Choking and gagging are very different and believe it or not, gagging is actually a very common part of feeding in those early weeks and months of starting solids. It’s important to know the difference between choking and gagging and understand “normal” gagging vs. when your child may benefit from seeing a feeding specialist or your child’s pediatrician.
Here are some things parents need to remember when it comes to gagging during mealtime: 1. Gagging is a protective reflex, that helps babies push food/objects forward if it gets close to blocking the airway. So, it’s a great reflex for babies to have in early feeding experiences to aid in decreasing the risk of choking when starting solids. 2. The gag reflex will begin moving further back in the mouth as the baby ages in the first year of life. It becomes “less sensitive” as the baby gains more positive sensory experiences in the mouth. Providing positive oral experiences (teethers, oral probes, oral massage, etc.) early can aid in decreasing gag sensitivity. 3. Gagging will occur more often in the first few months of starting solids (6-8 months) but gagging should NOT cause baby to become extremely distressed or be happening with all food presentations. This can be an indicator your baby may benefit from changing or adapting your food presentations to their skill level or seeking out help from a knowledgeable feeding specialist (ST, OT).
4. When your child does gag, remain calm and provide positive self-talk (i.e. “keep chewing, you’re doing great”; “it’s okay, that was a big piece”) . Don’t offer the next bite until baby has recovered and is showing readiness signs to continue with mealtime.
Okay, so now you’re feeding your baby solids but how do you know if they’re actually gagging or choking?!
Choking is a life-threatening event when a foreign object becomes lodged into the airway causing a blockage of air flow. Things to know about what it looks like:-Child’s face may change color with bluish coloring around lips-Child may have panicked look on their face with wide eyes-No sound is coming from your child-Requires immediate intervention!
Gagging is a protective mechanism (reflex) that causes the child to protrude the tongue quickly forward and expel any food nearing the airway. Things to know about what it looks like:-Minimal to no color change of face-Surprised facial expression with open mouth posture-Possible eye watering-Audible coughing, gurgling, or retching sounds of food coming forward-Resolves quickly
We never want parents to feel scared or nervous to feed their but feeling prepared in case of any accident or medical emergency will help you feel more prepared when starting solids with your child. It's important to always be alert, mindful, and positive during mealtimes with your child. Direct supervision and being CPR/First Aid trained can give parents confidence they need to feed their baby confidently.
Now that we’ve discussed what choking looks like. Here are some tips to make difficult foods safer:
Grapes/cherry tomatoes- cut into quarters and remove skin if child is really having difficulty managing middle texture+skin
Small berries or veggies (blueberries, raspberries, peas, edamame)- pre-smash when presenting to the child so food is no longer a round “airway blocking” object.
Nuts (peanuts, almonds, cashews, etc.) avoid giving in whole-form until after 2 years of age, otherwise pulverize into dust-like consistency to add on to yogurt, ice cream, etc.
Hotdogs/meat sticks- avoid giving until after the age of 2, otherwise cut into small pieces when first introducing, may even remove skin if needed.
Fish with bones- remove the bones or serve fish without bones present.
Nut butters- avoid giving in large gobs, add water or milk to thin out the consistency and decrease the “stickiness” when giving it to the child.
Large pieces of raw vegetables- steam the vegetable to soften it and make it easier for the child to chew and swallow safely.
Hard Candy- avoid giving in whole-form until after 2 years of age, otherwise pulverize into dust-like consistency to add on to yogurt, ice cream, cakes, etc.
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