Baby Gagging and Chocking
There is a distinction difference between a baby choking and a baby gagging in a baby, knowing the difference could save a life:
Gagging is a natural reflex as your baby learns to chew and swallow solid foods. It is often accompanied by loud sounds. Additionally, your child’s skin may appear red during gagging, although redness might be less noticeable on brown and black skin.
On the other hand, choking is silent. In the case of children with fair skin, their skin may turn blue (cyanosis) during choking. For children with brown or black skin, the gums, inside of their lips, or fingernails may take on a blue hue.
The Tongue-Thrust Reflex
Up until approximately 6 months of age, infants exhibit a reflex that prompts them to push their tongue forward in response to stimulation at the back of their throat. Known as the tongue-thrust reflex, this can pose difficulties when introducing solid foods early on. It is advisable to commence solid feedings once this reflex subsides. It is not unusual for infants to experience gagging or reject initial spoonful’s of pureed food during this transition.
Encouraging your infant to consume more food than they desire may lead to gagging, as can overfilling their mouth with an excess of food or offering items they find unpalatable. Some infants may experience gagging as they explore by putting their own fingers into their mouths until they learn their limits. Until an infant gets the rhythm of sucking, some infants will gag while breastfeeding or bottle-feeding, especially if it’s flowing too quickly for them.
The Gag Reflex
In newborns, any unfamiliar object contacting the back three-quarters of the tongue can trigger a gag reflex. This reflex gradually transitions further back as infants develop. By the age of 10 months, stimulation on the back third of the tongue becomes necessary to induce the gag reflex. As this reflex matures, infants acquire the ability to endure new oral sensations, facilitating their exploration of toys, foods, and objects with their mouths, fostering learning throughout this developmental stage.
Put simply, a baby’s tongue exhibits a heightened sensitivity to prevent choking, making them prone to gagging while transitioning to solid foods, and occasionally even before that stage. As long as the gagging occurrences are sporadic and do not cause distress to the baby, it is typically considered normal and not a cause for concern.
Why do babies Gag?
- Children develop oral motor skills to handle foods with various textures effectively.
- Gagging, a reflex action that aids in preventing choking, can be triggered by objects like fingers, food, spoons, or toys touching the back of the mouth. Typically, the gag reflex lessens around 6 months when babies start eating solid foods. Some children may have a hypersensitive gag reflex, leading them to gag more easily.
- Gagging brings food forward into your baby’s mouth to help them learn how to chew.
- Gagging commonly occurs when infants transition from smooth to lumpy foods or learn to chew. It’s best addressed by introducing textured foods that align with oral motor skill development. Additionally, exploring the mouth with hands and toys and encouraging feeding independence can help reduce the gag reflex.
- Through positive reinforcement, gagging can become a learned response. To prevent this, it’s essential not to overreact to the child’s gagging but simply remove the food piece and offer reassurance.
Different from choking, where the airway is blocked, causing breathing difficulties, gagging involves audible retching noises. Choking is silent. It’s crucial to supervise babies and young children while they eat to ensure their safety.
Importance of Gagging
A baby gagging can be a distressing sensation. Children who frequently gag, especially when encountering specific foods or textures, are at a higher risk of developing aversions to these items. It is essential for the process of learning to eat to be enjoyable and positive.
Consider this analogy: During the developmental stages of learning to walk, infants often take unsteady steps, stumble, and experience falls. These challenges are integral to the learning process, with most children resiliently getting back on their feet and persisting. However, if a child repeatedly falls and sustains discomfort, they may develop a hesitance to continue, opting for the safety of crawling until they feel more confident to try walking again.
Eating is a vital developmental process, and excessive gagging in children can impede this progression. Such challenges may result in picky eating habits, food aversions, and food jags, where children limit their diet to a few specific options for extended periods. Persistent negative encounters with food can instigate food aversions, necessitating professional intervention to address these issues effectively.
If you observe that your infant consistently becomes distressed following gagging incidents or displays aversion to specific foods triggering gag reflexes, it is advisable to seek guidance from a Paediatrician or healthcare professional.
What does baby gagging look like
When a child experiences gagging, they might instinctively push their tongue forward or out of their mouth, accompanied by a retching motion in an attempt to dislodge food. This action can be accompanied by watery eyes, coughing, or even vomiting. It is essential to allow the child to gag and cough as this signifies that their airway is not entirely obstructed.
Coughing typically serves as an effective means to clear the individual’s airway. It is advisable to refrain from patting them on the back or attempting to retrieve the object from their mouth, as these actions may inadvertently push the obstruction further into the airway. The recommended approach is to remain composed, provide support, and ensure the baby fully recovers.
Should I worry if my baby is gagging?
Observing your infant gag for the first time, or at any point, can be an anxiety-inducing experience. However, it is a natural and crucial aspect of their developmental journey in learning to eat. The gag reflex serves as a protective mechanism that prevents large objects from entering the airway. In infants, this reflex is located farther forward in the mouth compared to adults, starting mid-tongue and gradually shifting rearward with age.
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Gagging incidents are common during the initial stages of introducing solid foods and typically diminish as the baby becomes more adept at manipulating food in their mouth. Signs of gagging may include facial reddening, watery eyes, as well as sputtering, coughing, and retching sounds.
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Encouraging your baby to practice eating can help lessen the gag reflex response. Introducing safe teething toys can also aid in familiarizing them with this reflex. Should persistent gagging occur without improvement, seeking advice from a Paediatrician is advisable.
What you should and shouldn't do if your baby is gagging:
What You Should do:
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.
What you shouldn’t do:
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.
Don’t pat them on the back as it can cause whatever they’re gagging on to go farther down their airway.
What to Know About Gagging and GER
Gagging can also indicate frequent gastroesophageal reflux (GER), a condition in which stomach contents ascend into the throat, prompting a baby to experience retching.
Gastroesophageal reflux (GER) commonly manifests during feeding times but can occur at any time of the day. If you observe your infant gagging while in a supine position or reclining, such as in a car seat, it’s advisable to inform their healthcare provider if gagging episodes happen outside of feeding times as well.
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)
According to the National Institute of Diabetes and Digestive and Kidney Diseases, symptoms of GER or GERD in infants includes;
- Arching the neck and abnormal movements of the neck and chin
- Choking, gagging, or problems swallowing
- Irritability, particularly when regurgitating
- Refusing to eat or loss of appetite
- Complications that include poor weight gain, coughing, and wheezing
- Vomiting
What To Do When Your Baby Is Gagging
If your infant experiences gagging, it is advisable to remain composed and observe the situation quietly. Similar to how we react when a toddler stumbles while learning to walk, it is essential not to overreact. Gagging is a normal occurrence as babies familiarize themselves with different foods, particularly during their initial 12 months of life.
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When your baby experiences gagging,Â
- if there are no indications of choking, simply pause for a few moments to allow the baby to regain comfort and resume feeding.
- 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 their 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.
Gagging is Not Chocking
A baby gagging and a baby choking are very different. The way you can assist your little one when choking is very different to how you would handle a baby or toddler who is chocking.Â
Always stop, breath and think first.
Gagging is a common reflex that a child needs to assist with learning motor skills associated with their mouth. Gagging is noisy.
Choking is an object partially or completely blocking the airway. Choking is silent. Choking needs first aid interaction.
Gagging | Choking |
|---|---|
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 noises | Quiet or silent |
Don’t intervene, as you could push food further into their throat | Work to dislodge the blockage |
What causes Choking
Choking incidents in infants commonly stem from inhaling small objects placed in their mouths, like food, buttons, coins, balloons, toy components, or watch batteries. It can lead to either a complete or partial obstruction of the airway.
A complete blockage necessitates immediate medical intervention, as it constitutes a critical emergency. Conversely, a partial blockage can swiftly escalate to a life-threatening situation if the infant’s air intake is compromised.
Insufficient oxygen intake can induce permanent brain damage in as little as four minutes. Prompt administration of first aid for choking is pivotal in preserving life.
What does Choking look like?
Choking often occurs silently, making it challenging to detect audibly. Instead, visual cues are crucial in identifying choking incidents.
Initial Signs include a child with an
- open mouth,
- widened eyes,
- drooling,
- and a bluish tint around the lips or eyes.
In cases of partial obstruction, one might hear audible gasps for air or faint noises. Being vigilance during meal times is essential. Infants may exhibit gagging before choking or may choke without prior warning signs of gagging.
The danger signs of choking are:
- Bluish skin color (cyanosis)
- Difficulty breathing — ribs and chest pull inward
- Loss of consciousness (unresponsiveness) if blockage is not cleared
- Inability to cry or make much sound
- Weak, ineffective coughing
- Soft or high-pitched sounds while inhaling
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What to do when your child is Choking
First Aid
DO NOT perform these steps if the infant is coughing hard or has a strong cry. Strong coughs and cries can help push the object out of the airway.
If your child is not coughing forcefully or does not have a strong cry, follow these steps:
- Lay the infant face down, along your forearm. Use your thigh or lap for support. Hold the infant’s chest in your hand and the jaw with your fingers. Point the infant’s head downward, lower than the body.
- Give up to 5 quick, forceful blows between the infant’s shoulder blades. Use the palm of your free hand. Looking between each blow to see if the item has come out.
If the object does not come out of the airway after 5 blows:
- Turn the infant face-up. Use your thigh or lap for support. Support the head.
- Place 2 fingers on the middle of the breastbone just below the nipples.
- Give up to 5 quick thrusts down, compressing the chest one third to one half the depth of the chest.
- Continue 5 back blows followed by 5 chest thrusts until the object is dislodged or the infant loses alertness (becomes unconscious).
IF THE INFANT LOSES ALERTNESS
If the child becomes unresponsive, stops breathing, or turns blue:
- Shout for help.
- Give infant CPR. Call 000 or the local emergency number after 1 minute of CPR.
- If you can see the object blocking the airway, try to remove it with your finger. Try to remove an object only if you can see it and it can easily be removed safely.
DO NOT
- DO NOT perform choking first aid if the infant is coughing forcefully, has a strong cry, or is breathing enough. However, be ready to act if the symptoms get worse.
- DO NOT try to grasp and pull out the object if the infant is alert (conscious).
- DO NOT do back blows and chest thrusts if the infant stops breathing for other reasons, such as asthma, infection, swelling, or a blow to the head. DO give the infant CPR in these cases.
When to Contact a Medical Professional
If an infant is choking:
- Tell someone to call 000 or the local emergency number while you begin first aid.
- If you are alone, shout for help and begin first aid.
Always call your doctor after a child has been choking, even if you successfully remove the object from the airway and the infant seems fine.
