Many parents have a legitimate fear when introducing their baby to solids that they could accidentally choke. But food isn’t the only choking hazard to babies. Any sort of small object or toy can pose harm to babies. Choking occurs when a person isn’t able to breathe because something – whether food, a toy, or another object – is blocking the airway.
Given their habit of putting almost everything in their mouths, babies are at an especially high risk of choking. Medline Plus warns that permanent brain damage may occur in as little as four minutes if a person doesn’t get enough air. That’s why knowing the signs of choking in infants, and more importantly, how to respond in the moment is essential for parents to keep their children safe.
Below, we discuss how to identify if your infant is choking, what should do in such instances, and conversely, what you shouldn’t do. Familiarizing yourself with these steps could end up saving your baby’s life.
Choking vs. Gagging: Knowing The Difference
Choking and gagging can present some of the same signs, and while the latter is a normal reaction many babies have when trying new foods, the former is a serious danger that threatens your baby’s life. That’s why one of the first things parents need to know when introducing their baby to new foods is how to spot the difference between choking and gagging.
Babygaga recently had the opportunity to speak with Solid Starts’ double board-certified pediatrician Dr. Rachel Ruiz about transitioning your babies to solids, who spoke about the difference between gagging and choking. “True choking is when the airway is obstructed, and your baby is having trouble breathing,” Dr. Ruiz explained. “Signs of a baby choking can include an inability to cry, difficulty breathing, skin tugging into the chest, a look of terror, high-pitched sounds, or a change in skin color.”
She continued, “Gagging, however, is a natural, 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 your baby work the food forward on their own and to refrain from sticking your finger in your baby’s mouth, which can push the object further down your baby’s throat.”
“Importantly, the gag reflex of a 6- to 10-month-old baby is much more sensitive than that of an adult,” Dr. Ruiz added. “Because it is so sensitive, a baby’s gag reflex is triggered easily. Which means your baby is going to gag—a lot—when starting solids.”
SR Nutrition explains that many children will become loud and their faces will turn red when gagging on food. On the other hand, if they become quiet and their face starts turning blue, it’s an indication they need help. During gagging, an infant’s tongue will thrust forward, their face may turn red, and parents may hear sounds such as spluttering, coughing, and gagging. The publication warns parents not to intervene as it may make it worse. They add that gagging is normal, especially during the weaning process, as babies become familiar and learn to control their gag reflex. Gagging happens less as the baby becomes more experienced with new foods.
Choking, on the other hand, is often characterized by silence. The infant may have a small cough or no cough at all, but accompanied by a face turning blue, it’s a clear sign they’re choking. SR Nutrition says to call for help and begin methods to dislodge the object. Children’s Hospital Los Angeles adds that children may initially cough, gag, or have high-pitched, noisy breathing when they first begin choking, which quickly turns into silence as they struggle to breathe.
Signs Of Choking In Babies
The following are clear signs your infant may be choking:
- Weak, ineffective cough
- Skin turning blue
- Soft or high pitched sound when inhaling
- Inability to make much sound
- Loss of consciousness
How To React If Your Baby Is Choking
“First, ensure that baby is actually choking. If the baby is coughing, let them cough it out,” Dr. Ruiz explained to Babygaga. “Never place your finger in your child’s mouth as you can accidentally make the situation worse and push the food particle even further down, worsening the obstruction." She continued. “If you suspect your baby is choking, immediately administer infant choking first aid with alternating back blows and chest thrusts and call 911 on speakerphone so your hands are free. If another person is present, one person should immediately perform choking first aid while the other calls emergency services.”
As per Dr. Ruiz’s advice, take the following steps if you observe your baby is choking:
Yell For Help If Possible
The first thing you should do is try to dislodge the object not call for help. Only call for help if there’s someone nearby that you can yell to. Don’t take the time to dial 911. Your baby needs your assistance before this.
If you notice your baby is coughing and there’s another person nearby, quickly yell for help. Instruct the person to call 911 so you can access medical help as soon as possible. However, if you are by yourself with the baby, it’s important to try and dislodge the object as soon as possible. In this case, wait until you have stopped the choking before calling for additional help. This may seem counter-intuitive, but it can only take a matter of minutes for a baby to choke. That’s why it’s important to dislodge the object as soon as possible.
Perform First Aid Or CPR
Medline Plus explains it’s imperative parents know how to perform first aid on their baby in the event of choking. The publication provides step-by-step instructions depending on the situation.
If the baby is quiet: Medline Plus explains that if the baby is not coughing a lot or making a lot of noise, it’s important to try to dislodge the object as soon as possible. They recommend laying the infant face down, along your forearm while using your thigh or lap for support. Proceed to hold the baby’s chest in your hand and their jaw with your fingers. Their head should be pointed down. Then, using the palm of your free hand, give five forceful blows that hit between the infant’s shoulder blades. This should hopefully dislodge the cause of the choking.
If the object still isn’t dislodged: If after five blows nothing comes out of the airway, Medline Plus offers further instructions. They tell parents to turn the infant face up, again using your thigh or lap for support. Using two fingers placed on the breastbone, located below the infant’s nipples, give five forceful thrusts. “Give up to 5 quick thrusts down, compressing the chest one third to one half the depth of the chest,” the publication explains. “Continue 5 back blows followed by 5 chest thrusts until the object is dislodged or the infant loses alertness.”
If the baby is unconscious: Medline Plus explains that parents need to call for immediate help if their baby becomes unresponsive, including if they stop breathing or are turning blue. Verbally call for help in hopes someone nearby or in the household hears you. While calling out for help, make sure to perform infant CPR – we recommend taking a first-aid class to learn how to properly do this, or in the meantime, watching a YouTube tutorial. Infant CPR is not the same as adult CPR. After one minute goes by of CPR, Medline Plus instructs parents to call CPR. If you are able to see what’s blocking the child’s airway, manually remove it with your fingers if it’s safe to do so.
What Not To Do When Your Baby Is Choking
Call 911 right away
As has been stated, the most imperative thing to do when a baby is choking is to free their airway. Do not immediately get on the phone to dial 911. Time is of the essence, so it’s better spent trying to dislodge the object. If the infant goes unconscious, and you’ve been attempting CPR for a minute, then calling 911 while continuing to attend to your baby.
Don’t perform first aid if the baby is coughing forcefully
Medline Plus explains that if a baby is coughing forcefully, has a strong cry, or is breathing steadily, their gag reflect may be able to dislodge the object. Attempting to help them when this occurs, however, may hinder the process and make things worse. But it’s important to be ready to step in if their symptoms worsen.
Don’t pull out the object if the baby is conscious
It’s only safe to pull out the object if it’s visible and the baby is no longer alert. Doing so when the infant is conscious risks the object moving back, deeper into the air as their gag reflect reacts to having an adult hand in the mouth.
How To Prevent Choking In Infants
Preventing choking in babies starts with parents, who need to take precautionary measures to reduce the likelihood.
Get Rid Of Distractions
Turn off anything that could take away your baby’s focus from eating. Especially when transitioning to solids, there’s a learning curve babies must get used to in order to chew and swallow foods properly. Things like T.V. can distract them from this important process. “It’s important to create a peaceful eating environment free from sudden noises or distractions (turn the tv off, etc.),” Dr. Ruiz emphasizes.
Make Sure Baby Is Sitting Correctly
Improper positioning increases the likelihood the food could go down the wrong windpipe, so ensure your infant is properly and comfortably seated in their high chair. “Have baby sitting upright in a supported highchair, with their hips flexed with feet firmly planted on a footrest,” Dr. Ruiz explained. It’s best to avoid giving foods to a baby when not in a highchair as they may not be properly sitting upright, thereby increasing choking hazards.
Cut Food Correctly
Certain foods are bigger risks for choking than others. Children’s Hospital LA provides a list of foods that are known choking hazards in babies:
- Candy
- Caramels
- Cheese
- Chips
- Fruits with skin
- Grapes
- Gum
- Ice cubes
- Lollipops
- Marshmallows
- Nuts
- Peanut butter
- Popcorn
- Pretzels
- Raisins
- Vegetables
Dr. Ruiz explains it’s important to make sure food choices are age-appropriate and to cut them down to size to lessen the choking risk. “Learn what foods are common choking hazards and how to modify them,” she explained. “For young eaters, avoid giving small, hard round objects (hard carrots cut in coin shapes, sausages, candy, whole nuts, seeds, whole grapes, cherry tomatoes).”
Take A First Aid Course
In order to know how to administer first aid and infant CPR in case of an emergency, sign up for a first aid course that will teach you the basics. “If you’ve never taken a first-aid training course, now is a good time,” dr. Ruiz recommended.
Don’t Leave Baby Unattended
Never leave a baby alone with food. Choking can happen in a matter of minutes, so it’s imperative to stay close by so you can react if there is an emergency. “Lastly, never, ever leave your baby unattended while eating and stay within an arm’s reach at all times,” Dr. Ruiz emphasized.
Sources; Medline Plus, SR Nutrition, Children’s Hospital Los Angeles,