What's The Difference Between Baby Gagging And Choking? (Plus, How To Safely Introduce Peanut)
Learn how to tell the difference between baby gagging and choking, and how to introduce solids safely.
When baby is ready for solid foods, it's the start of an exciting journey. But this milestone can also bring worry to parents. Once baby starts solids (and especially if little one starts baby-led weaning), one of the biggest sources of anxiety is that baby could choke on food.
But it can be difficult to tell the difference between gagging, which is a perfectly normal part of baby weaning, and choking, which is dangerous for baby.
Today, we'll explain how to tell the difference between baby gagging and baby choking. We'll also go over ways to help prevent your baby from choking on food.
What is gagging?
Gagging may seem like a cause for concern, but it isn't--- it's perfectly normal for baby to gag during weaning. In fact, gagging is the natural way your baby's body helps stop choking, especially as they're learning how to eat their first solid foods.
When you start feeding them solids, baby's gag reflex is farther forward in the mouth, to provide a better defense against choking.
This means that, during the first few months of weaning, your baby will gag, cough, and spit out food more often. But that's just their body naturally keeping them safe as they learn.
Even though it may seem like baby is gagging a lot, don't worry. Baby is learning a new skill, and eating solids takes practice.
(As baby gets older and more accustomed to solids, their gag reflex will move back into its permanent home in the mouth, leading to less gagging.)
What does gagging sound like?
Gagging is a loud process.
Baby will make loud gagging noises, gurgle, sputter, and loudly cough.
What does gagging look like?
Baby's tongue will thrust forward.
Baby will expel (spit up) the food they were eating.
Sometimes, baby will vomit the food up. But even if your baby vomits, this is a normal part of gagging.
Remember: Don’t intervene if your baby vomits! This is a normal part of gagging, but it could turn into choking if you intervene.
What is choking?
Unlike gagging, choking is a sign that baby is in danger.
Choking happens when baby's airway is blocked by a piece of food. If baby is choking, a piece of food is stuck in baby's windpipe, partially or fully blocking their breathing. Their gag reflex didn't successfully force the food out to protect them.
Choking could be life-threatening! If baby is choking, you need to assist them immediately!
What does choking sound like?
Choking is a silent danger, so you'll hear little to no sound from baby.
If baby is choking, they’ll be quiet or silent.
What does choking look like?
Baby will struggle to breathe.
Baby will also silently struggle to cough (or may not cough at all)
If baby is choking, they are in danger! Perform baby CPR right away!
Gagging Is Loud, Choking Is Quiet
How can you tell the difference between gagging and choking? What should you do in each scenario?
The most important difference, and the easiest way to tell the difference, is whether baby makes sound.
Remember: "Loud" (gagging) is normal, but "silent" (choking) could possibly be life-threatening.
A gagging baby may also turn "red," while a choking baby may also turn "blue," but this isn't always the case.
The popular rhyme "Loud and red, let them go ahead. Silent and blue, they need help from you!" may help you remember what to do in each situation.
Rely on the sounds more than the colors, though. Not all babies will turn red when gagging or blue when choking. But gagging is always loud, and choking is always quiet.
Gagging vs. Choking: What to do?
What to do if baby starts gagging? What to do if baby starts choking?
Let's break down the differences between gagging and choking in detail, and what to do in each situation:
Loud process =gagging. Let baby work it out!
When a baby is gagging, You'll hear them cough, gag, gurgle or sputter. This means their sensitive gag reflex is protecting them.
Baby's face will often go red.
Baby will open their mouth and their tongue will thrust forward.
Sometimes, baby may vomit, but this is just another way their body protects them from choking.
Let baby work through the gagging on their own. Do not intervene!
If you try to remove the food, you could push it back further and lodge it in their throat. This will make things worse, and may even lead to choking.
Silent struggle to breathe=choking. Baby needs your help right away!
When a baby is choking, they won't be able to cry.
They'll usually struggle to make other sounds.
They may be completely silent.
Their face and lips will often turn blue.
They'll usually struggle to breathe, so listen for high-pitched sounds when baby is breathing.
They will struggle to cough, or may not be able to cough at all.
(If they can cough a bit, that means they only have a partial blockage is, and they're trying to clear their airway. This is a good sign!)
If you see these signs, baby is choking and needs help right away.
Perform baby CPR immediately to stop the choking!
One essential step before you start baby weaning? Learn baby CPR, so you're prepared to help your baby out in case of choking.
Although you can find CPR guides online, taking a baby CPR class from a certified instructor (in person or via video call) is always best. The American Heart Association and the Red Cross offer online and in-person CPR classes from certified instructors.
You can also learn more about how to identify signs of choking, and how to help a choking baby, in this video from Nicklaus Children's Hospital.
YouTube video: How to perform first aid and CPR on a choking infant / baby?
Gagging Vs. Choking At A Glance
How Can I Tell If My Baby Is Gagging or Choking?
Gagging
Will be loud
Baby’s mouth will open and their tongue will thrust forward
Baby will loudly cough, sputter or gurgle
Often involves crying/fussing
No trouble breathing
Face may be red
Gag reflex is protecting baby from choking
Let baby work this out on their own. Intervening could cause choking.
Normal part of weaning
Choking
Will be quiet or silent
Baby’s mouth will open, but their tongue will not thrust forward
Baby will struggle to cough, or may not cough at all
Baby won’t cry. If baby tries to make noise, it will sound like they’re struggling
Baby will have trouble breathing. They may make high-pitched sounds when breathing.
Face or lips may be blue
Baby’s airway is blocked
Baby needs you to intervene! Perform CPR right away!
May be life-threatening
Protect Baby From Choking During Weaning: Safety Rules
Follow these six safety rules to reduce your baby's risk of choking during weaning:
Only introduce solid foods when baby is ready.
Being ready for solid foods is a developmental milestone. Not all babies are ready at the same age. But you'll know that baby is ready for solids if they show these signs:
Baby sits up with little to no help from you.
Baby holds their head and neck steady for an extended period of time.
Don't let baby eat while walking.
If baby eats while they walk, this could increase their choking risk. So, keep baby in a high chair or other secure seat whenever they eat, whether it's for a meal or snack.
Always watch baby closely while they eat.
This way, you’ll be able to act quickly if they’re choking. You'll also be able to tell how they're progressively developing their weaning skills --- you wouldn't want to miss this milestone anyway!
Avoid choking hazard foods.
Hard, round, and chunky foods are choking hazards, so don't feed them to baby.
Avoid foods like these:
Hard, uncooked vegetables, such as carrots
Whole nuts
Chunky nut butters
Any nut butter that isn’t watered down
Popcorn
Pretzels
Any other hard foods
Whole (uncut) cherry tomatoes
Whole (uncut) grapes
Whole meatballs
Foods larger than ½ inch in size: the AAP recommends avoiding these large food pieces due to the choking risk. So, cut up strawberries and any other foods/food pieces of a similar size.
Prepare foods carefully.
These food prep tips can help you reduce your baby's choking risk, especially if you choose to do baby-led weaning.
Only feed baby softer foods.
Soften carrot and other hard vegetables by cooking them.
Cut vegetables, fruits, cheeses, and meats and into long, thin strips. This doesn't just help prevent choking. As a bonus, it makes these foods easier for baby to pick up and manage.
Introduce a variety of safe food textures, to help baby learn to chew properly.
Feeding baby smooth, mashed, thick and lumpy textures helps your baby develop chewing and munching skills. When baby knows how to properly chew a variety of foods, this reduces their choking risk.
Babies don't know how to chew and munch when they are born. Rather, munching and chewing are learned behaviors. Babies naturally know how to suckle and suck, but they need practice to develop their chewing and munching reflexes.
If you start weaning by feeding baby purees, that's okay. But especially as baby gets older and more confident with eating solids, be sure to feed baby diverse textures of foods.
Introducing peanuts safely to prevent food allergies
In their new set of allergy prevention guidelines, the American Academy of Allergy, Asthma, and Immunology (AAAAI) recommends that in order “to prevent peanut...allergy, peanut...should be introduced around 6 months of life, but not before 4 months.”
Allergen introduction after 6 months can be too late to prevent allergies in some infants. However, many babies are not developmentally ready for solid food at this early age.
And even if your baby is ready, peanuts pose one of the greatest choking hazards if they aren’t prepared properly. Even unmodified peanut butter poses a choking risk for babies.
Instead, you can safely introduce peanuts by watering down smooth peanut butter (2 teaspoons of smooth peanut butter mixed with 2 to 3 teaspoons hot water). You could also mix peanut flour or peanut powder with baby’s food.
Learn more about how to safely introduce peanuts to babies. In that article, we cover new powder-based options for food allergy prevention that introduce peanuts and other allergy-causing foods by mixing with baby's puree or bottle.
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