Audio Transcript: Difference between gagging and choking in babies
First published: Jan 28th/2018; Updated: Feb 26th/2019
My baby is gagging on food: should I worry about choking?
Now that your child is eating food, it’s a good idea to learn the difference between gagging and choking in babies.
Both situations can be scary.
Getting all the information is important so you don’t panic but react wisely.
If your baby is gagging on food, it isn’t a sign s/he is gonna choke. And fingers crossed your baby never chokes.
Brushing up on your knowledge of gagging and choking can help you stay calm if any of these happen to baby.
What’s the difference between gagging and choking in babies eating solid foods?
Choking is the most common concern parents have when baby starts eating.
Regardless of how solid foods are introduced (traditional with purées, or baby-led weaning with soft pieces), all children are at risk of choking.
Also, all children have a gag reflex.
Parents should always offer safe food to prevent choking in babies.
Is my baby gagging on food? How can I tell?
Gagging is a good reflex kids have to protect their respiratory tract, and avoid choking.
As kids learn to move and manage food inside their mouth, they sometimes gag.
The gag reflex, can lead to coughing and sometimes vomiting. It’s a natural reflex that inadvertently prevents swallowing before baby is ready.
So, it’s healthy and normal.
Gagging is usually loud, and can sound like someone who is about to vomit. Baby can turn red as s/he is forcing to spit out the food.
Gagging is a healthy reflex all babies have. It tends to disappear as baby ages.
What is choking?
Choking happens when a piece of food (or any other object) blocks the airways.
It requires immediate attention.
Choking can be very dangerous as no air is no longer passing through, and baby can turn blue
Always supervise your child when eating. Choking is typically silent. Your child might not be able to cry/cough or breathe when choking.
Also a good idea to know what to do in this case – a CPR course is the best way to feel ready.
Choking is dangerous and requires to act right away.
Here’s a great video on choking and first aid. Although we encourage you to follow a course yourself on CRP.
Why is my baby gagging when eating?
When food touches the back of baby’s tongue it triggers the gag reflex.
In younger babies, the reflex is further forward on the tongue, triggering the gag reflex more easily and often.
It is a normal reflex to gag, and as baby explore and learn to eat, the reflex becomes less sensitive.
Will my baby stop gagging?
Based on reports, babies on average lose the sensitivity of their gag reflex by 8 months old.
Some kids will keep a more or less sensitive gagging reflex as adults. It should not interfere with their ability to eat. Keep in mind that this can vary widely between babies.
When baby is gagging, it is best to stay calm.
Try to avoid touching baby. Don’t pat their back as it could disrupt the protective effect of the gag.
Instead, you can gently say “It’s okay, you can cough”, or “Well done” so that baby knows that this natural reflex is protective, and there is nothing to worry about.
You can also explain to baby what happened. Did baby put his/her fingers too deep? Did baby take a large bite that was too much to manage?
Different things can trigger the gag reflex, which is what baby is learning.
If you worry that your baby gags too much or too often, seek out help. Some exercises can improve the development of your child, and reassure you as a parent.
Gagging is normal, but as babies learn to eat and mature, they will lose their prominent gag reflex.
Gagging and baby-led weaning: is it better than purées?
The short answer: no.
Recent research compiled evidence from the few studies that have looked at baby-led weaning practices vs. traditional purée feeding. There are not a lot of studies yet.
In terms of choking, when self-reported by parents, there was no difference between babies doing baby-led weaning vs. purées.
Let’s keep in mind that choking is a difficult behaviour to measure. It is self-reported by parents, who may not remember everything. Also, some parents might confuse gagging and choking.
But what is even more important is that choking was estimated to occur in 35% of all babies, no matter the feeding method.
Baby-led weaning or purées, babies are all at risk of choking.
The feeding method did not make a difference. The top 3 foods baby choked on were apple slices, crackers, and sausages.
Adopting safe feeding practices is key in preventing choking in babies.
How can I help my baby with sensitive gag reflex?
For babies with a very sensitive gag reflex, you can offer smaller pieces of food and smaller bites.
With time and experience, babies tend to lose the sensitivity of their gag reflex.
If you baby tends to take big bites that make him/her gag, offer less food at a time. This will prevent baby from putting all the available food in his/her mouth.
As baby grows and gain experience eating, s/he will lose the sensitivity of the gag reflex.
How do I get my baby to eat textured food?
At first, your baby might only eat puréed food; however, slowly transitioning to solid foods is important.
Here are some ideas to get your baby to eat textured food:
- Offer mashed food, purées with chunks, or grossly puréed food. Try different foods even if seeing your baby gag/refuse food is discouraging. All of this is part of learning to eat.
- Use a mesh feeder bag in complement to other foods. This will offer baby different ways to build their eating skills.
- Offer food that is only one texture. For example a thick soup (one texture) rather than a chunky soup (multiple textures).
- Offer teething toys with textures
Practice brushing your baby’s teeth. It helps get baby more comfortable with “stuff” in their mouth.
- Try baby-led weaning and offering big soft pieces of food for baby to play and explore with
It is not recommended to only offer smooth purées, and hope baby will grow and improve. Talk to your doctor if you have concerns or feel your baby isn’t progressing well.
It’s important to expose your baby to different textures and progress towards solid foods
How to prevent choking on food: Tips for Parents
Regardless of the feeding method your family chooses, all parents should avoid these risky behaviors:
Don’t put your fingers in your baby mouth:
Let baby lead the way. Putting fingers in your baby’s mouth can push food further down and increase choking risk.
Don’t put food in your baby’s mouth:
This may surprise baby and fall straight in the back of their mouth and lead to choking.
Letting baby grasp and feed himself/herself ensures that baby expects food and is ready to manage it.
Sit baby in a non-reclined high chair
Aim for a straight back at 90-degrees with their seat.
This ensures that baby can support his/her upper body and head, while having the ability to move the head down to gag and spit out food as needed.
Make sure baby is ready to eat
Visit this post to read on signs of readiness to start solid foods.
Always watch baby when eating
Sit with your child and observe.
Gagging is often loud and you can hear it.
Choking is silent: baby doesn’t have air and won’t produce a noise to warn you and ask for help.
So, refrain from doing the dishes, using the washroom… sit down with baby.
It also fosters family meals which has many advantages! More here on best practices during family meal time.
The key is to let baby lead, and take the time to sit down.
Choking prevention tips: We can’t eliminate the risk, but let’s reduce it
Avoid offering foods that are small and round, hard, sticky, or crunchy until your child is 4 years. For at-risk food, offer them in a safe way.
Avoid small, round, sticky, and crunchy food:
- Whole nuts and whole seeds
- Hard candies
- Chewing gum
- Food on skewers and toothpicks
Offer ‘dangerous’ food in appropriate sizes:
- Chunky nut butter like peanut butter: use smooth nut butters and spread thinly, never give a spoon of it
- Bread: toast it to ensure that the texture is not sticky when the bread mixes with the saliva
- Whole grapes, big blueberries, and other round fruits: smoosh or cut lengthwise in 4 quarters and pay attention to the seeds
- Cherry tomatoes: cut lengthwise in 4 quarters
- Hotdog and sausage: cut lengthwise and in pieces
- Whole beans like chickpeas: mash-cook them
- Fresh and dried fruit with pits: remove them from fruits before offering
- Hard raw foods like carrots and apples: grate them or cook them before offering
Avoid foods that are small and round, hard, sticky, or crunchy until 4 years of age.
Other ways to limit the risks of choking
- Be aware of your child’s evolving eating skills so that you can offer appropriate food for their stage
- Always feed your child when sitting properly at the dinner table: Not in a moving car, not in a rolling stroller, not while she is playing/walking/running.
- Avoid distractions at the dining table: avoid screens, games, and anything that can make your kid laugh while eating. A calm atmosphere is suitable so kids are fully in control of their actions. We want them to concentrate on eating. After all, they are learning a new skill.
- Know what to do if choking happens. Refresh your CPR skills.
- Remember that choking can also happen with toys and objects your child will find and place in his mouth. Scan your house for tempting objects your kid will likely wanna put in his mouth.
Choking risks exist with food and toys. Refreshing your CPR skills might be a good idea.
Print this reminder and post it on your fridge so that everyone feeding your child know how to react with gagging and choking. Also, a good idea to put this on the grandparents fridge too!
A side note on honey
Avoid honey until your child is 12 months-old.
That goes for all honey: raw, pasteurized, cooked, in recipes, or in prepared food.
This had nothing to do with choking, but it is to prevent infant botulism. Your child’s immune system is still unable to fight that bacteria, so it is better to avoid honey completely.
Avoid feeding your child honey until 1 year of age
Thanks for reading, and if you have any questions you can always comment below, or reach out to at the contact page.
Health Canada – Infant botulism: https://www.canada.ca/en/health-canada/services/food-safety-vulnerable-populations/infant-botulism.html
Health Canada – Infant feeding recommendations: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months/6-24-months.html#q3
Brown A, Jones SW, Rowan H. Baby-Led Weaning: The Evidence to Date. Curr Nutr Rep. Current Nutrition Reports; 2017;6(2):148–56. Click here
Cichero JAY. Introducing solid foods using baby-led weaning vs. spoon-feeding: A focus on oral development, nutrient intake and quality of research to bring balance to the debate. Nutr Bull. 2016;41(1):72–7. Click here
Rapley G. Baby-led weaning: The theory and evidence behind the approach. J Heal Visit. 2015;3(3):144–51. Click here
Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, et al. Complementary Feeding: A position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):119–32. Click here