Gagging: What You Need to Know About Feeding Baby

Baby-led weaning, or baby self-feeding, is more popular than ever when it comes to starting solids. But whether your new eater is feeding himself soft pieces of avocado, sweet potato, or other squish-able options or slurping purees off a spoon, you may see your baby gag and attempt to push food out of his mouth. Gagging may seem scary, but it's a natural part of the learning process and to be expected. That said, too much gagging isn't healthy.

When Gagging is Good

Gagging is nature's way of protecting your baby's airway and a normal response to new tastes, temperatures, or textures. Be thankful for that gag reflex; babies learn from it! According to Diane Bahr, author of Nobody Ever Told Me (Or My Mother) That!, a newborn will gag if something unfamiliar touches the back three-quarters of the tongue. As babies grow, the reflex shifts even farther back. But by ten months of age, something must touch the back third of the tongue to elicit the gag. As the reflex moves farther back, babies learn how to tolerate new mouth experiences and continue to explore toys, foods, and fingers with his mouth, learning every step of the way.

When to Worry

In infants who are breast or bottle feeding, frequent gagging may indicate a loss of control of liquid in the mouth. Signs that your baby is in distress or having trouble keeping the liquid away from his airway include frequent coughing, color change around his lips or eyes, or sudden changes in breathing patterns. Children who are being spoonfed or are self-feeding and consistently gag multiple times per meal may be having difficulty coordinating mouth movements to safely managing solids, which can lead to serious complications. Discuss any of these signs and the frequency of occurrence with your pediatrician, who may refer your child for a feeding evaluation to determine why he's having trouble.

Why Frequency of Gagging Matters

Gagging is not a comfortable experience. Children who gag frequently on a daily basis or always on specific foods or textures will likely develop an aversion to those foods. Learning to eat should be a pleasurable experience! Think of it this way: When babies are learning to walk, they toddle with unsteady steps, stumble, and fall. It's part of the developmental process and most kids get back up and try again. But if a child falls repeatedly and it hurts, he will learn to protect his body and may not want to try again for some time, instead relying on crawling. Eating is also a developmental process, and too much gagging can cause kids to stall in that development. This can lead to picky eating, fear of food, and scary food jags, where kids become highly selective and eat only a few different options for months. Food aversions are created with repeated negative experiences around food and require professional intervention. If you notice that your baby always becomes upset after gagging or avoids certain foods that cause him to gag, consult with your pediatrician, who may refer you to a feeding specialist.

Gagging on Food Going Up, Not Down

Gagging can also be a sign of frequent gastroesophageal reflux (GER), where the stomach contents rise into the throat, causing baby to wretch. GER often occurs during mealtimes, but is also seen throughout the day, especially when baby is lying down or sitting in a car seat. Should you notice your child gagging away from meals too, it's important to share that information with his physician. If food or stomach contents are inhaled into the lungs, it can be life-threatening. GER can develop into gastroesophageal reflux disease (GERD), a chronic condition that requires intervention to prevent damage to the esophagus (food pipe).

Gagging vs. Choking

Gagging is not choking. Gagging is a reflexive attempt to push something away from the airway, while choking is caused by food or an object partially or completely blocking the airway. When babies gag, it is not foolproof protection against choking. A gag may warn you of a possible choking episode, but not in every case.

Choking has little to no sound. It's unlikely you'll hear choking, but you will see it. Your child may be open-mouthed, wide-eyed and drooling with bluish skin around his lips or eyes. Partial obstruction may include audible gasps for air or faint noises. Always stay observant when your child is eating. Babies can gag and then choke, or they can choke without gagging first.

Here are some common signs that your baby or toddler is having difficulty learning to eat age-appropriate foods and is at risk for choking:

• Frequent gagging followed by a look of discomfort, panic, fear, or irritability.
• Lack of interest in eating
• Wet, "gurgly" voice quality
• Consistent coughing during or after eating/drinking
• Multiple episodes of chronic low-grade fever
• Strong preferences to certain foods for more than three weeks
• Swallowing foods whole or with minimal chewing
• Weight loss or poor growth

What to Do if Baby Gags

Stay calm, and observe quietly. Just like when a toddler falls as he is learning to walk, we don't want to over-react. Your baby will gag occasionally as he is learning to eat a variety of foods, especially in the first 12 months of life. If you don't see signs of choking, just wait a few seconds, and see if baby can remain comfortable and continue eating. Older babies or toddlers can then be encouraged to take a drink of water with a narrow straw, not a sippy cup with a spout. A straw will deliver just enough water to help wash away the tickly feeling and any residual particles of food. A sippy spout, which requires a child to tilt back the cup and tip up his chin to drink, can cause pieces of food to wash into the airway. Keeping the chin level or tilted down just slightly, as with a straw, decreases the likelihood of choking. Babies who have not yet learned to drink from a straw can be offered a baby-sized open cup (held by the adult) for tiny sips of water while their chin is slightly tucked.

Melanie Potock, MA, CCC-SLP, is an award-winning author, international speaker on parenting, and feeding expert. Her fourth book, Adventures in Veggieland: Help Your Kids Learn to Love Vegetables with 101 Easy Activities and Recipes will be published in October 2017.