Gagging

Written by Jamie Williams
Certified Practising Speech Pathologist

Our babies are born with reflexes that help them with feeding until they have developed the skills needed to manipulate & transfer food on their own. One reflex related to feeding, that we are all born that with is the gag reflex. Unlike many other feeding reflexes that integrate or disappear, the gag reflex remains, it does however change. At birth the gag reflex is located at the front of the mouth and as our oral-sensory skills develop & we have opportunities to mouth & eat, it moves further and further back and becomes less sensitive. The purpose of the gag reflex is to help protect our airway from things that are too large.

As your little one explores their hands, fingers, toys and food, their gag reflex begins to move further and further back. Their brain also begins to integrate sensations easier and easier so their tongue & their mouth become less sensitive to input. If the gag reflex didn’t move to the back of the mouth & became less sensitive; manipulating food, transitioning through the textures & transferring food to the back of the mouth to swallow would be really tricky. It still remains a protective reflex, its location just changes. It’s important that little ones are given lots of opportunity to explore safe objects and their hands/fingers orally prior to the introduction of solids AND as they transition through the different textures.

Gagging is a natural part of learning to eat, some little ones will gag more than others. Our aim at mealtimes is to provide a neutral to positive environment so that feeding and mealtimes are associated with positive memories & something our little ones enjoy being part of. This is why the way we react to gagging & seeking support for persistent gagging is important. 

Introducing solids can feel overwhelming, sometimes we can hover without realising and our little ones pick up on our anxiety. Please be reassured that you will both develop confidence in the feeding journey one step at a time. Right from the start, eat with your little one and ensure the focus of mealtimes is sharing and connecting around a meal. Having your own food (even if you are just having a nibble) builds connection, gives your little one a model for eating & can help keep the focus on the meal. A relaxed mealtime baseline will flow easier into a relaxed response to gagging. Your little one is going to look to you for reassurance when they gag. It will matter less about what you say here and more about HOW you say it. Use a soft, slow, gentle voice, reassuring facial expressions & continue to sit at their level. Phrases like, “Oops,” “You are working it out,” “It’s ok” are great to add.

If gagging is happening repeatedly during a meal, it’s impacting your little one’s enjoyment of mealtimes or it doesn’t seem to be decreasing over time there may be an underlying reason. 

Here are some examples of the possible reasons your little one might be gagging persistently:

• They haven’t developed the oral motor skills needed for that texture/consistency of food.
• They are communicating something with their gag – e.g. “Please don’t make me eat this,”
• Structural difference - a part of their anatomy is making feeding difficult (e.g large tonsils, tightening of the oesophagus)
• Hypersensitivity - they are over responsive/reactive to things in their mouth. E.g. the gag reflex hasn’t moved further back in their mouth or become less sensitive.
• They may not be developmentally ready for food or for the texture you’re presenting.

There are few strategies that you can try that may help persistent gagging depending on the underlying cause:

• Offer opportunities for your little one to mouth safe objects of different textures, temperatures, shapes & sizes.
• Offer hard munchables if your little one is not yet biting off food. Hard munchables are very firm foods, that are large in size (but big enough to fit in the mouth) and would be difficult to bite through. 
• Offer mango pits with flesh removed, bones with meat removed, corn cob with corn removed. Encourage your little one to mouth these and dip them in a puree once they are comfortable with mouthing them. 
• Always honour their communication. Remember it is our job to provide and theirs to decide if they eat & how much.
• Offer textures spoons with purees on them. The texture on the spoon adds a little more sensory input to baby’s mouth (than just puree on a spoon). This is a nice way to take a small respectful step towards a more difficult texture.

Please reach out to a speech pathologist if gagging episodes don’t seem to be decreasing, your little one is distressed by their gagging or you are distressed by their gagging. A feeding assessment will help uncover the “why” and indicate any needed referrals as well as inform intervention is needed and how to support you and your little one on your feeding journey.