How do I know if my baby is gagging or choking? What should I do if my baby chokes?

Answer by Emma Hammett, Registered Nurse and founder of First Aid for Life

First Aid for Life have a free first aid course for choking, click here to access it.

Weaning your baby from breast milk or formula to solid foods can be a daunting process. Many parents are particularly worried about being able to help their baby if they choke.

According to a survey by St John Ambulance, 40% of parents have witnessed their own baby choke, yet over 80% of these parents had no idea what to do in such a situation. This is an alarming statistic, especially when you consider that an average of 34 children are treated in hospital for choking on food every day.

Choking is extremely common, but fortunately fatalities from choking are comparatively rare. The quicker and calmer you are able to help your baby if they are choking – the better for everyone.

The following is a comprehensive guide to help you recognise the difference between gagging and choking and be able to help your little one if they choke.

Eating is a learning process

Even though eating solids is natural and instinctive behaviour to us, it is – like walking – a process that babies must learn gradually. It can be helpful to remember that your baby is learning to regulate the amount of food they can chew and swallow at a time.

What is gagging?

Gagging is part of the weaning learning curve for babies. Don’t be alarmed if your baby is gagging, it is a normal reflex as they learn to eat solids and liquids.

The physical effect of gagging is to:

  • Bring the food back into the mouth;
  • Chew it further;
  • Consume it once more but in a smaller amount.

Although it may seem alarming, gagging is actually a safety mechanism designed to prevent choking. It happens whether you follow the spoon-fed weaning method or baby-led weaning.

Signs of gagging are:

  • Watering eyes
  • Tongue hanging out of the mouth
  • Retching movements or even vomiting.

Gagging can be caused by an overload of food, a dislike of the taste of food, or some babies even gag on their own fingers just to see how far they can put things in their mouths. Babies also gag on liquids as they learn the rhythm of sucking.

Gagging is often a noisy affair. It can be frustrating to see the food you’ve prepared for your baby be spat and retched up again. But do remember that this is a normal and healthy part of the weaning process and to be encouraged.

What is choking?

Choking occurs when food blocks the airway, rather than going down the oesophagus – it goes down the breathing tube, rather than the food one! Usually when we eat or drink and swallow – the epiglottis covers the top of the trachea (wind pipe) and stops food from entering it. Sometimes, particularly if talking, laughing or crying whilst eating, the flap of the epiglottis is unable to protect the trachea and enables food to enter.

The body’s reflex if this happens is to cough, to eject the food. However, if the airway becomes completely blocked the person is unable to cough and is silent. This is extremely serious and without help, they could die.

Signs of choking are:

  • Unlike gagging, choking tends to be silent. Hence the critical importance of always supervising your baby or toddler during meal times.
  • Babies have sensitive gag reflexes and often appear to struggle when trying new food textures and this can be frightening. The majority of the time they manage to clear the obstruction themselves, repositioning them with their head lower than their body can help.
  • Keep as calm as you can as babies quickly pick up on panic and this can make things worse. If they are able to cough, encourage them to do so. If they are quiet and struggling to breathe, help immediately.

What to do if your baby starts choking

  1. Stay as calm as you can.
  2. If they are able to cough, reposition them to see if they can clear it themselves.
  3. Have a quick look in the baby’s mouth and carefully remove anything obvious. NEVER blindly sweep inside the baby’s mouth with your fingers as it can cause damage and push the obstruction further down.
  4. Lay the baby downwards across your forearm, supporting under their chin.
  5. With your hand hit the baby up to 5 times firmly between their shoulder blades
  6. Check after each back blow to see if the obstruction has cleared
  7. If still choking; lay the baby on its back across your knees, head downwards. Place two fingers in the centre of their chest at the nipple line, and give up to five, firm upward chest thrusts.
  8. If the baby is still choking, call 999/112 and continue giving baby five back blows, alternated with five chest thrusts, until help arrives

If the baby becomes unconscious start CPR immediately.

How do I reduce the risk of choking?

To reduce the risk of your baby choking, we recommend:

  1. Ensure your baby is sitting up in their high chair and always supervise their meal times.
  2. Cut food into very small pieces.
  3. Puree or blend foods, especially at the beginning of the weaning process.
  4. Discourage older children from sharing food with babies.
  5. Supervise children and babies when eating together.

Be careful of your preparation of certain foods:

  • Cut small round foods (grapes, cherry tomatoes) into small pieces. Sticks or batons rather than circles is a good rule to follow.
  • Peel fruit, vegetables and sausages.
  • Remove pips or stones from fruit.
  • Remove bones from meat or fish.
  • Avoid hard foods such as raw carrot, apple, whole nuts and peanuts.

Take an infant specific First Aid course to make sure you’re #bepreparednotscared

Attending a first aid course will mean you can let your children develop and flourish, experiencing inevitable minor bumps and bruises, with peace of mind that you have the knowledge and skills to recognise and help if something is more seriously wrong.
Basic first aid can mean the difference between life and death and can massively affect the extent of your child’s recovery, the amount of pain they’re in and how long they need to be in hospital. Prompt first aid can even lead to someone recovering completely without the need for medical intervention at all!

Many parents book onto our courses when they’re pregnant, some wait until their babies have arrived and still more are prompted when they start weaning. The advice is to gain these skills as soon as you can and feel confident knowing that you are able to recognise if something is seriously wrong and know how to help. Parents can book on as individuals, arrange a group course at a time and place to suit them, or learn at work. Training should be refreshed regularly to ensure the information is current and fresh in your mind in case you need to jump into action. Refreshers can be practical or online.

The most important message is not to let yourself be in the position of wishing you had known what to do.