Choking vs. Gagging - How to Keep Baby Safe

One common concern about baby-led weaning by health professionals, parents, and well-meaning relatives is its safety – does baby-led weaning increase the incidence of choking in infants? Unfortunately, there doesn’t seem to be a definitive answer for this one. The short answer is: possibly not, at least not when families are well educated in the approach and follow guidelines related to high-risk choking foods and foods to avoid. 

One study found no difference in choking incidences among groups who followed varying baby-led weaning approaches or parent-led feeding ⁽¹⁾. Other studies have found that parents following BLW either report no concerns about choking or if they were nervous about choking when starting BLW, they reported becoming more relaxed and confident with the experience. ^{(2, 3)}

Ultimately, you will want to choose a feeding style that you feel comfortable with as a parent, whether that’s baby-led weaning, traditional weaning, or a combination of the two. To be prepared, we recommend you attend a live class in your area or take this online Baby CPR Course.

With any approach you take, it’s important to distinguish between gagging and choking.

CHOKING VS. GAGGING

Although it may still look and feel intense or scary the first time a parent witnesses it, gagging is different than choking.

GAGGING

When a baby gags, it is most likely because food that has not been chewed well has gotten too far back in the mouth. The gag reflex is a built-in protective mechanism to protect the airway from food. With practice, your baby learns that they need to chew first, then swallow the food. Fortunately, with continued practice with eating, the gag reflex should lessen over time. 

SIGNS OF GAGGING INCLUDE:

• sounds, such as coughing or hacking
• baby’s skin may turn red or a darker shade
• baby’s eyes might water

Babies usually recover fairly quickly, and you may see the food come forward in their mouth. Although not as common, vomiting after gagging may happen. During this time, watch closely and do your best to stay calm.

CHOKING

On the other hand, choking happens when there is a blockage of the upper airway, from food or an object. Complete blockage of the airway prevents a person from breathing effectively. Therefore, choking is a true medical emergency and requires quick intervention on your part.

SIGNS OF CHOKING INCLUDE:

• baby is quiet
• baby’s skin may turn blueish in color
• baby won’t be able to cry or make much sound

Your baby may become unresponsive or lose consciousness if the food is not cleared. This is why it’s recommended to know CPR before starting solids of any kind. 

HOW TO KEEP BABY SAFE

As a parent of two, I know how scary it can be to introduce solid foods to your baby. With the proper precautions and knowledge, the fears will loosen and feeding your baby can become a wonderful adventure for both of you.

• Avoid high-risk choking foods, as noted above.
• Always supervise with food – sit with your baby and try not to multi-task while your baby is eating.
• Baby should be sitting in an upright position for all meals and snacks, not reclined. If your baby starts to get sleepy during eating, remove food.
• No eating in the car seat unless an adult is in the backseat supervising your baby.
• Do not let baby eat on the go. Once your baby is crawling or walking, avoid letting them move around with food in their mouth or holding food in their hands.
• Check the temperature of foods before offering them.
• Check baby’s mouth after they are done eating. Some babies may pocket food in the sides of their cheeks or get food stuck to the roof of their mouth as they are learning to eat. If you see any food remaining, encourage your baby to keep chewing, spit it out if they need to, or take sips of water or milk. Avoid sticking your finger in your baby’s mouth to get the food out – we want baby to learn how to manage taking care of the food.

• (1) Cameron SL, Taylor RW, Heath AL. Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand families. BMJ Open. 2013;3(12):e003946.
• (2) Cameron SL, Heath AL, Taylor RW. Healthcare professionals’ and mothers’ knowledge of, attitudes to and experiences with, baby-led weaning: a content analysis study. BMJ Open. 2012;2(6):e001542.
• (3) Brown A, Lee M. An exploration of experiences of mothers following a baby-led weaning style: developmental readiness for complementary foods. Maternal & child nutrition. 2013;9(2):233–43.