* Gagging is good as long as it improves with time!
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!
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:
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:
Many parents who follow Feeding Littles utilize the concept of Baby-led Weaning (BLW), which means that babies feed themselves whole foods from the start. (Don't worry - it doesn't mean that baby weans early from the breast or bottle - the term weaning is the European use of the word, meaning introduction of solid foods.)
With BLW, parents don't spoon food into a baby's mouth. While this approach can be great for many families, it doesn't fit everyone, and many parents choose the "Traditional Weaning/Feeding" (TW) route where babies are spoon fed purees and gradually eat other textures, building up to self-feeding all foods. The goal of either approach is for a baby to learn how to eat all safe textures; BLW babies get there faster, but TW works well for many families too.
With spoon feeding/TW, parents are sometimes coached on what to feed baby and how much to offer, but nobody tells them how to actually do it. Turns out, most of us don't do it correctly from a developmental and motor perspective. Since Feeding Littles supports all ways of feeding babies (as long as they're fed!), we want to give you some pointers on how best to spoon feed a baby. Even if you plan to do BLW, keep reading - these tips apply to feeding kids in general, and some of these concepts may be completely new to you!
Remember: we share this information to educate and help you have your best feeding experience possible. We never intend to offend or shame anyone into thinking they have "done it all wrong" - we simply want to provide information that most people don't learn anywhere else. In the end - your child, your choice. Do what's best for your family.
#1: Starting too early - remember, "solids" refers to anything but breast milk or formula.
Parents hear that most governing bodies, including the American Academy of Pediatrics and the World Health Organization, recommend waiting until around 6 months to start solid foods. Some interpret this to mean that purees should be started earlier and whole, more "solid" foods can start at 6 months. This recommendation is meant to apply to all "complementary foods," which means anything but breast milk or formula, not just food that is in whole form. We think that a baby's gut and immune system is more ready for food around 6 months and when baby is showing readiness signs like good head control, sitting with minimal assistance, bringing hand to mouth, and interest in food. For some babies, this is earlier than 6 months, and for others it's later. We don't recommend starting much later than 7 months for allergen exposure reasons.
From an Occupational Therapist's perspective, additional cognitive signs are important to watch for when assessing readiness for any food. Before starting spoon feeding (or any complementary food feeding), make sure to ask yourself these questions:
Starting food too soon may not only cause digestive upset (including constipation!), but for some babies it can be a negative experience when they're truly not ready. Watch your baby and look for these cues that he's ready for food!
#2 Force feeding, holding down baby's hands, and tricking baby to eat.
As parents we have a lot of things to accomplish on any given day. Sometimes feeding seems to be just another item on our endless to-do list. Try to remember that your child's feeding journey is important in establishing great feeding dynamics into adulthood. We want our kids to know how to eat when they're hungry, stop eating when they're full, and fill their tummies with foods that help them feel their best. That process starts the moment your child is born, as you learn your baby's hunger and fullness cues. It intensifies as you begin your solid food journey. Below are a few tips to help you honor your baby's cues and help him listen to what his body - not the clock or an external rule - has to say:
When spoon feeding, most of us put the spoon toward the top of a baby's mouth and then scrape the food off the top lip or hard palate so it's comes off the spoon. Watch this video for an example of what this looks like, and notice how baby is also being fed quickly and without much time to open his mouth or respond to the spoon. See how he leans away and looks a little overwhelmed:
Furthermore, as baby gets messy and her face becomes covered in food, we usually like to scrape it off with the spoon. Here is an example of face scraping:
Depositing food at the top of a baby's mouth makes her an inactive member of the feeding process and doesn't teach her where food should go when she eventually brings it to her mouth herself. When we scrape her face after she has taken a bite, it can be uncomfortable and may lead to feeding aversions, as many babies don't like the sensation. Below are some additional tips about the mechanics of spoon feeding that you may find helpful:
#4 Staying on purees for too long.
Pureed food feels safe for parents who worry about babies choking on whole foods. Unfortunately, if a baby isn't introduced to other textures relatively quickly, he may have difficulties graduating off purees. One study suggests that if babies aren't fed lumpy foods by 9 months, their risk of feeding difficulty later in life increases. Babies aren't meant to be on pureed food for life - the goal for all babies is to eventually eat real food. Here is the typical progression of food texture in TW:
Of course, this continuum of textures is more important in feeding therapy and with kids who really struggle with various textures. Once you feel confident in your baby's eating ability, play around with lumpier foods like mashed fruit or veggies, soft finger foods like cooked green beans, or ground meat. Spoon feeding pureed food should be a short stage in your baby's eating experience. Your baby won't be able to pick up small pieces of food until he has his pincer grasp, but he can get longer, strip-shaped foods starting at 6 months.
Side note: keep in mind that baby food pouches are still pureed food, and they don't offer a sensory experience for the eater. We recommend using them sparingly.
#5 Spoon or hand feeding your toddler.
Barring developmental or medical challenges, most toddlers should self feed without being hand or spoon fed by a parent by 14-16 months. Some parents of older toddlers hand feed them regularly in order to "get them to eat," and we completely understand the fear behind trusting that your child will, in fact, eat when he's hungry. Hand feeding older toddlers doesn't allow them to decide how much to eat and can start to interfere with their hunger and fullness cues. It also prevents the toddler from honing in on age-appropriate feeding skills and takes away from much of the sensory and motor development experiences that feeding provides. If you need strategies to help with your picky toddler, check out our online course.
When spoon feeding an infant who starts to grab for the spoon, instead of getting frustrated, try to celebrate this huge developmental milestone! Your baby is showing you that he wants to start feeding himself - remember, that's the goal! Check out this video of a parent appropriately responding to her baby's desire to self-feed:
In this next video, watch how mom hands baby a loaded NumNum GOOtensil, which is designed to encourage babies to self feed. The center of the GOOtensil is hollow and allows purees or other smooth textures to be captured without worrying about which side of the utensil is "up," and the handle is short - perfect for baby's hands.
Need more help feeding your baby? Be sure to join our Feeding Littles Group on Facebook and follow along on our Facebook and Instagram pages! Stay tuned for an online version of our live Baby-led Weaning class, coming soon!
Megan and Judy, co-owners of Feeding Littles, bring you helpful info on food, nutrition, picky eating, and feeding young children. Megan McNamee MPH, RDN is a Registered Dietitian Nutritionist based in Scottsdale, Arizona. Judy Delaware, OTR/L is an Occupational Therapist specializing in feeding therapy with children 3 and under in Boulder, Colorado. Megan and Judy are both moms of two and love helping families develop a healthy appetite for all foods!