What a gag
So what is gagging? Gagging is a reflex - which means we can't consciously control it. It is usually present from birth, and we hold onto it our whole lives. Like most reflexes, it can be stronger or weaker, and more or less sensitive in different people. Some people (like sword swallowers) actively desensitise or suppress their gag reflex, and a few people are just born without it - but most of us have it. In adults, it is usually triggered by touch to the back 1/3 of the tongue, and sometimes the soft palate. The result is a quick spasm of the muscles at the back of the throat, designed to move food or drink forward and away from the airway. It is our body's first line of defense (second line is coughing!) against choking or aspirating (food or drink entering our windpipe and lungs). Sometimes a strong gag can lead to retching and vomiting. Gagging isn't painful or dangerous - but it doesn't feel hugely pleasant.
In babies, gagging is a bit different. Because little babies are not ready to eat solid foods, they are born with a gag reflex that can be triggered by touch much further forward in the mouth. This is protective and very clever of evolution! But of course once they move to solid foods, it's really inconvenient - you don't want to be gagging every time food reaches the middle of your tongue. So what most babies do instinctively is seek opportunities to desensitise their gag reflexes. They do this by mouthing things - food, non-food, whatever - and triggering or almost triggering the gag reflex often enough that their system learns that it's really nothing to worry about. If they don't have many opportunities to mouth, they will struggle to desensitise their gag, and transitioning to solids or lumpy solids may be more challenging. So tip one is: allow and encourage lots of mouthing!
The other challenging thing about gagging is that many adults interpret it as choking. Gagging is very different from choking. Where gagging is a defense mechanism, choking is a sign that all our defense mechanisms have failed, and something has blocked our airway. Gagging is usually noisy, whereas choking is often silent and can be accompanied by a change in colour. Gagging is not dangerous - it's protective; it shows us that our children are able to protect their lungs. Choking is dangerous - it shows us that our child's airway is blocked. Learn what to do if your child chokes (see attached), and it might help you manage your worry when they gag!
The appropriate response to choking is first aid. The appropriate response to gagging is to remain calm and wait to see if your child can independently clear the food. You can say "Ooops! Bit of a gag!" or "went down the wrong way!" but keep it light and positive. If your child can't clear the food, you can retrieve it with your fingers, or give them a sip of water to wash it down. If you are clearly scared when your child gags, if you shout or cry or grab them immediately, they learn that gagging is really scary, and may become more reluctant to eat or participate in oral play. Tip two: learn the difference between gagging and choking, and try to stay calm when your baby gags (reframing might help: "don't I have a clever baby, protecting his/her lungs like that!")
For some children, gagging can become a 'conditioned response.' That means that the child has felt so terrible in a previous situation that caused them to gag or vomit that now even reminders of that situation can make them gag. Think about a food you ate before you got food poisoning or gastro, or a particular type of alcohol you can't drink because you were once sick after drinking it - that's the sort of response we're talking about. That sort of gagging may require some professional input from an OT, speechie or psychologist, to help your child learn to feel safe and protected in that situation again.
When gagging is continual or distressing to you or your baby, then it might indicate a problem with any of a number of areas (e.g. oral motor skills, oral sensory skills, sensory integration, anxiety). The solution can sometimes be as easy as providing 'easier' food textures for a while, or it might be more complicated, You can speak to your MCHN, Paediatrician or Speech Pathologist if you are concerned.
Your take away messages:
- Gagging is a NORMAL and important part of a child's development.
- Children will gag less in the long term if they are allowed and encouraged to mouth objects early on.
- Keep calm when your baby gags so they can learn to keep calm too.
- Gagging and choking are different. Learn the first aid required to deal with choking.
- If you are worried, seek professional help sooner rather than later.