Gagging vs. Choking

What is gagging?

Gagging is a natural protective reflex that results in the contraction of the back of the throat to protect us from choking. Just like the reflexive kick that occurs when the doctor taps your knee in just the right spot, the gag happens automatically, initiating a rhythmic bottom-up contraction of your pharynx (the tube that leads to your stomach) to assist in bringing food up and to stop the swallowing reflex from making our bodies try to swallow.

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How Babies Swallow

Swallowing is a complex reflex with multiple lines of defense built in to prevent choking. These actions happen reflexively, meaning the brainstem tells our body to do them–they are involuntary. There are three important lines of defense that we have with every single swallow.

1. When we swallow, our vocal cords, which are like sliding doors inside the breathing tube, come together, closing off the airway and preventing food from entering the lungs.

2. The muscles of the throat pull the breathing tube slightly up and forward, tucking it safely out of the way of the food passing.

3. The epiglottis, a tiny flap of cartilage, tilts down to cover the airway forming a tight seal with the joints that help move the vocal cords.

Just like any good system, we have back up already built in. We even have back up for those back ups that are activated if needed. For example, if anything gets too close to the opening of the airway, even before it gets a chance to get in, the vocal cords immediately close (the technical name for this is the laryngeal adductor reflex), and our body immediately coughs to push the item away from the breathing tube. Our bodies are quite skilled at keeping us safe.

What is the difference between choking and gagging?

First, it is important to distinguish the difference between gagging and choking.

True choking is when the airway is obstructed, and the baby is having trouble breathing. Signs of a baby choking can include:

If you suspect 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 baby’s airway is open, but the child is not breathing.

On the other hand, gagging is a common protective reflex that results in the contraction of the back of the throat. It is a natural function and protects us from choking. When this happens, it’s important to let baby work the food forward on their own. Refrain from sticking your finger in baby’s mouth, which can push the object further down the throat, making the situation worse.

Kary Rappaport, Infant Feeding & Swallowing Expert, discusses the differences between gagging and choking.

We strongly recommend you take a CPR class online or at your local health facility and review safety procedures. Our Infant Rescue Guide and Toddler Rescue Guide can also help you visualize the difference and understand which rescue maneuvers to use. Further resources:

What is gagging in babies?

Gagging is a completely normal reflex in infants, children and adults alike. Gagging is very common and will happen a lot in baby’s solid food journey. All babies gag in their eating journey—it’s one way they learn how to eat. The good news is that babies typically outgrow gagging after a couple of months of practice with various textured foods.

Babies gagging on food is normal

Babies often gag well before they start solids, when breast or bottle feeding. This typically occurs when baby either isn’t properly latched, and the nipple triggers the reflex, or if the baby isn’t ready to swallow milk for whatever reason. Some babies gag when mom’s letdown is too fast. Others gag when they need to catch their breath instead of swallowing. Many babies will gag on a pacifier or certain bottle nipples if they aren’t familiar with them. All of these gags occur because the brain is trying to protect the baby from swallowing an “intruder,” or something the baby isn’t ready to swallow. This gag reflex typically lessens over the first few months of baby’s life when baby gets “desensitized” and learns to accept it (pacifier, nipple, or food texture) without gagging. This occasional gagging at a young age does not seem to bother most infants.

Interestingly, the gag reflex of a 6- to 10-month-old baby is much more sensitive and can be triggered more forward on the tongue than an adult. This is why babies gag easily: the more forward the gag trigger is on the tongue, the easier it is to trigger. It is not uncommon for babies to gag (and occasionally vomit) for the first few weeks of solids. If baby repeatedly gags and vomits past the first month of starting solids, consult your pediatrician, who may refer you to a swallowing specialist.

Gagging helps prevent choking

When the gag reflex is triggered, it forces the back of the throat to close, essentially preventing swallowing. If food caused baby to gag, the reflex forces the food (or object) forward towards the front of the tongue. Young infants naturally open their lips when they gag, which means that typically, the food or object that caused the gag keeps moving out of the mouth.

Gagging is completely normal and incredibly important for baby’s safety, both at the table and away from it.

Gagging helps babies learn to eat

For babies to build the skills for chewing and managing all foods (not just easy-to-chew foods), we need to give them opportunities to make mistakes, like taking a too-big bite of food. When a baby bites off too much food and cannot properly move it around to chew, the gag reflex will kick in and help thrust the food forward. The experience teaches baby that the food was too big to swallow. These experiences are essential for learning and building confidence in biting and tearing. Over time, baby will learn to take smaller bites and become more adept at moving food around to chew properly.

Once baby is a few weeks into their solid food journey, you can use the gag reflex to your advantage. Offer foods that are not as easy to chew to help advance baby’s oral development more quickly. When poorly chewed food touches the tongue, the gag reflex will do its job, and baby will learn they need to chew the food more.

It’s important to challenge baby before they get too accustomed to mashes and soft foods. Babies quickly learn that chewing and swallowing mashes and other easy-to-chew foods easily satisfies their hunger with minimal work. Many babies won’t bother trying to improve their skills with tough consistencies that require more biting and tearing, and may refuse the challenging foods and wait for the easier foods.

Why is my baby gagging? Gagging is easily triggered

When it comes to young babies, the gag reflex is pretty easy to trigger. Touch the middle of the tongue, and many babies will gag. If you watch a 3- to 4-month-old baby mouthing their hands and fingers, you will see them gagging themselves frequently. This is common and normal. Babies are typically not bothered by it and will often keep doing it.

Our mouths are one of the most sensitive parts of our bodies. The human mouth has many sensory receptors to detect touch, taste, temperature, pressure, and other input types. Babies are driven to explore with their mouths to learn about their world simply because the mouth is sensitive. Mouthing exploration could be very unsafe if babies didn’t have gagging as a natural safety net.

Importantly, young infants have immature hand and finger coordination, which means they can’t easily remove something they put in their mouth. They also have immature oral motor (tongue and mouth) coordination. They can’t easily use their tongue to find an object in their mouth and spit it out. This is another reason the gag reflex is a safety reflex, as it allows a baby to put an object in their mouth and then push it back out again without letting it get close to the throat. As babies put things in their mouth, the gag reflex tells them when things are not supposed to be there and prevents it from moving too far back towards the throat.

The gag reflex moves further back in the mouth as babies age

From birth to around 9 months, the gag reflex is triggered close to the front of the mouth (around the middle of the tongue). At this age, the gag reflex is as sensitive as it will ever be. This is important for safety because objects (food or anything else) will quickly trigger the gag reflex and be pushed out of the mouth before they get past the middle of the tongue.

Sometime around 7-12 months of age, the gag reflex slowly desensitizes. The gag trigger moves from the middle of the tongue to the back of the tongue towards the throat. At this point, food or objects can get much closer to the throat before the body recognizes something is too big to swallow and tries to push it back out. This might sound scary, but remember, our bodies are amazing! The gag reflex remains active and strong, so if something (food, barbie shoe, bug, etc.) hits the back of the tongue, the back of the palate (roof of the mouth), or even the back of the throat, the gag still kicks in.

Babies gag on puréed food and jarred baby food, too

The threshold for what triggers a gag and the gag’s intensity is different in every baby, but most infants will go through a period where anything in their mouth thicker than breast milk or formula will cause a gag. The brain says: “Wait, this isn’t right! I shouldn’t swallow this! GAG!” Many will gag with spoon-feeding experiences even with runny, watery bland purées.

Until the special day you decide to start solids, baby hasn’t had to manage anything but a watery-thin, fast-moving liquid. Enter something slightly thicker, slippery, and a different flavor — baby’s brain will kick in with protective mechanisms to gag and prevent swallowing this invading purée. This is usually short-lived because thin purées are quite similar to liquids and the texture won’t trigger a gag for very long.

Babies know to push the tongue against a breast or bottle nipple to initiate suction and move the liquid backward to their throat. Spoon-feeding can present unique oral-motor challenges. With a spoonful of purée dropped on the middle of the tongue, baby has nothing to suck or push against and doesn’t yet know the skills to help move that food backward. Because they can’t move the purée backward quickly, it either continues to sit on the middle of the tongue or will start spreading around the mouth, which can lead to gagging. Many wise babies will suck on the spoon to help them quickly move the purée back to swallow, just like they do from a bottle or breast. Those babies, who now have a way to control the purée, will often easily swallow with minimal or no gagging.

While not all babies who are spoon-fed gag, many do. Not surprisingly, when a baby is exclusively spoon-fed for a prolonged period of time (past 8 months of age, for example), that child may gag more when they start finger foods due to the lack of texture exposure.

Spoon-fed babies gag less at first but gag more later

When a baby is started on solids with thin, watery purées and pouches, the baby’s tongue receives less sensory input. While babies gag on purées too, they acclimate to the smooth texture or figure out how to use the spoon to suck back and swallow, which reduces gagging. However, all babies will frequently go through gagging periods when introduced to finger foods — whether 6-month-olds or older spoon-fed babies. When baby is first offered finger foods, the brain engages the safety call: “This doesn’t seem right! I don’t know how to move this! We shouldn’t swallow this food!” Often, this period of gagging will last longer with babies who started with spoon-feeding.

In 2016, the “BLISS” study found that babies who follow a spoon-feeding approach to solids (spoon feeding smooth purées > lumpy purées > finger foods) tend to gag less at 6 months but more at 8 months and later. Remember: around 8 months, a baby’s gag reflex becomes less sensitive and moves further in the back of the mouth. This means that food is closer to the throat before the body reacts and tries to push it out. In other words, waiting to introduce finger foods until after baby is 8 or 9 months old may increase the choking risk as the gag reflex is less sensitive, further back in the mouth, and baby is not accustomed to textures other than soft foods from a spoon.

By 8-9 months old, a spoon-fed baby has been practicing a very specific skill to eat. “Purées come into my mouth. I suck or lift my tongue to move that puréed food backward, and I swallow it.” Babies will always start with the skill they know and try to use that same pattern on solid foods. They try to move that solid food straight back without the necessary step of moving the food laterally to their gums to chew. This motor pattern often leads to even more gagging.

The older the baby, the more aware they are of gagging and its unpleasantness. A 9-month-old baby is more aware of gagging than a 6-month-old baby. “Hebbian plasticity”—a fancy term that brain specialists use—tells us that neurons that fire together wire together. This means that when one part of the brain lights up simultaneously as another part of the brain, the brain starts to build a connection between those two areas. So, frequently gagging as the baby gets older and more aware of their body may be problematic for some babies who seem to draw a connection between real food and gagging. These babies seem to learn quickly that real food will make them gag and can lead to refusal of any food that is not a purée or mash. By contrast, younger infants don’t seem affected as much as older babies and toddlers.

Baby-led weaning and gagging

At 6 months old, the gag reflex is necessary to exploring food. It’s what allows a young baby with almost zero chewing skills to put a piece of food in their mouth and, if it is too big to swallow, get that food safely back out.

Infants learn how to do amazing things—sitting, crawling, walking, and running—by using reflexes, fumbling around, and making lots of mistakes while slowly building strength and adding one movement on top of another. The same applies when learning to chew—babies use reflexes coupled with fumbling as they learn.

Amazingly, babies have two other key reflexes—the biting reflex and the tongue lateralization reflex— which help them learn to chew right away at 6 months. For foods to be properly chewed, baby needs to:

When babies first start finger food, they will struggle to use their biting and lateralization reflexes in any coordinated way. Simply put, they fumble around! As babies learn to eat, they won’t break down food enough to safely swallow, which requires the gag reflex to push the unchewed food back out. But every time baby does that, they are learning where the food is in their mouth. Slowly and incrementally, babies learn how to move food to different parts of their mouth. They learn their tongue can help push food around the mouth in lots of directions. They learn their palate, tongue, gums, and saliva will break the food down as it moves around their mouth. All of these actions turn a solid food into something like a mash!

Some experts suggest that purees teach babies to swallow correctly, and gives practice swallowing solids before you introduce the idea of chewing. Most babies do not need to be taught how to swallow. Swallowing is a deep brainstem reflex present by 15 weeks gestation and well established by full term birth. Babies already know how to swallow; there is no need to practice! Interestingly enough, thicker textures are actually easier for babies to swallow (think purees), and our feeding therapists explain that babies who have swallowing difficulty are actually prescribed thickened milk to drink! But purees do teach baby a motor pattern: bring food in, move it back, swallow. This is a dangerous pattern because most solid foods require chewing before you move them back and can safely swallow. We believe that exclusive purees are time wasted because baby isn't practicing chewing and is practicing a dangerous motor pattern that must be unlearned.

Interestingly, the BLISS study also demonstrated that infants who started solids with finger foods experienced more gagging at 6 months, but less gagging at 8-9 months as they developed more control and coordination in moving food around their mouth. This demonstrates that babies who are given the opportunity to work with finger foods early on in their solids journey—well before 8 months of age—develop the oral-motor skills required for mature eating more quickly than spoon-fed babies.

After a couple of months, most babies who start with finger foods at 6 months of age develop the skill and coordination to chew and move well-chewed food backward to swallow safely. The baby feels comfortable with their skills and is accustomed to food moving in this way. The body won’t initiate a gag so readily.

By contrast, babies who start solids with purées have had little chewing practice from 6-8 months. It’s likely they are less coordinated with moving food around their mouth, less able to break down the food, and less safe in the instance that the food gets pushed back further in the mouth than they can handle.

How to help baby move past gagging by building skill

Successful eating is not just about chewing but about feeling where the food is in the mouth and knowing if it’s chewed “enough” to swallow safely. As adults, most of us can identify and discretely spit out a tiny piece of bone or eggshell from a bite of food. Because this is happening inside the mouth, we aren’t using our eyes; our brains visualize what’s going on inside our mouth, even though we don’t frequently see what’s going on in there. We have a mental image of our mouth and where everything is in relation to other parts. Babies don’t have this “mental map” of their mouth at first.

To help you understand the necessity of a mental map, think about babies learning to stand. Before they can do this, they need to develop “body awareness” or, essentially, a mental “map” of where all their body parts are in relation to each other. Baby lays on the floor and slowly learns to roll around before they ever sit up. Rolling and touching their whole body—from head to toe—while their muscles push and pull helps form the mental “map” of their body. They need deep input all over their body to add all the details to that map. A small touch to one part of their body or a light brush of your hand over their body helps a little but isn’t really enough. It’s the floor’s firm input to the whole body while moving the muscles that really seems to form a clear map.

The same goes for the inside the mouth. When things touch the inside of our mouth, a map slowly “draws” in our brain. As babies develops the map inside their mouth, they gain more control, figuring out how to move food around appropriately. They also become more confident in their skill to move food around. This control seems to help quiet the gag response and move it further back in the mouth over time. The baby does not need the gag reflex to eat once they have a clear map and strong coordination. They now have active control to chew the food, know if it’s chewed enough, move it back to swallow, or spit it out and try again.

We know that many types of sensory input in the mouth help babies form the “mental map,” but that bigger inputs are more effective than light sensory inputs. (Think about the difference between a tight hug versus a tickle on the shoulder.)

There are two types of input that feeding therapists know are most effective for sensory-motor learning:

The simultaneous combination of tactile and proprioceptive input is most effective for forming the map. This is why feeding therapists frequently recommend giving resistive, flavorful foods like a rib bone for baby to chew.

Foods like a rib bone accomplish the trifecta:

Are these experiences for eating? No. These are “exercises” to help build a stronger connection between the mouth and the brain. Drawing a detailed map of the mouth contributes to decreasing the sensitivity of the gag. As this map develops, the baby also develops more confidence in their skill, further decreasing the gag’s sensitivity.

Baby gagging on food and throwing up

Gagging with vomit is so hard to watch, though it is pretty normal for some babies just starting solids. Some babies have a stronger or more sensitive gag reflex than others, bringing food up when they gag. This is even more common in babies with a history of reflux. To minimize this reaction, consider these three things:

1. Make sure your baby has at least an hour between a milk feed and table food to let the stomach digest a bit. A super full belly can make a gag turn into vomit much more easily. For example, we often see vomiting with gagging at breakfast, as the belly is super full from a big morning breast/chest feed or bottle.

2. Avoid the foods that tend to trigger the biggest gags for a while. Often, foods that produce lots of gagging are soft, mushy semi-solids like banana and avocado, or fruits and vegetables with skins. These foods can easily stick to the roof of the mouth or tongue and cause strong gagging that leads to throwing up (which often clears the food from the mouth).

3. Offer tons of opportunities for practice with long, resistive, teether type foods (like a mango pit, a spare rib or other thick rib with all lose bits and gristle removed and most of the meat cut off, or a thick pineapple core that does not taper and won't easily snap or break apart). These foods aren't for eating, but for helping the brain learn about and desensitize the inside of the mouth. Gagging is the brain's way of saying "something isn't right here," and mouthing these hard, resistive foods that baby can easily pull back out of the mouth helps the brain learn that food isn't an "intruder." Mouthing fingers, toys, and infant spoons as teethers outside of mealtimes can also help dampen that gag reflex a bit.

If you try these tips and your baby continues to forcefully gag and vomit at most meals, you may want to mention it to your child's medical provider.

When to seek help

We recommend you speak with your child’s pediatrician regarding a referral to a feeding therapist if:

Let’s normalize the gag

While it can be disturbing—and nerve-wracking to watch—gagging is a completely normal reflex in infants, children, and adults. Bottom line:

Infant CPR & First Aid Resources

One of the most important things you can do to protect baby is take a CPR class online or at your local health facility and review safety procedures. Our Infant Rescue Guide and Toddler Rescue Guide include visual pictures and step-by-step instructions on how to perform choking rescue maneuvers.

Some resources:

Remember, you are responsible for supervising your child’s health care and for evaluating the appropriateness of the information in this article for your child.  Only you know your child and how your child will react to foods and feeding procedures. Although the information presented in this article is based on well-documented research by medical and nutritional professionals, it is up to you to review and consider the information and how it will work with your child.

Always seek the advice of your pediatric doctor, nutritionist or health care provider with any questions you may have regarding a medical condition or feeding issue. You should refer to our Terms of Use for further information.

Reviewed by:

K. Rappaport, OTR/L, MS, SCFES, IBCLC

K. Grenawitzke, OTD, OTR/L, SCFES, IBCLC, CNT

This page has been created with typically developing infants and children in mind. The information here is generalized for a broad audience and is for informational purposes only. If your child has underlying medical or developmental differences, including but not limited to prematurity, developmental delay, hypotonia, airway differences, chromosomal abnormalities, craniofacial anomalies, gastrointestinal differences, cardiopulmonary disease, or neurological differences, we strongly recommend you discuss your child's feeding plan with the child's doctor, health care provider or therapy team. The opinions, advice, suggestions and information presented in this article on gagging are for informational purposes only and are not a substitute for professional advice from or consultation with your pediatric medical or health professional.