Why Gagging is Good*

* Gagging is good as long as it improves with time! 

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Your baby should - and needs to - gag in order to learn how to eat safely.

​Let's talk about the biggest source of stress for parents when they start Baby-led Weaning (BLW): the gag reflex. Babies who self feed starting at 6 months have to have larger pieces of food (around the size of an adult finger) that they have the ability to pick up, which inherently leads to a fear that baby will choke. 

Major governing bodies and health associations have always recommended offering finger foods around 6-7 months of age, and a recent study suggested that BLW does not increase risk of choking over spoon feeding as long as choking hazard foods like whole grapes and whole nuts aren't offered. However, it doesn't stop parents from being concerned about safety, since most of us are not comfortable with watching a baby gag.

Gagging is not the same as choking. In fact, gagging is good because it means that your baby's body is automatically protecting her airway. You will know baby is gagging and not choking if you can hear sound and if baby is working the food out quickly. Choking does not involve sound (no air = no sound).

Most babies gag frequently for 1-2 weeks when starting BLW. Fortunately, as they get more proficient at lateralizing the food to the side of their mouths to chew it before swallowing, gagging greatly reduces. Essentially, as your baby practices and learns that she can not just swallow whole food, she will gag less as and lateralize/chew more. The more gagging and practicing she does, the less she will gag in the long run. 

Instead of fearing the gag reflex, we want to teach you more about what it is, how it protects your child, and how to help your baby learn to chew safely. Our online course Infant Feeding: the Baby-led Way goes into even more detail about gagging and shows you multiple videos of what it looks like! 

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Coughing and gagging are similar.

​Did you know that gagging is considered one of two oral protective mechanisms? The other such mechanism is coughing. So, your baby protects her airway by coughing or by gagging.

Your baby will cough reflexively after the following things occur:

1. Foreign material enters the upper airway. This stimulates the laryngeal receptors, which triggers a cough to expel the foreign material and protect the airway. This happens with most infants daily as they learn to coordinate their breast or bottle skills.​
2. The bronchial receptors are stimulated by excessive secretions, such as mucous. This is obvious when an infant catches a cold or swallows water during bath time. 

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Gagging is a good thing.

​We are very comfortable seeing our baby cough, since most of us cough at some point during the day. Gagging, on the other hand, seems much scarier because we assume that it means the baby is choking on food. 

Remember, gagging is not the same as choking. Furthermore, gagging is simply a protective oral reflex, just like a cough! 
 
The purpose of the gag reflex is to protect the baby from ingesting items too large to be handled by the esophagus. Think of it like a gate keeper - NONE SHALL PASS! 
 
The gag reflex works by touch-pressure receptors located on the tongue or on the pharyngeal wall.  These receptors perceive food that is too large to pass to the esophagus and cause a reverse peristaltic movement in the pharynx. This can also cause a cough. Remember, since it's a reflex, it does it automatically without your baby doing it on purpose. 
 
The site for the elicitation of the gag reflex changes with increasing age, but our gag reflex never goes away - it is there to protect you. You may have gagged as an adult when your throat was swabbed for a strep culture or if you took too big a bite of food.
 
In a newborn, the gag reflex at the mid-tongue area. As the baby matures, the site gradually moves back to the pharyngeal wall or the posterior portion of the tongue.
 
As a feeding therapist, if I see a gag reflex that is too easily stimulated, it indicates a hyper-responsive reflex that may interfere with feeding. Conversely, if a gag reflex is not present, the baby may be neurologically depressed and feeding may not be indicated for safety reasons. These children may need to receive nutrition through a feeding tube. 
 
That is why encouraging a child to play in their mouth with toys such as a Fluxy is so important - it familiarizes baby with her gag reflex. 
 
We want to encourage babies to put their hands in their own mouth. (Yes, it seems gross, but it's actually an important developmental step!) Biting down hard on a toy like the Fluxy or another long, safe teether on the area where the molars will eventually arrive is essential. This allows for great oral awareness, developing jaw grading and strength, and desensitization of the gag reflex in a way that most babies allow (because many don't want us in their mouths)!  

So, gagging is good, and the more your allow your baby to gag on long teething toys before feeding begins and in the early stages of introducing food, the faster she will understand where her gag reflex is and will learn that food needs to be routed to the back of her gums, not straight down her throat. What's most important is that gagging improves with more exposure to real food.

Furthermore, the more you see gagging, the easier it will be on you. Most parents get really nervous by it when they see it at first, but by a few days in it's much more commonplace...and then baby does it less as she gets more skilled.

How can you help your baby right now?

Let your baby explore her gag reflex as much as possible, and don't be afraid to gently go in baby's mouth (with clean hands, of course!) and feel along the back gum line (where the molars will eventually be). Here's what you can do right now to help your baby with safe eating: 

1. Encourage your baby to put her hands and safe teething toys like the Fluxy and Como Tomo in her mouth. Try to avoid pulling a baby's hands out of her mouth when she's a drooling, teething mess - remember, she needs to have her hands in her mouth to familiarize herself with the gag reflex!
2. Help gently guide the Fluxy or other longer toy to the back corner of her mouth - biting with the front of her gums may feel good for teething, but it doesn't help with safe eating skills.
3. Watch your baby closely as she eats, and let her gag while staying calm. See if she spits out the food or tries to chew it again within a few seconds. Also watch that she's not struggling and is not turning blue or lacking oxygen. Remember, a baby can choke on anything - it is imperative that you are prepared at all times. We recommend taking an infant CPR class if you haven't already.
4. Gagging should improve with time - usually within the first few weeks. If you don't notice an improvement, speak with your pediatrician.

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