How to Make Sure Baby Doesnt Choke on First Food
Gagging is a natural protective reflex that results in the contraction of the back of the pharynx to protect usa from choking. Just like the reflexive kick that occurs when the doc taps your knee in just the right spot, the gag happens automatically, initiating a rhythmic bottom-up contraction of your pharynx (the tube that leads to your tum) to assist in bringing food upwardly and to stop the swallowing reflex from making our bodies try to swallow.
But starting solids? Have a expect at our virtual course on starting solids as well equally our guides and recipes on for the best showtime foods for baby. And if you are struggling with the transition from spoon feeding / purees to cocky-feeding with tabular array food, watch our Spoons to Fingers video.
Note: This page has been created with typically developing infants and children in listen. The information here is generalized for a broad audience and is for informational purposes only. If your child has underlying medical or developmental differences, including but non limited to prematurity, developmental delay, hypotonia, airway differences, chromosomal abnormalities, craniofacial anomalies, gastrointestinal differences, cardiopulmonary disease, or neurological differences, we strongly recommend you discuss your child'due south feeding plan with the child'due south doctor, wellness care provider or therapy team. The opinions, advice, suggestions and data presented in this article on gagging are for informational purposes only and are not a substitute for professional advice from or consultation with your pediatric medical or wellness professional.If your kid is having a health emergency, please phone call 911 or your emergency medical resources provider immediately.
How is choking different from gagging?
Kickoff, it is important to distinguish the difference between gagging and choking.
True choking is when the airway is obstructed, and the baby is having trouble breathing. Signs of a baby choking tin can include:
- inability to cry
- difficulty breathing
- skin tugging into the chest
- look of terror
- high-pitched sounds
- pare color changes (ranging from blue to purple to ashen-like)
If y'all suspect baby is choking, immediately administer infant choking get-go aid with alternate back blows and chest thrusts and call ix-one-1 or local emergency services on speakerphone then your easily are free. If another person is present, ane person should immediately perform choking commencement aid while the other calls for aid. Deport age-appropriate CPR if you believe baby'south airway is open, but the child is not breathing.
On the other hand, gagging is a common protective reflex that results in the wrinkle of the back of the throat. Information technology is a natural function and protects us from choking. When this happens, it'south of import to let baby piece of work the food forward on their ain. Refrain from sticking your finger in baby'south mouth, which tin can push the object further downwards the throat, making the situation worse.
We strongly recommend you take a CPR class online or at your local health facility and review safety procedures. Our choking, gagging & infant rescue video tin can also assist you visualize the departure. Farther resource:
- American Ruby-red Cross: Child & Infant CPR
- American Center Clan: Babe CPR Training Kits
- Harvard Health: Heimlich Maneuver on an Baby
Babies gagging on nutrient is normal
Gagging is a completely normal reflex in infants, children and adults alike. Gagging is very common and will happen a lot in baby'southward solid food journeying. All babies gag in their eating journey—it'due south 1 way they acquire how to eat. The good news is that babies typically outgrow gagging after a couple of months of practice with various textured foods.
Babies often gag well earlier they start solids, when chest or bottle feeding. This typically occurs when baby either isn't properly latched, and the nipple triggers the reflex, or if the babe isn't ready to eat milk for whatever reason. Some babies gag when mom's letdown is too fast. Others gag when they need to catch their breath instead of swallowing. Many babies will gag on a pacifier or certain bottle nipples if they aren't familiar with them. All of these gags occur considering the brain is trying to protect the baby from swallowing an "intruder," or something the baby isn't ready to swallow. This gag reflex typically lessens over the first few months of baby's life when babe gets "desensitized" and learns to accept it (pacifier, nipple, or food texture) without gagging. This occasional gagging at a immature historic period does not seem to bother most infants.
Interestingly, the gag reflex of a half-dozen- to 10-month-quondam baby is much more sensitive and can be triggered more than forward on the natural language than an adult. 1 2 This is why babies gag easily: the more than forward the gag trigger is on the tongue, the easier it is to trigger. 3 Information technology is non uncommon for babies to gag (and occasionally vomit) for the first few weeks of solids. If baby repeatedly gags and vomits past the first month of starting solids, consult your pediatrician, who may refer you to a swallowing specialist.
Lookout our video on gagging and all of the other normal, sometimes nerve-wracking things babies practise while starting solids.
Gagging helps preclude choking
When the gag reflex is triggered, information technology forces the back of the pharynx to shut, essentially preventing swallowing. If food caused babe to gag, the reflex forces the nutrient (or object) forrard towards the front end of the tongue. Immature infants naturally open up their lips when they gag, which means that typically, the food or object that caused the gag keeps moving out of the rima oris.
Gagging is completely normal and incredibly important for infant's safety, both at the table and away from information technology.
Gagging helps babies acquire to eat
For babies to build the skills for chewing and managing all foods (non just easy-to-chew foods), we need to requite them opportunities to make mistakes, like taking a as well-big bite of nutrient. When a baby bites off too much nutrient and cannot properly movement it around to chew, the gag reflex volition kicking in and help thrust the food forward. The experience teaches infant that the food was too big to swallow. These experiences are essential for learning and edifice conviction in biting and trigger-happy. Over time, baby will larn to take smaller bites and get more adept at moving food around to chew properly.
Once baby is a few weeks into their solid food journey, you can use the gag reflex to your advantage. Offering foods that are non equally easy to chew to help accelerate baby's oral development more than chop-chop. When poorly chewed food touches the tongue, the gag reflex volition do its job, and baby will learn they need to chew the food more.
It's important to claiming babyearlier they get too accustomed to mashes and soft foods. Babies apace larn that chewing and swallowing mashes and other like shooting fish in a barrel-to-chew foods easily satisfies their hunger with minimal work. Many babies won't bother trying to meliorate their skills with tough consistencies that require more bitter and trigger-happy, and may refuse the challenging foods and wait for the easier foods.
Why is my baby gagging? Gagging is easily triggered
When information technology comes to young babies, the gag reflex is pretty easy to trigger. Touch the middle of the tongue, and many babies will gag. If you watch a iii- to 4-calendar month-old baby mouthing their hands and fingers, you will run across them gagging themselves ofttimes. This is common and normal. Babies are typically not bothered by information technology and will frequently keep doing it.
Our mouths are one of the most sensitive parts of our bodies. The human being oral cavity has many sensory receptors to find touch, taste, temperature, force per unit area, and other input types. Babies are driven to explore with their mouths to acquire about their world simply because the mouth is sensitive. Mouthing exploration could be very unsafe if babies didn't accept gagging equally a natural condom cyberspace.
Importantly, immature infants take immature hand and finger coordination, which ways they can't easily remove something they put in their mouth. They also accept young oral motor (tongue and mouth) coordination. They can't easily use their tongue to find an object in their mouth and spit information technology out. This is some other reason the gag reflex is a safety reflex, equally it allows a baby to put an object in their mouth and and then button information technology back out once again without letting it get close to the throat. As babies put things in their mouth, the gag reflex tells them when things are non supposed to be there and prevents it from moving too far back towards the throat.
The gag reflex moves further back in the oral cavity as babies historic period
From birth to around 7-9 months, the gag reflex is triggered close to the front of the mouth (around the centre of the tongue). At this age, the gag reflex is as sensitive as information technology will ever be. 4 This is important for prophylactic because objects (nutrient or anything else) will speedily trigger the gag reflex and be pushed out of the oral fissure before they get past the eye of the tongue.
One-time around seven-12 months of age, the gag reflex slowly desensitizes. The gag trigger moves from the eye of the tongue to the back of the tongue towards the throat. 5 At this point, food or objects can get much closer to the throat before the trunk recognizes something is too big to swallow and tries to push button it back out. This might sound scary, simply recall, our bodies are amazing! The gag reflex remains active and strong, and so if something (food, barbie shoe, issues, etc.) hits the back of the tongue, the dorsum of the palate (roof of the mouth), or fifty-fifty the back of the throat, the gag still kicks in.
Babies gag on puréed food and jarred baby nutrient, too
The threshold for what triggers a gag and the gag's intensity is different in every baby, only almost infants will go through a period where anything in their oral fissure thicker than breast milk or formula will cause a gag. The brain says: "Expect, this isn't correct! I shouldn't consume this! GAG!" Many will gag with spoon-feeding experiences fifty-fifty with runny, watery bland purées.
Until the special twenty-four hour period you make up one's mind to start solids, babe hasn't had to manage anything only a watery-thin, fast-moving liquid. Enter something slightly thicker, slippery, and a different flavor — baby'southward brain will kicking in with protective mechanisms to gag and preclude swallowing this invading purée. This is normally curt-lived considering thin purées are quite similar to liquids and the texture won't trigger a gag for very long.
Babies know to push the tongue against a breast or bottle nipple to initiate suction and move the liquid backward to their throat. Spoon-feeding tin present unique oral-motor challenges. With a spoonful of purée dropped on the center of the tongue, baby has zippo to suck or push against and doesn't yet know the skills to help motility that food backward. Considering they can't move the purée astern rapidly, it either continues to sit on the middle of the natural language or will start spreading around the mouth, which can pb to gagging. Many wise babies will suck on the spoon to help them quickly move the purée dorsum to swallow, just like they practise from a bottle or breast. Those babies, who now have a way to control the purée, will often hands swallow with minimal or no gagging.
While not all babies who are spoon-fed gag, many do. Not surprisingly, when a baby is exclusively spoon-fed for a prolonged period of time (by 8 months of age, for example), that child may gag more than when they start finger foods due to the lack of texture exposure.
Spoon-fed babies gag less at first merely gag more after
When a baby is started on solids with thin, watery purées and pouches, the babe'southward tongue receives less sensory input. While babies gag on purées too, they acclimate to the polish texture or effigy out how to use the spoon to suck dorsum and swallow, which reduces gagging. However,allbabies volition frequently go through gagging periods when introduced to finger foods — whether six-month-olds or older spoon-fed babies. When baby is commencement offered finger foods, the brain engages the safe call: "This doesn't seem right! I don't know how to move this! We shouldn't swallow this food!" Oftentimes, this period of gagging will terminal longer with babies who started with spoon-feeding. half-dozen
In 2016, the "Elation" report establish that babies who follow a spoon-feeding approach to solids (spoon feeding smooth purées > lumpy purées > finger foods) tend to gag less at 6 months but more than at 8 months and afterwards. seven Remember: around viii months, a baby's gag reflex becomes less sensitive and moves further in the dorsum of the rima oris. This means that food is closer to the throat before the trunk reacts and tries to push it out. eight In other words, waiting to introduce finger foods until subsequently baby is viii or ix months erstwhile mayincrease the choking take a chance as the gag reflex is less sensitive, further back in the mouth, and baby is not accustomed to textures other than soft foods from a spoon.
By 8-9 months quondam, a spoon-fed baby has been practicing a very specific skill to eat. "Purées come into my mouth. I suck or lift my tongue to move that puréed nutrient backward, and I consume information technology." Babies volition e'er showtime with the skill they know and attempt to apply that same pattern on solid foods. They try to motility that solid food directly dorsum without the necessary step of moving the foodlaterally to their gums to chew. This motor blueprint often leads to even more gagging.
The older the babe, the more than aware they are of gagging and its unpleasantness. A 9-month-old baby is more than aware of gagging than a six-month-sometime infant. "Hebbian plasticity"—a fancy term that encephalon specialists use—tells united states that neurons that fire together wire together. This means that when one function of the brain lights upward simultaneously equally some other function of the brain, the encephalon starts to build a connexion betwixt those two areas. So, frequently gagging as the baby gets older and more enlightened of their body may be problematic for some babies who seem to draw a connection between real nutrient and gagging. These babies seem to learn apace that real nutrient will make them gag and can atomic number 82 to refusal of whatever food that is not a purée or mash. By contrast, younger infants don't seem afflicted as much as older babies and toddlers.
Infant-led weaning and gagging
At 6 months old, the gag reflex is necessary to exploring nutrient. It's what allows a young babe with almost zero chewing skills to put a slice of food in their mouth and, if it is besides big to swallow, get that food safely back out.
Infants acquire how to do amazing things—sitting, crawling, walking, and running—by using reflexes, fumbling around, and making lots of mistakes while slowly edifice strength and calculation ane movement on summit of another. The same applies when learning to chew—babies use reflexes coupled with fumbling as they learn.
Amazingly, babies accept ii other fundamental reflexes—the biting reflex and the tongue lateralization reflex— which assistance them learn to chew right away at 6 months. For foods to exist properly chewed, baby needs to:
- Take a bite.
- Motion that food to the side (tongue lateralization).
- Munch upwards and downwardly to break down the food downwardly.
- Move the nutrient back to the tongue for swallowing.
When babies first start finger food, they will struggle to utilize their biting and lateralization reflexes in any coordinated way. Simply put, they bollix around! Every bit babies larn to consume, they won't break down food plenty to safely eat, which requires the gag reflex to push the unchewed food back out. But every time baby does that, they are learning where the food is in their oral cavity. Slowly and incrementally, babies learn how to move food to different parts of their mouth. They larn their tongue can help push button food around the mouth in lots of directions. They learn their palate, tongue, gums, and saliva will suspension the food downwards every bit information technology moves around their oral cavity. All of these actions turn a solid food into something like a mash!
Some experts suggest that purees teach babies to eat correctly, and gives exercise swallowing solids before you innovate the idea of chewing. Nigh babies practise not demand to be taught how to swallow. Swallowing is a deep brainstem reflex present past 15 weeks gestation2 and well established by full term birth. Babies already know how to swallow; there is no need to practice! Interestingly enough, thicker textures are actually easier for babies to consume (think purees), and our feeding therapists explain that babies who have swallowing difficulty are actually prescribed thickened milk to drink! But purees do teach baby a motor pattern: bring food in, movement information technology back, consume. This is a dangerous pattern because near solid foods require chewing before you move them back and can safely eat. We believe that exclusive purees are time wasted considering baby isn't practicing chewing and is practicing a dangerous motor pattern that must be unlearned.
Interestingly, the BLISS study also demonstrated that infants who started solids with finger foods experienced more gagging at 6 months, justlessgagging at 8-9 months every bit they developed more than command and coordination in moving food around their mouth. 9 This demonstrates that babies who are given the opportunity to work with finger foods early in their solids journey—well earlier eight months of age—develop the oral-motor skills required for mature eating more rapidly than spoon-fed babies.
After a couple of months, most babies who start with finger foods at 6 months of age develop the skill and coordination to chew and move well-chewed food astern to eat safely. The baby feels comfy with their skills and is accustomed to food moving in this way. The trunk won't initiate a gag and so readily.
By contrast, babies who start solids with purées have had little chewing practice from vi-8 months. Information technology's likely they are less coordinated with moving food around their mouth, less able to interruption downward the nutrient, and less condom in the case that the food gets pushed dorsum further in the mouth than they can handle.
How to aid baby move past gagging by building skill
Successful eating is not only nigh chewing simply about feeling where the food is in the mouth and knowing if information technology's chewed "enough" to swallow safely. As adults, near of us can identify and discretely spit out a tiny slice of bone or eggshell from a bite of food. Because this is happening within the mouth, we aren't using our optics; our brains visualize what's going on inside our mouth, fifty-fifty though we don't frequently run across what's going on in there. Nosotros have a mental image of our mouth and where everything is in relation to other parts. Babies don't take this "mental map" of their oral fissure at first.
To assist you lot understand the necessity of a mental map, think about babies learning to stand. Before they can do this, they need to develop "body sensation" or, substantially, a mental "map" of where all their body parts are in relation to each other. Baby lays on the flooring and slowly learns to roll around earlier they ever sit down up. Rolling and touching their whole body—from head to toe—while their muscles push and pull helps form the mental "map" of their trunk. They need deep input all over their body to add all the details to that map. A small touch on to one part of their body or a lite brush of your mitt over their body helps a little simply isn't really enough. It's the flooring'south house input to the whole torso while moving the muscles that really seems to form a articulate map.
The same goes for the inside the mouth. When things touch the inside of our mouth, a map slowly "draws" in our brain. Every bit babies develops the map inside their mouth, they gain more control, figuring out how to move food around appropriately. They as well become more confident in their skill to move food effectually. This control seems to assist quiet the gag response and motility information technology further dorsum in the mouth over time. The baby does not need the gag reflex to swallow one time they take a articulate map and strong coordination. They now have active control to chew the nutrient, know if it's chewed enough, motion it dorsum to swallow, or spit it out and endeavor once more.
Nosotros know that many types of sensory input in the oral cavity help babies grade the "mental map," simply that bigger inputs are more effective than calorie-free sensory inputs. (Think about the difference between a tight hug versus a tickle on the shoulder.)
There are two types of input that feeding therapists know are most effective for sensory-motor learning:
- Touch or tactile input – when food touches a function or many parts of the mouth
- Letters from the muscles and joints or proprioceptive input – when the oral fissure gnaws on firm or resistive foods that don't break when chewing.
The simultaneous combination of tactile and proprioceptive input is most constructive for forming the map. This is why feeding therapists frequently recommend giving resistive, flavorful foods like a rib bone for baby to chew.
Foods similar a rib bone accomplish the trifecta:
- Baby tin concord the food, easily put it in their mouth, and pull it dorsum out with their easily, which gives them control to keep the food at the front of their rima oris fifty-fifty if they don't have oral motor control.
- Baby gets big input to their mouth (touch input and muscle feedback as they bite on the bone), which maps the oral cavity and leads to amend command in the future.
- Baby triggers two key reflexes (biting reflex and the natural language lateralization reflex), which mimic chewing and help babe build forcefulness and coordination for future eating.
Are these experiences for eating? No. These are "exercises" to help build a stronger connection between the oral fissure and the brain. Drawing a detailed map of the rima oris contributes to decreasing the sensitivity of the gag. As this map develops, the baby also develops more conviction in their skill, further decreasing the gag's sensitivity.
When to seek aid
We recommend you speak with your child's pediatrician regarding a referral to a feeding therapist if:
- Baby continues to gag at nearly meals after an initial learning period (one to two months of finger foods).
- Baby is oftentimes becoming upset afterwards gagging (crying, tantrums, vomiting).
- Baby is airsickness at well-nigh meals, even on an empty stomach.
Let's normalize the gag
While it can be disturbing—and nervus-wracking to watch—gagging is a completely normal reflex in infants, children, and adults. Bottom line:
- Babies will likely gag when they first start solids, regardless of starting on purées or finger nutrient.
- Babies who are spoon-fed thin purées are likely to gagless initially but gagmore afterwards on when they get-go finger foods.
- Babies who start with finger foods tend to gagmore in the beginning andlesslater as their oral-motor skills develop more than quickly.
- All babies gag in their eating journeying—it's one way they learn how to eat. The expert news is that babies typically outgrow gagging after a couple of months of exercise with diverse textured finger foods.
Infant CPR & Starting time Aid Resources
1 of the nigh important things you can do to protect baby is take a CPR class online or at your local wellness facility and review safety procedures. Some resources:
- American Cerise Cross: Child & Baby CPR
- American Heart Clan: Infant CPR Grooming Kits
- MedlinePlus: Choking First Aid for Infants Under ane
Remember, yous are responsible for supervising your child's health care and for evaluating the ceremoniousness of the information in this article for your child. Just you know your child and how your child will react to foods and feeding procedures. Although the information presented in this article is based on well-documented research by medical and nutritional professionals, it is up to you to review and consider the information and how it volition piece of work with your child.
Always seek the advice of your pediatric doctor, nutritionist or wellness care provider with any questions y'all may have regarding a medical status or feeding upshot. You should refer to our Terms of Use for further data.
Reviewed past:
K. Rappaport, OTR/L, MS, SCFES, IBCLC
K. Grenawitzke, OTD, OTR/L, SCFES, IBCLC, CNT
- Rapley, G., & Murkett, T. (2010).Baby-Led Weaning. The Essential Guide to Introducing Solid Foods.
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- Naylor, A. J., & Marrow, A. L. (2001). Infant Oral Motor Development in Relation to the Duration of Exclusive Breastfeeding.Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods, 21–25.
- Naylor, A. J., & Marrow, A. 50. (2001). Infant Oral Motor Development in Relation to the Duration of Sectional Breastfeeding.Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods, 21–25.
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- Naylor, A. J., & Marrow, A. L. (2001). Infant Oral Motor Development in Relation to the Elapsing of Sectional Breastfeeding.Developmental Readiness of Normal Full Term Infants to Progress from Sectional Breastfeeding to the Introduction of Complementary Foods, 21–25.
- Fangupo, Fifty. J., Heath, A.-L. M., Williams, Southward. M., Erickson Williams, 50. West., Morison, B. J., Fleming, E. A., Taylor, B. J., Wheeler, B. J., & Taylor, R. W. (2016). A Baby-Led Arroyo to Eating Solids and Chance of Choking.PEDIATRICS,138(iv).
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