sure your baby has at least an hour between milk feeds and solid foods to allow time for digestion.
Example of an 8 month old (6.5 corrected) baby gagging on watermelon. Thank you to her wonderful parents for allowing permission to share.
What should I do when my baby gags?
If gagging doesn’t seem to be causing baby distress, it’s usually not a cause for concern. The best way to help a gagging baby is to stay calm and positive and encourage your baby to chew and swallow.
If certain textures seem to be causing more gagging than others, it can help to simply wait a week and then try offering the food again. Baby's abilities can change immensely even within the span of one week during infancy.
Don’t stop offering a particular texture or food if your baby gags unless advised by a medical professional. Babies need to practice!
If you have a baby who takes big bites, you can encourage smaller bites by offering only 1-2 pieces of food at a time and role-modeling smaller bites during mealtimes. Sometimes it also helps to offer a little water in an open cup to help wash food down the throat.
If your baby has a hypersensitive gag reflex, try offering teething toys and oral development tools* with many different textures (you can even start to brush their gums with a toothbrush). Children with a sensitive gag reflex also tend to do better if they feed themselves as much as possible.
If you have concerns about gagging, feel it is excessive, or causing your baby distress, talk about it with your pediatrician. Pediatric occupational therapists, feeding therapists, and speech-language pathologists can work with babies who may be gagging excessively due to sensory issues or oral motor developmental delays.
What if my baby gags while breast or bottle-feeding?
Many young babies can have their gag reflex initiated by milk if it is released from the bottle or breast too quickly. If breastfeeding, sometimes the force of your milk during “letdown” is so strong that it can cause your baby to gag and pull off the breast. If bottle feeding, the nipple may be releasing milk too fast.
If your baby is frequently gagging while breastfeeding, try nursing your baby in a more upright position to help ease the force of the milk. You can also try nursing in a side-lying or “laid-back” position to help slow the milk flow. Make sure your baby is latched properly.
It is also helpful to ensure your breasts are not too full, which can usually be prevented by feeding your baby every 2-3 hours. If your breasts are too full and you’re concerned about a forceful letdown, hand express or pump a little milk a few minutes before feeding time to avoid a strong letdown.
If your baby sometimes gags or chokes while taking a bottle of breast milk, try a different nipple with a slower flow. You can also pace your baby while bottle feeding by holding it at less of an upright angle and allowing your baby to pause for breaks.
What is the difference between gagging and choking?
Gagging is a normal, built-in safety mechanism and an important part of learning to eat. It is very common in 6-7 months old who are just learning how to eat solids and less common in older babies. Gagging is how your baby protects their airway and pushes food to the front of the mouth that is not quite ready to be swallowed.
Choking, however, is a silent, serious event that happens when a bigger piece of food becomes stuck in the airway, blocking the airflow.
A gagging baby will make sounds like coughing or sputtering and may have watery eyes. A choking baby will not make sounds (because the airway is blocked), may become upset, turn blue, and grab their throat. Intervention is required to help the baby remove the blockage from their airway.
Quick Tips for Choking Prevention:
Educate yourself on which foods are choking hazards and avoid serving these foods to your child
Ensure that all parents and caregivers are well-informed, trained in infant first aid and CPR*, educated on how to prevent choking episodes, and familiar with the steps to take in the event of one
Cut food for babies and kids under 4 years old into pieces no bigger than ½ an inch, making sure to slice any cylindrical foods into long quarters
Encouraging adequate chewing during meals
Always supervise your child during meals and snacks
Make sure that your child is sitting while eating (never allow running, walking, playing or lying down with food)
Known choking hazards according to the American Academy of Pediatrics:
Whole nuts, grapes, cherry tomatoes
Raw vegetables
Whole large seeds or seed kernels
Whole or large circular sections of hot dogs, sausages, and meat sticks
Hard or sticky candies (including jelly beans, gummy bears, and marshmallows)
Chunks of nut/seed butter (it's okay to thinly spread peanut butter on a cracker or bread)
Large pieces of cheese and raw, hard fruit (especially apples)
Raw leafy greens
Citrus fruit membranes
Whole corn kernels (even if cooked)
Popcorn
What do I do if a baby is choking?
Try to stay calm; panicking may impair your ability to respond effectively
Perform infant CPR if your child is unresponsive and not breathing (if you haven't received CPR training, call 911 and follow their instructions)
Give back blows and chest thrusts if your child is conscious but choking (try to place Red Cross’s printable PDF in all infant feeding areas)
Does baby-led weaning increase gagging and choking?
Studies show that baby-led weaning (BLW) does not increase the risk of choking if the appropriate-sized foods are offered. In fact, this study found that babies who were offered finger foods the least often had the highest frequency of choking episodes.
If your baby is 6 months old and using the palm of their hand to pick up foods, then feed them adult pinkie-finger-sized soft foods. If your baby uses their thumb and first finger to pick up foods (also called the pincer grasp), cut soft foods to the size of a chickpea. Foods should be soft and easily squished between your thumb and forefinger.
The American Academy of Pediatrics found that infants fed using the BLW approach gag less frequently than spoon-fed infants by 8 months of age. This means that while babies fed finger foods earlier may gag more frequently initially, they will usually gag less frequently as time goes on.
While BLW may not increase choking risk in infants, choking is still a risk for all babies (whether fed using BLW or traditional spoon-feeding) and children under the age of four. I recommended infant choking and CPR training using this self-paced online course from Safe Beginnings that teaches you everything you need to know to prevent and manage infant and child choking, CPR, and first aid-related emergencies*. (Use my code for 20% off: MALINA).
For even more specific safety tips on safe food textures and food sizing during BLW, check out my best-selling book, Simple and Safe Baby-Led Weaning, and to hear about one mom’s experiences in helping her babies and toddlers overcome excessive gagging, check out this post. With knowledge comes confidence!
And if you’re getting ready to start your baby on solids, or if your baby has recently begun his or her feeding journey and you need guidance on food sizing, balanced baby meals, introducing the top allergenic foods, and making sure baby is getting the important nutrients, check out my new online course for parents, which will walk you through the whole process of starting solids using a baby-led approach.
Thanks for reading!
