Starting solids with a baby can be a fun exciting for some parents or caregivers, but anxiety riddled and challenging for others. When a baby is introduced to food, there is a huge sensory experience – new smells, new sights, new sounds, new textures, new tastes. Babies must learn to move their tongue and mouth in new ways at the same time as trying to sit up.
These skills and experiences are easy for proficient eaters (i.e. older children and adults). We take eating for granted as a straightforward skill. But what happens when a baby struggles to start eating? What is considered typical versus unusual? Where to turn for help?
This “Feeding a child who struggles to eat” series will highlight many of the common issues happen and how parents/caregivers can help.
Gagging
What is gagging?
Gagging is a normal process when babies learn to eat and put things in their mouth. Almost all babies will experience gagging at some point. In the first 6-7 months of life, gagging can occur when the back ¾ of the tongue is touched.
As the baby experiences food, different textures and items in their mouth (e.g. toys, their own fingers, utensils), the gag reflex will slowly reduce (also called desensitize). By 7-10 months old, the gag reflex moves further back on the tongue. As a result, babies gag a lot less when they eat.
Gagging helps protect a baby’s airway from food getting into it. If the gag reflex is triggered, a baby will have a cupped tongue that juts out forcefully. Gagging helps move food out of the mouth. Some babies have a sensitive gag reflex that is triggered easily.
If you are not expecting to see a baby gag, it can look very scary the first time. You may panic or think the baby is having an emergency. Gagging can be so forceful that it can make a baby throw up. Don’t fear! Gagging is not painful. It is the easiest way for a baby to get food out of their mouth.
Gagging can be confused with choking. Choking is a medical emergency where a person cannot breathe. When eating, choking can occur when food gets stuck in a child’s trachea. Gagging is different because it is a reflexive movement that happens before food gets to the trachea.
If a baby is choking, they cannot breathe and will not make sounds. A baby who is gagging will have a retching sound.
| Gag | Choke |
| Reflex triggered on the tongue. | Medical emergency where a person cannot breathe. |
| Food is in the mouth of back of the throat. Not blocking the airway/trachea. | For eating, food is lodged in the trachea. |
| Baby will make a retching sound. | Baby will make no sounds. |
What to do about gagging?
First step for parents and caregivers when you see your baby gagging:
- Try to stay calm. Take a breath.
- Remind yourself that the baby is learning to eat
- Use calm, reassuring voice to the baby encouraging them to get the food out
- Give the baby time to gag if needed and see if they figure out their mouthful of food
- If the food does not come out and the baby is still struggling, you can help the baby get the food out by gently swiping their mouth with your finger.
Just because you see a baby gag does not mean there is a problem. Gagging is a normal process that happens when babies are learning to eat. What to do next?
How to help a baby who is gagging:
- Try offering smaller bites or spoonfuls
- Allow a baby to touch and experience the food with their hands first. This will help them learn through touch what they will put in their mouth.
- Let the baby feed themselves
- Offer foods very gradually where you start with thinner, less textured foods and slowly increase the thickness and texture of the food.
- Offer food to the side of the baby’s mouth instead of the center of their mouth.
- Try foods that can dissolve easily e.g. Baby crackers
- Tip: You can dip the cracker in puree to help it start dissolving before it goes into the baby’s mouth.
You’ve tried everything and it’s not working…
Some babies will have difficulties transitioning to solids that is resistant to typical strategies such as the ones above. Babies that continue gagging or have excessive gagging could have experienced medical issues or have underlying sensory challenges. Lack of experience with different textures will also lead to prolonged gagging.
If you and your baby are struggling to transition to textures, make sure to get help. Talk to your family doctor, or pediatrician. Get referred to a feeding therapist aka an occupational therapist, speech and language pathologist or other health care professional experienced in baby feeding.
More resources for gagging and how to transition to textures:
- AboutKidsHealth.ca Sensitive gag reflex: Transition to textured foods
- Ellyn Satter Institute Great resource for challenges around feeding
- NHS Start 4 Life: More information about transitioning to solids
Pro tip: Take a baby first aid course to give you the confidence to handle any situation. Having the knowledge to manage a child if they choke is priceless. Plus you’ll learn a few other first aid tricks that can come in handy. Courses are available through local Red Cross.