Choking in Babies and Toddlers
Gagging and Choking in Kids: What’s the Difference and what do I need to know?
The information here is strictly educational and not medical advice. It should not substitute professional medical consultation. If you are concerned your baby is choking, immediately call 9-1-1.
Before we even get started, if you are a parent or regularly care for children I HIGHLY recommend you learn cardiopulmonary resuscitation (CPR) and the age-appropriate Heimlich maneuver so that you are ready in case of emergency!
Check out the bottom of this post for additional resources to prepare yourself in the instance of a choking event.
Okay, let’s dive in!
Why is my baby gagging and what is it?
When starting to introduce solid foods to your baby, it can feel scary, especially when you see them gag and worry they are choking.
When babies are learning to eat, it is developmentally normal for them to gag.
Gagging is a protective reflex in the back of a baby’s throat that helps to prevent choking. It is an automatic response that initiates a contraction of the tube that leads to the stomach (the pharynx) to help expel food and stop the swallowing reflex.
When introducing solid foods, gagging is a normal part of a baby’s development. Babies have a gag reflex located towards the front of the mouth, which helps prevent choking by pushing food out. Although it can be alarming, gagging is generally a good sign that your baby is learning to eat safely. It is not uncommon for babies to gag (and sometimes even vomit) when starting solids in the first few weeks. Their gag reflex will eventually move towards the back of their tongue and they will learn to cope with different textures and amounts of food. If your baby repeatedly gags and vomits longer than the first month of solids, discuss with your pediatrician for further evaluation.
What is the difference between gagging and choking?
True choking is a serious emergency where an object blocks the airway, preventing your baby from being able to breathe. Unlike gagging, choking is quiet and can be life-threatening.
Signs of Choking:
Unable to breathe
Gasping or wheezing
Can’t talk, cry, or make noise
Skin or lips turn blue or purple
Look of terror or panic
If you suspect the baby is choking, immediately administer infant choking first aid with alternating back blows and chest thrusts and call 9-1-1 or local emergency services on speakerphone so your hands are free. If another person is present, one person should immediately perform choking first aid while the other calls for help. Conduct age-appropriate CPR if you believe the baby’s airway is open, but the child is not breathing.
Download our FREE Gagging Vs. Choking Guide for easy-to-reference visual tools.
When gagging happens, the back of the throat contacts to protect the opening of the airway from becoming blocked. When this happens, it’s important to let baby work the food forward independently. Remain calm and keep your hands from their mouth. Sticking your fingers in the baby’s mouth can push the object further down the throat, worsening the situation.
Signs of Gagging:
Coughing
Retching or vomiting
Spitting food out
Watery eyes
Loud gagging noises
Download our FREE Gagging Vs. Choking Guide for easy-to-reference visual tools.
How to prevent choking?
Pay attention to Food Preparation
Cook or steam hard food, like carrots, until it is soft enough to pierce with a fork.
Remove seeds, pits, and tough skins from fruits and vegetables.
Finely chop foods into thin slices, strips, or small pieces (no larger than 1⁄2 inch), or grate, mash, or puree foods. This is especially important when serving raw fruits and vegetables, as those items may be harder to chew.
Remove all bones from fish, chicken, and meat before cooking or serving.
Shred tough meats.
Cut tube-shaped foods, such as baby carrots, string cheese, hot dogs, etc., into short strips rather than round pieces.
Small round foods like grapes, cherries, blueberries, and cherry tomatoes should be cut into slices length wise and quarter them
In addition to the foods listed, avoid serving foods that are as wide around as a nickel, which is about the size of a young child’s throat
Pay attention to the Feeding Environment
Serve meals and snacks at a table or high chair.
Avoid propping bottles for self-feeding.
Ensure children sit upright while eating.
Remind children to swallow before talking or laughing.
Allow plenty of time for meals and snacks.
Model safe eating behavior.
Avoid eating in the car.
What are common choking hazards?
Food Items
Fruits & Veggies
Uncut grapes, cherries, or grape tomatoes
Pieces of hard raw vegetables or fruits
Dried fruits
Watermelon with seeds
Protein Foods
Hot dogs and sausages
Sausages
Tough or large chunks of meat: beef jerky, large steak pieces
Large chunks of cheese (especially cheese sticks)
Bone in meat or fish
Whole nuts or seeds
Thick layers of nut spread
Other Foods
Popcorn
Potato chips, pretzels
Whole grain kernels
Hard candies, marshmallows
Ice cubes
Non-food choking hazards
marbles and beads
condiment caps and wrappers
food labels and food packaging
foil wrap
straws
twist ties
rubber bands
plastic clips
water and soda bottle caps
batteries
buttons
chapstick tube caps
coins
magnets
paper clips
jewelry (earrings, rings, etc)
paper
confetti
pills
balloons
rocks
legos
other small toy pieces
water beads
Download our FREE Gagging Vs. Choking Guide for easy-to-reference visual tools.
What to Do if Your Child is Choking
If you can see the object, try to remove it. Don't poke blindly or repeatedly with your fingers. You could make things worse by pushing the object further in and making it harder to remove.
If your child's coughing loudly, encourage them to carry on coughing to bring up what they're choking on, and don't leave them.
If your child's coughing isn't effective (it's silent or they can't breathe in properly), shout for help immediately and decide whether they're still conscious.
If your child's still conscious, but they're either not coughing or their coughing isn't effective, use back blows.
If the baby or child is not breathing call 911, set the phone down, and progress to attempting to dislodge the object as 911 has an ambulance on the way in the event you are unsuccessful at dislodging.
If your baby or child has already lost consciousness and is not breathing, call 911 immediately, and begin CPR.
Never leave the child unattended at any stage of attempting to dislodge or performing CPR.
Additional Resources
For a visual aid that includes - several lists of common choking hazards, how to properly prepare foods and the feeding environment, and basic steps for what to do in the event of choking, and allows you to easily share with a caregiver
Download our FREE Gagging vs Choking Guide
For CPR and choking rescue training, visit:
American Red Cross : https://www.redcross.org/take-a-class/cpr/performing-cpr/child-baby-cpr
American Heart Association : https://cpr.heart.org/en/courses/infant-cpr-anytime-training-kits
MedlinePlus: Choking First Aid for Infants Under 1 https://medlineplus.gov/ency/presentations/100221_1.htm
Learning CPR and the age-appropriate Heimlich maneuver is crucial. It can make all the difference in an emergency situation. Always be prepared!
If you have questions or concerns about your baby’s readiness to try new foods, are concerned they are gagging too frequently, or suspect they are not eating correctly, schedule some time with their healthcare provider. They may recommend a feeding specialist who can help your child learn how to eat correctly and safely. If you are ready to get started but are intimidated or not sure where to start, apply to work with us and we can guide you every step of the way.
apply here!
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The content, information, opinions, and suggestions listed here have been created with typically developing children and babies in mind. The information here is generalized for a broad audience. The information here should by no means be used as a substitute for medical advice or for any circumstance be used in place of emergency services. Your child is an individual and may have needs or considerations beyond generally accepted practices. If your child has underlying medical or developmental differences, including but not limited to prematurity, developmental delay, airway differences, craniofacial differences, gastrointestinal differences, cardiopulmonary disease processes, or neurological differences, we strongly recommend you discuss your child's feeding plan with the child's doctor, health care provider or therapy team. By accessing this site and the information in it, you acknowledge and agree that you are accepting responsibility for your child’s health and well-being. By using and accepting the information on this site, the author (Cierra Crowley) is not responsible for any adverse effects or consequences resulting from the use of any suggestions discussed. It is important to talk to your child’s pediatrician or medical provider to start anything new or make any changes.
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Center for Disease Control. (2022, February). Choking Hazards. CDC. https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/choking-hazards.html
Fangupo, L. J., Heath, A.-L. M., Williams, S. M., Erickson Williams, L. W., Morison, B. J., Fleming, E. A., Taylor, B. J., Wheeler, B. J., & Taylor, R. W. (2016). . PEDIATRICS, 138(4).
Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):691-707, vii.
Naylor, A. J., & Marrow, A. L. (2001). Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods, 21–25.
