Amanda Kyle, MA, CCC-SLP
When our kids start to eat orally, the fear of gagging and choking is ever present with many parents. And initially, as your child explores new foods and textures, their desire for new foods may outpace their oral motor skills. This can bring about a subset of gagging that is totally developmentally appropriate. So, let’s look at what is going on to help determine if your child’s gagging needs more direct intervention, or will just be a normal phase that will be over soon. First off, let’s differentiate between coughing, choking, and gagging given that all three of these behaviors creates the same fear and anxiety in a parent, but each has a different purpose.
Coughing is the rapid expelling of air intended to clear an airway. This movement of air can happen to clear liquids, solids or mucous, or could be triggered by an irritation or inflammation. Choking occurs when something is occluding the airway, and is cleared by coughing and gagging or from outside intervention (such as back blows).
Gagging is the body’s reaction to prevent a choking episode. It is a reaction to force an item in the mouth forward, out of the back of the mouth or beginning of the throat where coughing would be ineffective. The tricky thing about gagging is that the gag reflex does not start at the back of the throat, where we often think of it (since that is where ours is as adults). Instead, our gag reflex starts in the front of the mouth, and all of the mouthing of toys, objects and eventually food moves the gag backward to where it will remain into adulthood, typically near the uvula (the dangly thing in the back of your throat) or the faucial pillars (the “jaw joint” inside of the mouth).
This movement of the gag reflex back in the mouth does require a child to gag themselves in order to be achieved. In this way, gagging is a very normal part of feeding development and is not always a bad thing, or an indication that your child dislikes the food they are trying. Kids gag themselves often as they are learning to self feed, as well as through exploration. This serves to get that gag where in belongs, in the back of the throat.
I tend to call this process “happy gagging.’ This is where a kiddo is going about their business, gags themselves, takes a minute (usually with a ‘that was weird’ look on their face) and then goes about their business. This kind of gagging is not distressing, it does not causing vomiting, and it is not deterring them from their activity. This can also occur with new flavors or textures as they are learning to add these to their repertoire, but again, expect to see that happy gagging and then they move on.
It is important to note through this, to remain calm as the parent. Kids often look to their caregivers when they don’t know how to react to something. If you are calm, cool, and showing it is not a big deal, they will learn that this is calm, cool and not a big deal.
The gagging that I worry about when I see kids developing feeding skills is gagging that eliciting vomiting consistently, gagging that is distressing (the child gags and begins crying or becomes extremely dysregulated), or gagging that is progressing to coughing and choking. This kind of gagging could be due to sensory intolerances, poor oral motor skills (if you can’t move food around your mouth well, it gets stuck and the only way to get it out is to gag it out), or food that is too advanced for their eating age. These are all signs of atypical gagging and that indicate that we need to make adjustments to what and how we are offering foods in order to keep your child safe.
If you are seeing gagging and you are unsure of which category it falls into, talk with you team and we can problem solve through it together!
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