Choking is a leading cause of injury and death in the United States, so it’s no wonder that many parents are very concerned about it. Gagging, however, is a very normal process. It causes no harm to your baby, but can be extremely difficult for you. Knowing the difference between gagging and choking can really make mealtime less stressful.
Every baby will probably gag at some point in their feeding journey. Knowing what to look for and how to handle it will make the experience less challenging for everyone.
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Choking
Choking is when a person can’t speak, cough, or breathe (1). If not corrected, it can lead to brain injury and death. Because of this, I recommend that every adult responsible for feeding children takes a first aid/CPR course so that they know what to do in the event of choking. Safe Beginnings offers a course that is highly recommended (not an affiliate, just have heard great things).
Choking is often silent. This is why I recommend that an adult can see baby’s face at all times during a meal. If your baby is sitting on your lap or riding in a stroller, they could easily choke without you being able to see. Ideally, baby will always be eating in a high chair (or other supportive seat) with an adult facing them. In some cases, you may hear some wheezing, but if their airway is completely blocked, they will not be able to make noise.
It is also very scary for a baby to choke. They may appear frightened or like they are in pain. You will likely need to intervene, which is why a course preparing you can be so helpful.
Baby Led Weaning and Choking
If foods are offered in a safe manner, there is no increased risk of choking with baby led weaning. It is important to know how to safely modify foods, which is why I created an entire section demonstrating how to modify a variety of foods in my Starting Solids Made Easy Course. As a general rule of thumb, foods should be smooshable between two fingers and served in large pieces at 6 months and smaller pieces once baby has mastered their pincer grasp.
Gagging
Gagging is a completely normal response. A baby’s gag reflex is going to be triggered much further forward in the mouth than an adult. So you may need to have something placed close to your throat to gag, a baby will not. This helps to protect them from choking. If their reflex is triggered, they will gag and spit out whatever is in their mouth.
Often when gagging, a baby will make some noises, turn red, and stick their tongue out. They are generally unphased and will continue eating right after, like nothing happened. In some cases, a baby may vomit with gagging.
If you see your baby gagging, your instinct will probably be to help them. It’s better to let them work it out on their own. Cheer them on, do an exaggerated chewing motion, or encourage them to spit out the food, but do not put your fingers in their mouth. This can actually push the food further back, causing them to choke. Try to stay as calm as possible. If your baby sees you panic, they may start to panic.
Choking vs Gagging
| Choking | Gagging |
|---|---|
| Not normal, possibly life threatening | Normal reflex, not dangerous |
| Requires intervention | Usually requires no intervention |
| Silent, possibly some slight wheezing | Watery eyes |
| Baby may cough if airway is only partially blocked | Red face |
| Blank stare or pained look | Tongue thrusting forward |
| May turn blue, especially around the lips | Some sounds may be made (belching, coughing, crying) |
| May vomit after |
Top Choking Hazards
This list is not meant to be all inclusive, but should be a good starting point. Most of these foods should be avoided or modified until around age 4 when a more mature chewing pattern is developed.
- Corn kernels – should be avoided under 1, can offer to baby on the cob
- Uncut cherry or grape tomatoes, grapes, cherries, melon balls, large berries – quarter until around age 4
- Pieces of hard raw fruit or vegetables – shred, slice paper thin, or cook to soften
- Whole or chopped nuts – finely grind
- Peanut or other nut butters – globs should be avoided, can spread thin on foods or mix into foods to help dilute
- Tough or large chunks of meat – opt for tender meats, shred when possible
- Hot dogs, meat sticks, or sausages – quarter length wise
- Fish with bones – remove the bones prior to serving
- Large chunks of cheese, including string cheese – shred the cheese, melt it
- Granola bars – look for softer bars or make some yourself
- Potato or corn chips, pretzels, or similar snack foods – avoid until around age 4 if possible
- Crackers or breads with nuts, seeds, or whole grain kernels – opt for breads without these until around age 4
- Hard candy, jelly beans, caramels, gum drops, or gummy candies – offer other candy or chocolate without nuts until around age 4
- Chewing gum – avoid until age 4 or later if your child is unable to remember to spit it out
- Popcorn – it’s lightweight and a good size for choking so should be avoided until around age 4
What does this mean for you?
If you’re ever unsure, it’s never a bad idea to modify the food! No matter how you start your feeding journey, by around 9 months, we want all babies to experience textures other than purees (some purees are fine). If you are feeling overwhelmed, check out my course! It’s designed to help make you feel confident.
Krystyn Parks is a Registered Dietitian and Lactation Consultant who specializes in feeding children. She has a Master’s Degree in Nutritional Science from California State University Long Beach. She is an International Board Certified Lactation Consultant and has been registered with the Commission on Dietetic Registration since 2013.