Gina Johnson
Gagging in newborns is a natural protective reflex that prevents choking. It is a normal part of the learning process as they get used to eating and drinking. However, it can be distressing for parents to witness their newborn gagging in their sleep. The most common cause of gagging in newborns is gastroesophageal reflux (GER) or acid reflux, which can lead to spitting up or vomiting. Other causes include an immature digestive system, being overfull, or the breast milk or formula being administered too quickly. It is important to differentiate between gagging and choking, as choking is a medical emergency that requires immediate action.
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What You'll Learn
Gastroesophageal reflux disease (GERD) or acid reflux
It is not uncommon for newborns to gag in their sleep. This is because babies have a strong gag reflex that usually lasts until they are about six months old, which is when they start solids. The gag reflex is a protective mechanism that prevents choking by stopping food or any other object from entering the windpipe.
Gastroesophageal reflux (GER) is common in babies under two years old. It occurs when the contents that have gone down to the stomach come back up into the oesophagus, which is the tube that goes from the throat to the stomach. GER is not a cause for concern and does not create any problems in babies. In most cases, babies outgrow GER by the time they are 12 to 14 months old.
However, when GER becomes severe or chronic, it may indicate gastroesophageal reflux disease (GERD) or acid reflux. GERD is a more long-term, serious, and chronic condition that can cause symptoms like coughing, noisy breathing, abdominal discomfort, and frequent vomiting. It is characterised by the backflow of stomach acid into the oesophagus, leading to heartburn, chest pain, and trouble swallowing.
GERD can be treated with medicine and lifestyle changes. Doctors may prescribe medication to block and lower the amount of stomach acid. Lifestyle changes may include keeping the baby upright for about 30 minutes after feeding to reduce reflux symptoms and placing the baby on their back to sleep. In rare cases, surgery may be required, but most babies outgrow GERD by 18 months of age.
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How to differentiate between gagging and choking
It is understandable that you may be concerned about your newborn's gagging. Occasional gagging is normal in newborns and can be caused by various factors, such as gastroesophageal reflux (GER) or acid reflux, an immature digestive system, or the introduction of new foods and textures. While it can be worrying, gagging is a protective reflex that helps prevent choking.
Now, let's get into the details of how to differentiate between gagging and choking:
Gagging:
- Gagging is a loud process, with the baby making gagging noises, gurgling, sputtering, and coughing.
- The baby's tongue will thrust forward, and they may expel or spit up the food they were eating.
- Gagging is often accompanied by vomiting, which is a normal protective response to prevent choking.
- You may notice that your baby turns red in the face when gagging.
- Gagging is the body's way of protecting against choking. It helps expel food or objects away from the throat and towards the mouth.
- The baby will be able to breathe in between gags or after gagging.
- Gagging is not an emergency and is a normal part of a baby's development, especially when they start solids.
Choking:
- Choking is a silent danger. The baby will be quiet or silent as they struggle to breathe or cough.
- Choking occurs when the baby's airway is partially or fully blocked by food or an object, leading to breathing difficulties.
- While not always the case, you may notice a bluish discoloration of the lips during choking.
- Choking is a medical emergency that requires immediate action, such as performing baby CPR and calling for emergency assistance.
It is important to remember that if you try to remove food or an object from your baby's mouth during gagging, you could accidentally push it further down, increasing the risk of choking. Always let your baby work through the gagging on their own and do not intervene unless it turns into choking.
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Tips to prevent gagging while feeding
It is natural to be concerned about your newborn's well-being, especially when they gag in their sleep. Gagging is a protective reflex that prevents choking, and it is common in newborns as they learn to eat and drink. Here are some tips to prevent gagging while feeding:
- Let your baby relax before feeding: Create a calm and soothing environment to help your baby feel relaxed before feeding. This can include establishing a consistent feeding routine and ensuring your baby is comfortable and content before starting.
- Don't force-feed: Respect your baby's appetite and never force them to eat more than they need or desire. Allow them to eat at their own pace and stop when they show signs of fullness.
- Choose the right feeding equipment: Seek expert advice from a healthcare professional or a board-certified lactation consultant to choose the most suitable feeding bottle, nipple length, and bottle hole size for your baby's age and feeding skills.
- Introduce solids gradually: Start with purees and gradually transition to solid foods as your baby adjusts. Ensure your baby can sit upright on a feeding table before starting solid foods. Most babies can be weaned at around six months of age.
- Maintain an upright position: Use a feeding table or high chair that keeps your baby in an upright position during feeding. This position helps with reflux and reduces the risk of gagging.
- Start with small amounts: Offer small amounts of food on a spoon, placing it gently on the front part of your baby's tongue. This allows them to explore new textures and tastes without overwhelming them.
- Thicken breast milk: If your baby is spitting up a lot, consider thickening your breast milk with infant formula or adding infant cereal to the bottle. However, consult your paediatrician or a gastroenterologist before making any changes to your baby's diet.
- Manage reflux: If your baby has gastroesophageal reflux (GER) or acid reflux, keep them upright for about 30 minutes after feeding. This helps reduce reflux symptoms and decreases the likelihood of gagging during sleep. Consult your paediatrician for specific recommendations based on your baby's condition.
- Monitor for choking: Although gagging is normal, be vigilant for signs of choking. If your baby's lips turn bluish, they are unable to make noise, or they exhibit other signs of distress, take immediate action by performing baby CPR and calling for emergency medical assistance.
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Signs that your baby is in distress
Occasional gagging is normal in newborns and young babies. This is because babies have a strong gag reflex that helps prevent choking. The gag reflex is activated when an object touches a sensitive area at the back of the throat, causing an automatic muscle contraction that pushes the object out of the mouth. This protective reflex is important for babies who are learning eating and drinking skills.
However, gagging could also be a sign of gastroesophageal reflux (GER) or acid reflux, which is common in babies under 2 years old. This can be identified by other symptoms such as abdominal discomfort or frequent coughing. In some cases, acid reflux can lead to gastroesophageal reflux disease (GERD), a more serious and long-term condition. If you are concerned about your baby's gagging, it is important to seek medical advice.
- Intense cramping, along with severe back pain during pregnancy, could indicate fetal distress.
- Meconium, a thick, tar-like substance, is usually released from a baby's bowel after birth. However, if it is present in the amniotic fluid during pregnancy, it could indicate fetal distress.
- Abnormal fetal heart rate, such as a fast heart rate of higher than 100 beats per minute or a slow heart rate of lower than 60 beats per minute, could be a sign of fetal distress.
- If your baby is choking, this is a medical emergency. Signs of choking include a bluish discolouration of the lips and an inability to make noise.
- If your baby has reflux, they may need to sleep slightly inclined to prevent choking and gagging.
It is important to monitor your baby's movements and behaviour and seek medical advice if you have any concerns.
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What to do if your baby is gagging
Gagging in newborns is a protective reflex that helps prevent choking. It is triggered when an object touches the sensitive area in the back of the throat, causing an automatic muscle contraction that pushes the object out of the mouth. This reflex is especially strong in babies until they are about six months old. Occasional gagging is normal in newborns and young babies, and it helps them throw up food that is too big to swallow.
If your baby is gagging, it is important to remain calm and let their body get rid of the object on its own. Do not place your fingers or any other object in their mouth as this could accidentally push the object further into their throat. Instead, kneel next to them so they look down at you and offer gentle, calming words. You can also try to keep them in an upright position, which may help slow the flow of milk.
If your baby is choking, this is a medical emergency. Signs of choking include a bluish discolouration of the lips, inability to make noise, gasping or wheezing, and grabbing at the throat. If you notice these signs, you should immediately start baby CPR and call emergency services.
To prevent gagging, there are several things you can do:
- Ensure your baby is relaxed before feeding.
- Never force them to eat more than they need or desire.
- Choose the right feeding bottle and nipple size, seeking expert advice if necessary.
- Introduce solids gradually, starting with purees and moving to solid foods as your baby adjusts.
- Ensure your baby is able to sit upright before starting solids.
- Give a small amount of food on a spoon to the front of the baby's tongue rather than a spoonful of food to their mouth.
If your baby is consistently gagging or upset after gagging, consult a pediatrician or healthcare provider. Gagging can be a sign of gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD), especially if it occurs away from mealtimes.
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Frequently asked questions
Gagging in newborns is a natural protective reflex that prevents choking. It is usually triggered when an object touches a sensitive area at the back of the throat. This can happen when your baby is sleeping on their back and mucus or spit touches the back of their throat. Reflux can also cause gagging in newborns.
Gagging is a natural response to new tastes, textures, or temperatures. It is a protective reflex that brings food forward into the baby's mouth to help them learn how to chew. Choking, on the other hand, means that your baby's airway is partially or completely blocked, preventing them from breathing.
If your baby is gagging, it is important to stay calm and observe quietly. Do not place your fingers or any other object in your baby's mouth as this can accidentally push the object further into their throat. Let your baby's body get rid of the object on its own.
Here are some tips to prevent gagging:
- Make sure your baby is relaxed before feeding.
- Do not force your baby to eat more than they need or desire.
- Choose the right feeding bottle and nipple length.
- Gradually introduce solids, starting with purees and moving to solid foods as your baby adjusts.
- Ensure your baby is able to sit upright before starting solids.
- Feed your baby small amounts of food on a spoon, tipping the spoon to get a bit of food on the front of their tongue.
