Introducing solid foods to your baby is an exciting time for parents and children. The process of slowly moving from milk feeds to trying a variety of different tastes and textures can be exciting and daunting at the same time. One question I am always asked by patients at the start of their weaning journey is ‘what do I do if she chokes?’ Alongside I don’t want to offer finger foods ‘as she might choke’.

It’s a common misperception that gagging and choking are the same thing and they are often confused… but they most definitely are not.

Gagging is normal; it’s a normal reflex all babies are born with to prevent them choking. So what is the difference?

Gagging:

Think of gagging as your babies in built protective mechanism against choking. Babies have highly sensitive gag reflexes that are triggered very close to the front of the tongue, especially at the start of weaning.

This means they will often gag when they first start solid foods and for the first few weeks of weaning. This might mean they simply push food out of their mouth with their tongues, or they may wretch or look like they are about to vomit. They are rarely distressed by this and will often simply continue eating again straight after.

Gagging occurs because your baby needs to mature their oral motor movements with time as they learn to eat. They don’t yet have the control to coordinate chewing and moving food to the back of their mouth to swallow, so they gag to stop food going down the wrong way. Therefore, don’t be put off if you baby gags during the early phase of weaning. She is simply learning to train her oral muscles to work in a different way and move food from the front of her mouth to the back in order to swallow.

As your baby continues on her weaning journey and practices eating, the gag reflex will move further back in her mouth and she will naturally gag less.

Some babies may have more pronounced gag reflexes, for example if they have suffered with reflux, vomiting, or had tubes for feeding etc. If you are worried about your babies gag reflex always seek help via your GP who can refer you to a specialist speech and language therapist.

What do I do if my baby is Gagging during feeding?

Firstly, try not to panic and remain calm. This is easily said I know, but if you can recognise that she is gagging (and not choking) it is important to let her body do what it will naturally do.

Wait a few seconds, maybe count to10 slowly in your head, it is very likely she will bring the offending food to the front of her mouth and spit it out or start to eat it again.

By stepping back and allowing her to gag, you are allowing her to learn how to coordinate her muscles and perfect her new skill.

Remember never to leave your baby alone whilst feeding. It is important she is always well supported or able to in an upright position. This will reduce the risk of choking significantly as the gag reflex may not be as effective if they are leaning backwards.

Choking:

Choking is very different to gagging. This is when your baby’s airway becomes blocked. They may be coughing and trying to remove the offending obstacle but they may also be unable to dry, cough or make any noise at all. They may be unable to breathe and you may see their lips or face turn blue.

This is a medical emergency and they will need immediate help.

During weaning, try to avoid foods that can cause choking such as:

• Whole nuts – always give nuts crushed or powdered to babies
• Whole grapes, blueberries or cherry tomatoes – always serve them quartered
• Fruits with stones – remove the stones and serve quartered
• Bony Fish – check and remove all bones
• Cook vegetables so that they are soft

What do I do if my baby is choking?

The NHS website, Resuscitation Council UK & the Red Cross websites all have great advice, and step by step videos to teach you basic first aid and support with choking. You may want to attend a local First Aid Course; your GP should be able to advise you about local courses.

If you baby is showing signs of choking, here are some simple steps you can take as advised by the NHS.

• If you can see the object, try to remove it. Don’t poke blindly or repeatedly or you could push it further back and make things worse.

• If your baby is coughing, encourage them to keep coughing, this might help to bring up what they are choking on. Don’t leave them.

• If the coughing isn’t effective (its silent or they can’t breathe in properly) Shout for help immediately and decide if they are still conscious.

• If you baby is still conscious, but they are either not coughing or their coughing isn’t effective, use back blows

 

Back blows for babies under 1 year old:

• Sit down and lay you baby face down along your thighs, supporting their head with your hand.

• Give up to 5 sharp back blows, with the heel of 1 hand in the middle of the back between the shoulder blades

• If back blows don’t relive the choking and your baby is still conscious, give chest thrusts.

 

Chest Thrusts for babies under 1 year old:

• Lay your baby face up along the length of your thighs

• Find the breastbone and place 2 fingers in the middle

• Give 5 sharp chest thrusts (pushes) compressing the chest by about 1 third

 

Following back blows and chest thrusts reassess you child as follows:

• If the object still isn’t dislodged and your child is still conscious, continue the sequence of back blows and chest thrusts

• Call out or send for help, if you’re still on your own.

• Don’t leave the child

Call 999 if the blockage doesn’t come out after trying back blows and chest thrusts. Keep trying his cycle until help arrives.

Even if the object has come out, get medical help. Part of the object might have been left behind, or your child might have been hurt by the procedure.

 

Unconscious child with choking:

• If a choking child is, or becomes unconscious, put them on a firm flat surface and shout for help

• Call 000, putting the phone on speakerphone so your hands are free

• Don’t leave the child at any stage

• Open the childs mouth. If the objects clearly visible and you can grasp it easily remove it.

• Start CPR – www.nhs.uk/conditions/pregnancy-and-baby/resuscitating-a-baby/

What do I do if my baby is choking?

In summary, it is important to be able to recognise the difference between gagging and choking and the different ways we would treat both.

Gagging is your baby’s natural inbuilt protective mechanism to prevent them choking, as they learn to feed themselves. Choking however, is when her airway is blocked and she will need immediate help and First Aid.

The following table summarises the key differences between the two.

Airway clear Blocked airway
Wretching Coughing, Silent
Breathing Not breathing
Normal colour Face/lips turning blue
Normal reflex Not normal
Don’t Panic, stay calm, count to 10 & wait Emergency – Start First Aid Immediately & seek help

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