Gagging vs. Choking in Babies and Toddlers

When a baby starts solid foods, gagging can look frightening. Knowing the difference between gagging and choking can help you stay calm when it matters and act quickly when it counts.

Gagging is a protective reflex

Gagging is the body's way of keeping food from going too far back in the mouth. It is normal, especially while children learn to eat solids. It tends to be noisy. A baby who is gagging may:

• Cough, sputter, or retch
• Make wet or gurgling sounds
• Get a red face or watery eyes
• Push food forward with the tongue
• Recover quickly on their own

As children grow, the gag reflex moves further back in the mouth, which is one reason gagging often becomes less frequent with practice.

Choking is an emergency

Choking happens when the airway is blocked. It is often quiet. A choking child may:

• Be unable to cry, cough, or make sounds
• Struggle to breathe, or not breathe at all
• Have a face that turns pale, blue, or dusky
• Look panicked or become limp

If you think a child is choking, call 911 right away. Do not wait to see whether it passes.

It is a good idea for every parent and caregiver to take a hands-on infant and child choking first aid and CPR class, for example through the American Red Cross or the American Heart Association. A class teaches the steps far better than reading about them.

How to make mealtimes safer

• Have your baby sit upright and supported when eating
• Stay with your child during every meal and snack
• Offer foods in sizes and shapes that are appropriate for your child's age and skills, and ask your pediatrician which foods to avoid at each stage
• Avoid feeding children in cars, while walking, or while laughing or crying
• Avoid putting food in a child's mouth when they are not ready

When gagging deserves a closer look

Some gagging is a normal part of learning to eat. It is worth asking about if:

• Gagging is frequent, or happens with almost every meal
• It often ends in vomiting
• Your child is afraid of eating or refuses foods because of gagging
• Your child gags on purees or on textures they should be ready for
• Your child coughs or chokes often during or after feeds, or has a wet voice after swallowing

A feeding evaluation looks at the mouth skills, sensory needs, and swallow safety behind these signs. You do not need a referral or a diagnosis to ask for one. Read more about feeding therapy for babies and toddlers and swallowing difficulties.

If you are unsure what an evaluation involves, see what to expect at a feeding evaluation.

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