What Parents Should Know About Babies Gagging During Feedings

Baby-led weaning, or baby self-feeding, is more popular than ever when it comes to starting solids. But whether your new eater is feeding themselves soft pieces of avocado, sweet potato, or other squish-able options or slurping purees off a spoon, you may see your baby gag and attempt to push food out of their mouth. You might even notice your baby gagging on bottled milk or while nursing.

Gagging may seem scary, but it's a natural part of the learning process and is to be expected. That said, too much gagging isn't healthy. Keep reading to learn about why babies gag and when to be concerned.

Babies Gagging During Feeding: What's Common

Gagging is nature's way of protecting your baby's airway and a normal response to new tastes, temperatures, or textures. Be thankful for that gag reflex; babies learn from it!

According to Diane Bahr, author of Nobody Ever Told Me (Or My Mother) That!, a newborn will gag if something unfamiliar touches the back three-quarters of the tongue. As babies grow, the reflex shifts farther back. But by 10 months of age, something must touch the back third of the tongue to elicit the gag. As the reflex moves farther back, babies learn how to tolerate new mouth experiences and continue to explore toys, foods, and fingers with their mouths, learning every step of the way.

In other words, your baby's tongue is extra sensitive to gagging to prevent choking, and most babies will gag periodically while learning to eat solids (and even before!). As long as the gagging isn't constant and they're mostly unbothered by it, the gagging is probably OK.

When To Worry About Your Baby Gagging

In infants who are breast or bottle-feeding, frequent gagging may indicate a loss of control of liquid in the mouth. Signs that your baby is in distress or having trouble keeping the liquid away from their airway include:

• Frequent coughing
• Color change around lips or eyes
• Sudden changes in breathing patterns

Whether spoonfed or self-feeding, babies who consistently gag multiple times per meal may have difficulty coordinating mouth movements to safely manage solids, which can lead to serious complications. Discuss any of these signs and the frequency of occurrence with a pediatrician or health care provider, who may refer your child for a feeding evaluation to determine why they're having trouble.

Why Frequency of Your Baby's Gagging Matters

Gagging is not a comfortable experience. Children who gag frequently or always on specific foods or textures are more likely to develop an aversion to those foods. Learning to eat should be a pleasurable experience!

Think of it this way: When babies are learning to walk, they toddle with unsteady steps, stumble, and fall. It's part of the developmental process; most kids get back up and try again. But if a child falls repeatedly and it hurts, they will learn to protect their body and may not want to try again for some time, instead relying on crawling.

Eating is also a developmental process, and too much gagging can cause kids to stall in that development. This can lead to picky eating, fear of food, and food jags, where kids become highly selective and eat only a few different options for months. Food aversions are created with repeated negative experiences around food and require professional intervention.

If you notice that your baby always becomes upset after gagging or avoids certain foods that cause them to gag, consult with a pediatrician or health care provider.

What to Know About Gagging and GER

Gagging can also be a sign of frequent gastroesophageal reflux (GER), where the stomach contents rise into the throat, causing a baby to wretch.

GER often occurs during mealtimes but is also seen throughout the day. You might notice your baby gagging when lying down or reclining in a car seat. Should you notice your child gagging away from meals, too, it's important to share that information with their physician.

If food or stomach contents are inhaled into the lungs, it can be life-threatening. GER can develop into gastroesophageal reflux disease (GERD), a chronic condition that requires intervention to prevent damage to the esophagus (food pipe).

According to the National Institute of Diabetes and Digestive and Kidney Diseases, symptoms of GER or GERD in infants includes:

• Arching the nack and abnormal movements of the neck and chin
• Choking, gagging, or problems swallowing
• Irritability, particularly when regurgitating
• Refusing to eat or loss of appetite
• Complications that include poor weight gain, coughing, and wheezing
• Vomiting

Gagging vs. Choking in Babies

Gagging is not choking. Gagging is a reflexive attempt to push something away from the airway while choking is caused by food or an object partially or completely blocking the airway. When babies gag, it is not foolproof protection against choking. A gag may warn you of a possible choking episode, but not in every case.

Choking has little to no sound. It's unlikely you'll hear choking, but you will see it. Your child may be open-mouthed, wide-eyed, and drooling with bluish skin around their lips or eyes. Partial obstruction may include audible gasps for air or faint noises. Always stay observant when your child is eating. Babies can gag and then choke or choke without gagging first.

Here are some common signs that your baby or toddler is having difficulty learning to eat age-appropriate foods and is at risk for choking:

• Frequent gagging followed by a look of discomfort, panic, fear, or irritability
• Lack of interest in eating
• Wet, "gurgly" voice quality
• Consistent coughing during or after eating/drinking
• Multiple episodes of chronic low-grade fever
• Strong preferences for certain foods for more than three weeks
• Swallowing foods whole or with minimal chewing
• Weight loss or poor growth

What To Do When Your Baby Is Gagging

If your baby is gagging, stay calm, and observe quietly. Just like when a toddler falls as they learn to walk, we don't want to overreact. Your baby will occasionally gag as they learn to eat a variety of foods, especially in the first 12 months of life.

Here is what to do when your baby is gagging:

• If you don't see signs of choking, just wait a few seconds, and see if your baby can remain comfortable and continue eating.
• Older babies or toddlers can then be encouraged to take a drink of water with a narrow straw, not a sippy cup with a spout. A straw will deliver just enough water to help wash away the tickly feeling and any residual particles of food. A sippy spout, which requires a child to tilt back the cup and tip up their chin to drink, can cause pieces of food to wash into the airway.
• Keeping the chin level or tilted down just slightly, as with a straw, decreases the likelihood of choking.

Babies who have not yet learned to drink from a straw can be offered a baby-sized open cup (held by the adult) for tiny sips of water while their chin is slightly tucked.

Additional reporting by Jennifer White.