Choking vs. gagging: What parents need to know when introducing solid foods to children

The transition from breast milk and formula to solid foods is a major milestone for babies. It’s also one that’s often met with a fair amount of anxiety from parents. Pediatricians recommend that parents start introducing solids to their babies around 6 months of age. But before your child takes that first bite, there are a few things all parents should know.

Starter foods

Since your baby’s chewing and swallowing abilities are still developing, you’ll want to start with soft foods — avocados, bananas, unsweetened apple sauce, well-cooked sweet potatoes or infant cereal. You can either feed your baby with a spoon or give them larger chunks of food and let them explore and feed themselves – this is known as baby-led weaning. Both techniques are perfectly fine. The one thing you do want to keep in mind is to avoid foods with added salt or sugar.

There is no need to stress about how much solid fold your child is eating at 6 months of age as they still should be receiving all of their required calories from breast feeding or formula. Also, just because your baby did not appear to like a certain food the first few times they tried it does not mean they will not like it in the future. Some children need to try a food 10-15 times before they start to enjoy it.

1

As you continue to introduce new foods, allergies can become a concern — one of the most common being peanuts. I would recommend starting one new food every few days. If your child is allergic to a certain food, trying multiple foods for the first time all at once may make it difficult to know which food caused the allergy. Some children who may be at higher risk of having a peanut allergy (those with eczema or an egg allergy) could benefit from starting peanuts at a younger age (4-6 months old). Parents of these higher risk children should talk to their pediatrician before trying peanut butter or other peanut containing foods for the first time. Children who do not have some of these risk factors can begin more common “allergic foods” such as creamy peanut butter and eggs whenever parents feel comfortable.

If an allergic reaction does occur, it will typically develop within 10-15 minutes and could include a breakout of hives, multiple episodes of vomiting or mild swelling of the lips. If any of these occur, refrain from introducing any other foods and contact your child’s pediatrician. If there is any increase in swelling around the lips or mouth or if your child starts wheezing or having difficulty breathing, call 911 immediately.

Choking vs. gagging

The main reason so many parents are nervous about starting solids is the threat of choking that hangs over every bite. But if you practice safe eating — baby sitting upright in a highchair, pureed or well-cooked fruits and vegetables cut into appropriate sizes — the risk of choking is low.

A common source of anxiety for parents is confusing gagging with choking. While it certainly can be alarming, rest assured your child’s gag reflex is their body’s natural defense against choking. When you start feeding solids around 6 months, your child’s gag reflex is actually farther forward in the mouth — it’ll move farther back in the throat as they get older. Because of that, coughing and gagging and expelling food will be a common occurrence during those first few months of solids.

2

If your baby starts to cough or gag, give them time to work through it on their own. Don’t try and remove the food with your fingers initially as you risk pushing it farther back and causing it to get lodged in their throat. In extreme cases, your baby might actually vomit. Again, this is a perfectly normal and an instinctual defense against choking.

Choking, on the other hand, means a piece of food has partially or completely blocked the windpipe. Whereas gagging involves a lot of coughing and gurgling, choking can cause high pitched sounds while breathing or may even be silent. If this occurs, you need to intervene immediately.

CPR and first aid

If you suspect your baby is choking, a series of back blows alternating with chest thrusts may help to dislodge the object from their throat. The object should only be removed from the mouth if it can clearly be seen as “blind sweeps” can push the food or object further back in the throat. CPR and a call to 911 will be necessary if they lose consciousness.

No matter what age or stage of development your child is at, I always encourage parents to take a CPR and first aid class. It’s one of those things you hope you’ll never have to use, but if a situation ever arises, you’ll be thankful you know the proper technique.

While you can find visual CPR guides online, I strongly recommend every parent takes a hands-on class from a certified CPR instructor. And since CPR technique varies depending on the age of the child, you’ll want to refresh your training every couple of years. The American Heart Association and Red Cross offer CPR and first aid training courses throughout the state. While there is a cost, it’s a small price to pay for peace of mind.

While it might take a little practice, remember that eating is natural. Above all, be calm and confident and trust your baby.

Patrick Lehman, MD Pediatrician Bayshore Pediatrics

Children’s Wisconsin has more than 20 primary care offices conveniently located throughout the Milwaukee area and southeast Wisconsin. Find a pediatrician near you.