Baby gagging vs. choking during BLW: How to tell the difference

Dana Peters - Pediatric Registered Dietitian / Pediatric Registered Dietitian / Updated Aug 27, 2021
baby gagging vs choking blw

Learning to eat solid food is a BIG milestone for both your baby and you as a parent. For many of us, food is how we show we care, how we celebrate, and how we keep our culture alive. How exciting for our babies to be part of that! 

But even though it’s an exciting time, it comes with its share of worries. (Hello, parenting in general!) What foods can my baby eat? Do I need to cut baby’s food into tiny pieces? What foods are a choking hazard for my baby? 

Learning the difference between gagging and choking—and how to handle them both—is one way to help ease your worries.


IN THIS ARTICLE


As your baby starts solids, it’s helpful to remember eating is a new skill they need to master, much like rolling over or crawling. They don’t immediately know how to chew, or how much to put in their mouths at a time—they need practice! As babies are exploring and learning about new food, it’s common for them to gag. 

The gag reflex is a protective mechanism that actually helps prevent choking. During a gag, the airway isn’t blocked, and baby is actively working to spit out or swallow a piece of food. Choking occurs when the airway is blocked, and baby is unable to get the food out themselves.  

It’s important to note, according to the research currently available, baby-led weaning does not increase the risk for a choking episode when compared to a traditional or puree weaning style. No matter which feeding method you choose for your baby, all parents and caregivers should know and follow proper safety precautions when starting solids. 

  • Wait until your baby is ready before starting solids

  • Always feed baby in an upright, supportive highchair 

  • Offer soft foods that are easily mashed between your thumb and pointer finger

  • Avoid serving high-risk choking foods 

  • Never leave your baby alone during mealtime

  • Offer all meals and snacks while sitting down. Avoid letting older babies walk, run, or play while eating. 

  • Offer only small amounts of food at a time 

  • Limit distractions during mealtime. Turn off screens and remove toys from the eating area 

baby choking vs gagging blw

It can be nerve-wracking to watch your baby gag the first time (or any time really!), but it’s a completely normal and beneficial part of learning to eat. The gag reflex is an automatic response that prevents large objects from entering their airway. In babies, the gag reflex is much further up in the mouth than in adults. It starts about mid-tongue and moves further back as the baby gets older.  

Gagging is common during the first few weeks of starting solids, and should reduce over time as your baby becomes more proficient at chewing and moving food around their mouth. When a baby gags, their face may turn red and eyes begin to water. Sputtering, coughing, and retching noises are normal.

One of the best ways to reduce the gagging response is to allow them opportunities to practice eating. You can also introduce safe teething toys to help them explore the gag reflex. If your baby’s gagging isn’t improving, it’s best to call your pediatrician. 

  • Stay calm and let your baby work through gagging on their own

  • Watch your baby closely. Look for them to spit the food out, or start to chew it again in a few seconds

  • Older babies can be encouraged to take a drink of water from a straw cup once they’ve worked out the gag. Using a sippy cup or open cup requires the child to tilt their head back which may cause food pieces to end up in the airway. A straw cup helps wash down any remaining small particles of food

  • Don't overreact. Babies look to their parents or caregivers to see how they should react. If you make a big deal out of it or seem anxious, they might too

  • Don't stick your finger into your baby’s mouth. This could cause the food to go further back into their mouth and may push it back into the airway

Choking occurs when an object or piece of food is too big, and actually blocks the baby’s airway.  

While gagging is characterized by coughing and noise, choking is characterized by silence. Oftentimes, a baby will look scared, and may also start to turn blue or purple, especially on their lips. The baby may cough if the blockage of the airway is only partial.

If you think your baby is choking, take immediate action. If possible, ask someone to call 911 while you begin first aid. The standard steps for infant first aid are below. Taking an infant first aid class may also help you feel more prepared as your baby starts solids. 

If your baby is younger than age 1, use the following guidelines: 

  1. Place your baby face down on your forearm, with your arm resting on your thigh for support. 

  2. Deliver five quick, strong blows between the shoulder blades with the heel of your hand. This should hopefully dislodge the food.

  3. If needed, turn your baby on their back with their head lower than their chest. Use two fingers to press down quickly on the center of the breastbone, just below the nipples, five times. 

  4. Repeat back blows and chest compressions until the food is dislodged. Never put your fingers into your baby’s mouth unless you see the object as you may push the blockage further back. 

If your baby is age 1 or older, use the following guidelines: 

  1. Stand behind the child and wrap your arms around their waist. 

  2. Make a fist with one hand and place your fist just below the chest. Grab your fist with your other hand. 

  3. Press into their abdomen with a quick upward push. Repeat inward and upward thrusts until the piece of food comes out. 

Guidelines referenced from Stanford Children’s Hospital.

Being mindful of high-risk choking foods is one of the best ways to prevent a choking episode with your baby or toddler. The foods listed below remain choking hazards until about age 4. 

Some of these foods should be avoided completely, such as whole nuts, while others may be cut up in safe pieces such as grapes. 

Firm, smooth, or slippery foods Small, dry, or hard foods Sticky or tough foods
Whole grapes, cherries, berries, grape/cherry tomatoes Popcorn, hard pretzels, potato/corn chips Spoonfuls of peanut, nut, or seed butters
Whole pieces of canned fruit Small pieces of raw vegetables (carrots, celery) or partially cooked hard vegetables Large, hard pieces of fruits and vegetables
Hot dog-shaped foods including cheese sticks & whole bananas Apples or other hard raw fruit Tough meat, or large pieces of meat
Peanuts, tree nuts, and seeds Cooked or raw whole-kernel corn, raw green peas Large pieces of cheese
Whole beans Crackers or breads with seeds, nut pieces, or whole grain pieces Fish with bones
Hard or round candy, jelly beans Marshmallows, chewing gum, chewy fruit snacks, sticky candy

Gagging and choking can both happen quickly, and learning the differences helps you to take quick and appropriate action if needed.  

Remember, gagging is a protective mechanism that helps protect your baby from choking. It usually doesn’t require intervention. Choking, on the other hand, is an actual blockage of the airway and does require intervention.  

GaggingChoking
Airway is clear Airway is blocked, or partially blocked
Face may turn red, eyes may water Face and lips may turn blue or purple
Sputtering, coughing, and retching noisesQuiet or silent
Don't intervene, as you could push food further into their throat Work to dislodge the blockage

As your baby learns to eat, they may experience reflux, or spit up, during or after a meal. It may also happen as a result of gagging or choking. While it isn’t always possible to pinpoint the cause, you can watch for the following common clues. If any of these are possible, try to slow down your baby’s eating by offering small portions at a time. 

  • Did your baby overstuff their mouth?

  • Did your baby pocket food in their mouth or cheek? (cute in squirrels, babies not so much)

  • Did they eat a lot of food quickly?

Most babies grow out of infant reflux around 18 months. As long as your baby continues to grow and seems happy, there’s no reason to worry about it. 

According to the Mayo Clinic, the following are reasons associated with reflux to contact your pediatrician: 

  • Baby isn’t gaining weight 

  • Regularly spits up forcefully 

  • Often irritable after eating  

  • Spits up a green or yellow fluid

  • Spits up blood or something that looks like coffee grounds

  • Refuses food

  • Blood in their stool

  • Difficulty breathing or chronic cough

  • Starts spitting up at 6 months or older

Baby food safety FAQ

Q: Should I cut my baby’s food into small pieces?

A:

It depends! If you’re starting solids using a baby-led weaning method, larger, pinky-sized foods are actually safer. By 9 months, babies should begin to eat table foods cut into small pieces, regardless of weaning style.

Q: My baby is throwing up while eating. Is that normal?

A:

It can be. Throwing up can happen if a baby puts too much in their mouth at once. If your baby consistently throws up while eating though, contact your pediatrician, especially if they’re not gaining weight or they’re refusing to eat.

Q: How can I tell if my baby has food allergies or is just gagging?

A:

Gagging is a normal, beneficial part of learning to eat, and not a sign of a food allergy.

Q: Should I remove big pieces of food from my baby’s mouth?

A:

Probably not. Reaching into your baby’s mouth can cause the food to enter the airway and cause them to choke. If you notice your baby has a large piece of food in their mouth, remain calm and watch what happens. Likely your baby will work it out themselves by coughing or spitting the piece of food out.