Babies gagging on solid food

Why babies gag themselves, and what to do if your baby's gagging on food

It's normal for babies to gag. They may gag when they're first getting used to eating, taste something they don't like, or have too much to eat. Gagging is different from choking: Gagging resolves on its own, but a choking baby needs help. You can tell a baby is choking if they're unable to cry, talk, or cough. If your newborn is gagging, try slowing the flow of milk by changing nursing positions or changing the bottle nipple. If your baby gags on food, they may not be ready for solids yet – or you may need to keep trying.

We all have a gag reflex – it's a lifelong automatic response that helps prevent choking.

Gagging is normal for babies as they learn to eat solids, whether they're spoon-fed or you're doing baby-led weaning. Gagging brings food forward into your baby's mouth to help them learn how to chew.

Until your baby's around 6 months old, they also have a reflex that causes them to thrust their tongue forward whenever the back of their throat is stimulated. This tongue-thrust reflex can make early solid feedings a bit of a challenge, so it's best to wait until the reflex is gone to try solid feeding. Still, gagging on or pushing out those first spoonfuls of pureed food isn't uncommon.

Prodding your baby to eat more than they want can cause them to gag, as can having too much food (or food they don't like) in their mouth. Some babies will even gag on their own fingers until they figure out how far they can put things in their mouths. And until they get the rhythm of sucking, some infants will gag while breastfeeding or bottle-feeding, especially if it's flowing too quickly for them.

The difference between gagging and choking

Gagging is different from choking. Choking means your child's airway is partially or completely blocked, which prevents breathing. Here's how to recognize the difference between gagging and choking:

A child who's gagging may push their tongue forward or out of their mouth and do a retching movement to try to bring food forward. Their eyes may water. They may cough or even vomit. Let your child continue to gag and cough – it means their airway isn't completely blocked.

Coughing can usually effectively clear their airway. Don't pat them on the back or reach into their mouth to try to grab the object. Doing either can cause whatever they're gagging on to go farther down their airway. It's best to calmly stay with them and make sure they completely recover.

A child who's choking is unable to talk, cry, or cough because their airway is blocked. They may gasp or wheeze, make odd noises, or make no sound at all while opening their mouth. They may grab at their throat or appear panicked. A choking child might turn blue because they aren't getting oxygen. They may need first aid for choking – back blows and chest thrusts (or, for children over age 1, abdominal thrusts) – to dislodge the blockage.

This is best done by someone who's trained, so it's a good idea to learn first aid for choking and infant CPR in case you ever need it. BabyCenter offers a virtual Infant CPR and Choking course led by a top pediatric ER doctor.

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If your child is unable to breathe, talk, or make noise, call 911 immediately.

Newborn gagging

Newborns might have their gag reflex stimulated if the breast milk or formula they're fed comes out too quickly, especially when they're first getting used to eating.

Try to get your baby to relax during feedings and don't push them to eat more than they want.

If you're breastfeeding, the flow of milk coming out (the "letdown") can be strong – especially in the early weeks – and cause your baby to gag. Try nursing your baby with them in more of an upright position, so they aren't lying down. This might help slow the flow as it enters their mouth. You can also try nursing in a side-lying position (with both of you lying on your sides) to slow the milk flow as well.

If you create a lot of milk, or it's been a little longer than usual since you last nursed your baby and your breasts feel engorged, you can try pumping or hand-expressing milk for just a few minutes to get past the initial forceful letdown before nursing your baby. Then, the milk flow will be a little slower.

If your baby is bottle-fed, make sure the nipple is the right size. Nipples with faster flow have more holes, and can allow too much breast milk or formula to come out at once, causing babies to gag.

What if your baby's gagging on food?

It's scary when your baby gags on food, but it's part of the normal process of learning to eat. Try not to worry when it happens, as hard as that might be.

From birth to around 7 to 9 months, the gag reflex is actually triggered closer to the front of the mouth. Because of this, gagging might be more common when first starting solids and lessen once your baby gets older (around 9 to 12 months), when the gag reflex moves more to the back of the mouth.

If you're starting to introduce solid foods and your baby gags, here's what you can do. 

Make sure your baby is ready for solid food before you introduce it. This usually happens around 6 months old, once your baby is able to sit upright, has good head control, grasps, turns away when full, and shows an interest in food, leaning forward and opening their mouth when food comes near.

When you think your baby's ready, start by putting a small amount of food on a spoon. Tip the spoon to get a bit of the food on the front of their tongue, rather than putting the whole spoonful in their mouth, which may trigger the gag reflex.

If your baby pushes the food out with their tongue, it doesn't necessarily mean that they don't like it – they're probably just trying to figure out this new way of eating. Feed them slowly while they get the hang of it.

After a few tries, they'll start using their tongue to move the food to the back of their mouth. If your baby is still pushing food out of their mouth or having trouble swallowing food after a week of trying, they may not be ready for solids yet.

If you're introducing your baby to solid food through baby-led weaning, gagging is also a normal part of the process. Your baby's learning to feed themself, and that's naturally going to come with some bumps along the way. Let your baby work out the gagging on their own, but keep an eye on them to make sure they're not choking.

To help keep your baby from gagging on finger foods, feed them soft, easy-to-swallow food that's cut into bite-size pieces once they develop the pincer grasp, at around 8 or 9 months old. If you're doing baby-led weaning, you'll give them large pieces of soft foods to grab and gnaw on. These foods should pass the squish test – they should squish easily between your thumb and forefinger or between your tongue and the roof of your mouth – so they're easy for your baby to eat.

Don't give them foods that are choking hazards, like whole grapes, hot dogs, nuts, raw vegetables, large chunks of meat or cheese, popcorn, or other cylindrical foods that can block the airway (like pieces of sausage or hot dog).

If your baby gags because they don't like the texture of solid food, try giving them different types of food – and remember that it's normal to have to give a baby a new food many times before they'll accept it.

If your baby turns away or cries, they're done eating. Resist the urge to push extra food on them or make them eat more once they're done.

Your baby will most likely gag less as they get more meals under their belt and as they get older, though some kids do have an overactive gag reflex. If your baby is still gagging about a month after starting solids, mention it to their doctor. Your baby's doctor can give you input and check for problems, or may even suggest seeing a specialist, just to be sure.

Feeding Development and Difficulties : Ava

• Gagging or choking - Challenges increasing textures in the diet

  • Development of oral motor skills enables children to manage foods with an increasing range of textures.
  • Gagging is a reflex action that helps to prevent choking.  It can be triggered by fingers, food, a spoon or toys touching the back of the mouth.  The gag reflex diminishes at around 6 months of age coinciding with the age at which most babies are learning to eat solid foods.  Some children have a hypersensitive gag reflex and will gag more easily.
  • Gagging is a common response when infants are making the transition from smooth to lumpy foods or when learning to chew.  It is best managed by providing graded food textures that support or match the development of oral motor skills.  Exploring of the mouth with hands and toys and encouraging feeding independence helps with diminishing the gag reflex.
  • With positive reinforcement gagging can become a learnt behaviour.  To prevent this avoid overreacting to the child’s gagging response. Simply remove the piece of food and provide reassurance.
  • Gagging is not the same as choking where the airway becomes blocked preventing breathing.  Unlike gagging where the child will make retching noises choking is silent.   Babies and young children should always be supervised when eating.

  Case scenario

  Ava aged 14 months is referred for assistance with feeding.  Her parents are concerned that Ava has a swallowing problem as she will only eat smooth puree foods.   If she is given any lumps in her food she will gag and usually vomit. 

  Remember to consider your own response before viewing suggested answers.

  Question 1

  What are the key elements of your assessment of Ava’s feeding difficulty?

  Key elements of your assessment include:

  • Parent’s perception of the problem.
  • Medical, developmental, growth and social history.
  • Dietary assessment.
  • Observation of feeding.

  Your assessment reveals the following details:

  Parent’s perception of the problem

  • Ava’s parents report, “Ava started solids when she was almost 6 months old.   She seemed ready.  She was very interested in watching her sisters eat.  However she didn’t really seem to enjoy the foods I gave her.  She would spit a lot out.  She liked the commercial baby foods better than the foods we made for her.  They seem smoother and she managed them better. ”
  • “When I tried her on the next stage foods with the lumps but she gagged and looked like she was about to choke.”   
  • “We waited a while before trying again but she still gags on the tiniest lumps.  It is getting worse and now she vomits if she finds a lump. We are sure she has a swallowing problem.”

  Medical, Developmental, Growth and Social History

  • Ava was born at term.  There are no concerns regarding her development and her growth has tracked consistently around the 25th percentile.  She has not had any significant illnesses.
  • Ava lives with both her parents.  Mum does not work and is the primary carer for Ava and her two older sisters.  Dad is employed full time.

  Dietary assessment

  • Ava has smooth infant cereal for breakfast.  Lunch and dinner typically consists of smooth commercially prepared foods that include meat and vegetables.   This is usually followed by puree fruit with yoghurt or custard.  She is either fed by mum using a spoon or self feeds by sucking food directly from the ‘pouch’.   
  • Sometimes Ava will mouth toast or biscuits until they go soggy but she doesn’t appear to swallow any.
  • Ava was breast-fed until around 10 months of age. She then commenced infant formula and is currently having 3 small bottles per day. She also has water from a cup.

  Mealtime Observation

  • Ava is well supported in a high chair.
  • She is offered lunch as described above.  She is observed to be happy and interactive when being spoon fed and enjoys the independence of feeding herself from the pouch.
  • Mum agrees to offer Ava some fork mashed fruit so that the observer can make an assessment of Ava’s response.
  • As mum predicts Ava gags and vomits.  The observer notes that mum fusses over Ava when she gags.   She has a bowl ready at the table to ‘catch the vomit’ and prevent a mess.
  • It appears that mum has a low tolerance for mess as Ava is also not encouraged to use a spoon to self-feed.

  Next Question

Child chokes on food | Mamovediya

Although the reluctance to swallow solid food is a natural response in many situations, and not just those involving food, infants and young children should not constantly choke.

If your child is constantly choking, or the face starts to turn red, or the skin around the lips turns blue, take your child to the doctor. In rare cases, this may indicate a problem requiring medical attention. nine0005

Although your father may be alarmed that you choke on the first spoonful of solid food, this happens quite often when the child starts eating. You have to learn to eat solid food.

In the sucking reflex, babies move their tongue to the front of their mouth and then up to the palate. They make 10 to 20 sucking movements, and then a big gulp follows. With solid food, however, the tongue must almost reverse, sending the food to the back of the mouth. nine0010