Choking vs gagging when starting solids

Choking is one of the main concerns parents have when they start introducing their baby to solid food. I am often told by parents that they feel anxious about letting their baby feed themselves and so they decide not to take a baby led approach.

Acknowledging we feel like this is so important and sharing our concerns is really helpful. Making sure we are fully informed also helps and knowing the difference between gagging and choking can be reassuring and can increase our confidence in choosing a baby led approach.

Let's start with how baby's develop their eating skills starting with the tongue thrust reflex.

All healthy babies are born with a 'tongue thrust' reflex which occurs when something touches the tongue and the tongue pushes the object out of the mouth (apart from a nipple or teat). It is triggered close to the front of the tongue and it's protecting our baby from swallowing something they shouldn't. It is also telling us that developmentally our baby is not ready to start eating solid food.

Between four and six months this reflex starts triggering less and less towards the front of the tongue. At around six months, babies are able to pick up food, bring it to their mouth and take bites, and chew and even swallow without triggering this reflex.

However, for some babies the reflex will still be triggered when they chew and when they go to swallow the food. This is where we see our baby gagging.

Gagging is a normal protective reaction that babies do in response to food when they are not able to swallow it. It is often described as a noisy process; retching, coughing, spluttering, where food is pushed to the front of the mouth away from the airway.

Some babies will gag a lot which tells us that our baby is still learning. A very strong triggering might result in vomiting. A less strong one might result in the food pushed to the front of the mouth to be chewed again and then swallowed.

It is alarming to see your baby react this way. It's important to trust our baby in knowing that they are able to deal with the food.

Choking occurs when a baby’s airway is blocked. A baby who is choking will be unable to cry, cough, make any noise or breathe (British Red Cross, 2020). They will be very distressed, grab at their throat or may turn blue and immediate first aid is required to dislodge the blockage (Brown, 2017).

The British Red Cross and St Johns Ambulance have some really helpful information on their websites on what to do if your baby is choking. There are lots of first aid training courses available for parents, grandparents and family members to attend. They can help build your confidence in giving first aid should you need to.

Top tips to reduce the risk of choking: -

1. Ensure your baby is an upright position, never in a reclined position

2. Stay with your baby when they are eating and pay attention to them.

3. Offer appropriate foods

4. Avoid putting your fingers in your baby's mouth

5. Keep distractions to a minimum

To summarise: -

Gagging is a normal part of learning to eat.

Choking is a problem and requires first aid.

I highly recommended attending a first aid course

British Red Cross (2020) Learn first aid for a baby who is choking <>

Brown, A (2017) Why starting solids matter. Pinter and Martin Ltd.

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