Starting solids is a very exciting time for parents. Whether choosing purees (traditional feeding) or BLW (baby led weaning), the top concern for most parents is always choking. Babies often gag as they learn this new skill, which can be scary! But knowing the difference between gagging and choking, and how to reduce choking risk, can be life-saving.
This post will help you and other caregivers to understand the differences between gagging and choking, what to expect, what to do and what NOT to do to reduce choking risk.
Not to be a fear monger, but anyone can choke on anything – even purees. Choosing baby led weaning does not increase choking risk – in fact, a recent study found no difference in choking frequency between infants fed with purees vs. baby led weaning, and that those who were puree-fed were significantly MORE likely to choke when introduced to finger foods than babies who had started on finger foods in the first place.
I believe that everyone should know what to do if someone (baby, child or adult) is choking, but this is an especially important skill to have for anyone involved in feeding babies – parents, babysitters, grandparents, other caregivers. Take an infant CPR course in your area to give you the peace of mind of knowing what to do should an emergency arise!
At the end of this post, I’ve included my FREE 2-page printable PDF download – print this out to stick it on the fridge to help remind you, your partner, grandparents, babysitters and other caregivers about what’s normal and what’s not, what to do, and how to reduce the risks. Daycare providers may also find this handout helpful for babies starting solids while under their care!
Gagging is a completely normal part of learning to eat solid foods. Baby’s gag reflex starts out quite close to the front of their mouth, and gradually moves back as they get older and more practiced with solid foods. This is a protective mechanism against choking – it means that larger objects (including bigger pieces of food, rocks, Lego blocks, dog toys…) will trigger the gag reflex early on and cause baby to release them back out of their mouth before it gets too far into their mouth. It also means that when they are starting to eat solid foods, even appropriately sized foods with appropriate texture (purees or soft solids), some babies will respond with gagging as they learn what to do with this new object. If they put too much food in their mouth at once, or move it back to swallow too quickly before mashing it well with their gums and hard palate, it will trigger the gag reflex and cause them to sputter and move the food back out of their mouth.
Gagging is normal, and even expected, when starting solid foods. Some babies are “gaggier” than others, meaning they have a more sensitive gag reflex, so they may gag more often when starting out. This doesn’t mean that they dislike the food, they are gagging because they are learning. If your baby is especially sensitive and it is becoming upsetting for them, or they’re vomiting frequently (see below), it may help to wait a little while before trying again. If baby is not quite 6 months old yet, wait until they’re closer to the age recommended to start solids. Waiting a day or two, or even longer, between offering solid foods is totally ok in the beginning, as they will continue to get the majority of their nutrition needs from breastmilk or formula.
What does gagging look and sound like?
- baby will cough, sputter, make retching noises (ie. they will make noise!)
- baby might turn red (because they’re coughing and sputtering)
- they may spit up or vomit. Spitting up is totally normal. Occasional vomiting is not a huge concern, but FREQUENT vomiting or large volumes may suggest an issue. Could just be that the milk feed needs to be separated more from solids. Perhaps baby is ill and vomiting anyway. There could also be another underlying issue such as reflux – if frequent vomiting continues (particularly if it’s happening even with just milk feeds), talk to your doctor or pediatrician.
- baby might be frustrated and upset, may have tears
What should you do?
- Do not intervene. Gagging is normal. Be close to baby and stay calm. Encourage them and keep your calm face on. They will work it out in a short time and likely forget all about it moments later (while your nerves continue to rage). If they’re upset, be ready for a cuddle!
- Do not attempt to remove the food from their mouth. This can actually push the food farther back and CAUSE choking
- Do not whack baby on the back. This can cause the food to go farther back and down their throat, again, CAUSING choking.
- If there is a food stuck to the roof of their mouth or side of cheeks, a little sip of water can help to loosen it up and allow them to chew/gum it for swallowing.
Choking happens when an object (food, rock, Lego…) is swallowed or falls into the esophagus, and blocks the trachea (windpipe). This is not normal or expected, and is a medical emergency.
What does choking look/sound like?
- baby will be quiet (because their windpipe is blocked). They may make small amounts of noise but often are silent
- they will look distressed, eyes bulging as they attempt to cough
- their lips or skin may start to turn blue
What should you do?
- intervene*. Remove baby from their high chair, flip them face down and on a decline over your knee and perform back blows to remove the object (it is important that they are face down and declined, this allows gravity to do some of the work to get it out). Call 911 if baby loses consciousness. *THIS IS NOT INTENDED TO REPLACE THE SKILL AND KNOWLEDGE OF A CREDIBLE INFANT CPR COURSE. Take a course so that you will know what to do in case of emergency.
I’m scared! How do I prevent choking from happening in the first place?
We can’t say with certainty that we can prevent choking from happening at all. But, there are steps we can take to reduce the risk of a choking incident.
- have baby sitting upright at 90 degrees to eat (that means no swings or rockers to eat)
- stay close to baby while they eat, both to monitor them in case of an incident, but also the social interaction of mealtime! Don’t go wandering into another room to clean up while they eat
- check inside their mouth after a meal to ensure no pieces are stuck on the roof of their mouth or cheeks, as these will loosen up later and potentially cause a later problem. A sip of water from an open cup will often loosen these bits to allow baby to swallow
- Minimize distractions. No TV, toys, videos or screens at the table.
- Do not offer choking risk foods. These include round foods that can block the airway like grapes, cherry tomatoes, whole nuts, sausages or hot dogs, baby carrots, and sticky things like raisins, thickly spread nut butters, and soft untoasted bread. Foods that can break off into large unexpected pieces are also a risk, like raw apples and raw carrot sticks.