The Important Difference Between Choking, Gagging & Coughing in Babies
When starting solids with your baby, choking and gagging are always the biggest concern. Choking is probably the number one reason why parents don’t give baby-led weaning a chance and decide against introducing finger foods from the start. This is a critical topic, and I wanted to cover everything you need to know so you can keep the baby safe and have more confidence with solids.
Staying calm & confident at mealtime
You want to cultivate a pleasant experience for your baby at mealtime, so they develop a healthy relationship with food. You and your baby are very connected, so your baby will be able to sense if mealtime is not a relaxed experience for you. Whether you decide to introduce finger foods right from the start or after a few months of purees, knowing and understanding the components of safe eating is crucial so that you’re able to stay calm and confident while starting solids with your baby.
The difference between choking, gagging & coughing
Choking is silent
Choking is completely silent and happens when something is completely blocking the airway. I've actually never heard of a baby choking with baby-led weaning when the parents and caregivers are well educated on the safety of food size, shape, and texture.
Gagging & coughing can actually be beneficial
Gagging and coughing, on the other hand, can be very noisy and quite dramatic. Babies might gag and cough often when starting finger foods because the gag reflex in younger baby’s mouths is quite far forward and moves back as they age. This serves as a safety mechanism against choking while they're learning to eat and helps them eject anything quickly if they need to. A baby’s gag reflex begins moving further back around 6-8m and should be completely back to where an adult would be around 12m.
Babies also have more taste buds further back in their mouths, which move forward as they age, because that’s where milk gets delivered by breast or bottle, exclusively the first half-year of their lives.
Gagging can be scary, but it’s safe
Gagging can be quite scary for parents to witness because it can be so dramatic, but it's actually a widespread occurrence and is part of a baby's learning process. Gagging helps babies begin to understand the size and shape that food must be so that they can safely swallow.
Safe eating
Baby should always be sitting upright and have complete control of all food in and out of their mouth. It’s advised not to try to take any food out of your baby's mouth when they're gagging. Instead, it’s best to let your baby’s natural gag reflex push the food out. The same applies if they eat a piece of food that you feel is too big for them or if they put too much food in their mouth at once. This is because if you put a finger in their mouth to try and help them get the food out, you could potentially push the food further back past their gag reflex, increasing the potential risk of choking. This is why it’s crucial only to offer baby safe foods.
READ: Baby's First Finger Foods: Size, Shape, Texture & Flavor
Vomiting while eating
Some babies may vomit when learning to eat, and this could happen for a few reasons. If the baby is gagging strongly, vomiting is the next natural reflex that helps them completely clear food from their passageway. Vomiting acts as a safety mechanism and is a very beneficial reflex.
It can be quite concerning to see a baby throw up because when adults throw up, it's associated with being nauseous or feeling sick. Although if you’ve seen a baby throw up while eating, you’ve probably noticed that they are generally unfazed by it. You'll witness them throw up in one breath, then turn around and continue eating in the next breath, as if nothing ever happened.
Why I don’t suggest chunky purees
Babies are often fed smooth runny purees first and then introduced to chunky purees before finger foods. However, chunky purées may not be necessary and could potentially delay the developmental benefits of self-feeding.
Babies suck purees off of a spoon without being chewed, in the same way, they suck breast milk. So a chunky puree could potentially trigger a baby’s gag reflex, making it more likely that they’ll gag or possibly even vomit.
Parents are then led to believe that babies must not be ready for finger foods yet because they can't even consume chunky purées without gagging. But the truth is, chunky purees are more likely to make baby gag than safe finger foods would be. It's just the chunky purees that are problematic in the early stages. For babies with a sensitive gag reflex, it may be best to wait to offer purees with a chunkier consistency until after the baby is comfortable with finger foods and can successfully manipulate food in their mouth.
Babies storing food in cheeks
One last point I’ll make is about ‘squirreling.’ I think I've made this term up as I haven't heard anyone else reference it, but it's when babies store food inside their cheeks after eating.
Squirreling can happen for a few reasons, but one of the most common reasons is if food is too tough or fibrous. Babies will sometimes store food in their cheeks to soften it, but you may not know they still have food in their mouths.
If you lie them down for a diaper change after a meal, the food from the side of their mouth may make its way further back in their mouth, which could cause coughing, gagging, and possibly vomiting or choking. So after a feed, give the baby’s cheeks a little squeeze to see if they're storing any food in there.
In review
Coughing and gagging are normal and safe - but choking, which is silent, is not.
And it's important you know the difference.
To gain more confidence
CPR COURSE: You may gain confidence from taking an infant CPR course, although choking is completely unlikely if feeding baby-safe foods. However, the knowledge gained through a CPR course would be beneficial if the baby could pick something up off the floor that could potentially block their airway.