Gagging versus Choking

When children turn six months old, their growing bodies require additional nutrition, particularly iron-rich foods.  Along with increased nutritional needs, children show their readiness for solid food in various ways, and it is the caregiver’s job to observe, detect and guide children through this exciting stage of eating solid food. 

During this transition, many caregivers watch nervously, wondering “Will this food cause the baby to choke?” If this is on your mind, you are not alone, and this post is for you.

Choking can initially look similar to gagging.  Both can communicate to an observer that the swallowed food is causing some discomfort, possibly leading to potential trouble.  However, what is happening inside the body is significantly different in choking versus gagging, and each requires a different response from caregivers.

What is gagging?

Let’s talk about gagging first.  Gagging is often a normal part of the learning process when children first start eating solids. Until now, children have only experienced liquid food such as human milk or infant formula.  The mechanics of swallowing liquid versus swallowing solids are very different.  Gagging happens when food swallowed goes down the wrong pipe, the windpipe.  This triggers the gag reflex.    Gagging is not a complete blockage of the windpipe so there is air going through to make noise. Gagging has a wet and gurgling noise.  The body instinctively coughs to push the food out.  

Young children may gag more often because they don’t have the same level of eating experience. Caregivers often watch nervously, as gagging can look very alarming. However, it’s important to remember that children can only learn by practice, and avoiding more textured food to prevent gagging is not a proper solution. The gag reflex is, reassuringly, the body’s built-in lesson plan to aid this process. The best action caregivers can take is to remain calm and reassure the child, as the unsettling sensation will pass when they manage to cough up the food.    

What is choking?

By contrast, choking1 occurs when food lodges in the windpipe, causing a complete blockage.  Choking is usually silent since no air is passing through.  Choking can quickly turn into a medical emergency, so it requires immediate action. Refer to your first aid training.  If you have not received first aid training for babies and children, it is highly recommended.  

How would you know if children are experiencing gagging or choking?  The best strategy is to always eat with the children in your care.  By being present and attentive, you can quickly identify signs of distress and take appropriate actions.  
Introducing solid food is an exciting time that marks the next phase of a child’s life experience. By incrementally offering solid foods with varied textures and creating a safe learning environment, caregivers can guide children in exploring the joy of eating and becoming competent eaters.

Source: Jennifer Schneidereit-Hsu, RD, UBC MPH practicum student (summer, 2023)

1.  Toddler’s First Steps: