Why Tiny Pieces in the Mouth Cause Gagging
Amanda Kyle, MA-CCC, SLP
When kids are starting to eat, one of the biggest fears that parents have is gagging and choking on food pieces. And while gagging can be a very normal part of feeding development, it is also a protective reflex for the body. Gagging is how we expel foods from the mouth or airway if it is needed.
With this, we often see gagging with small pieces of foods, especially early on in a child’s oral eating journey, but at the bottom of it, gagging really is just the body doing what it needs to do to keep the airway safe. It is a sign that the child is not yet ready for those small pieces.
When we are born, the tongue has forward and backward movement. This allows stripping of the nipple (whether on the breast or bottle) for feeding. Once babies are old enough to begin mouthing toys, foods, and anything else they can get their hands on, their tongue skills expand to allow movement from side to side. The tongue learns to go find things in the mouth and builds movement patterns. When a small piece of food goes into a place in the mouth where the tongue cannot reach and get it out – or to a place where the food cannot be chewed – gagging occurs. Essentially, the small pieces get ‘lost,’ and the gag ensures that the child does not accidently get the food stuck in their airway (which can happen when kids are eating foods and a piece gets away from them).
But, most often, gagging occurs when another person places food into a child’s mouth, and the person doing the feeding has no way to tell if they are placing the food in a location where the child can safely manage it. And this is the reason we advocate for the child being the only one to place foods in their own mouth.
Now, it’s important to remember that this type of gagging differs from the developmentally appropriate gagging, which typically occurs when the child holds an item and moves it around their mouth, hitting that gag location now and then. This type of gagging, that triggers a protective reflex, occurs with a small, free-floating piece in the mouth that the child is trying to expel. In other words, it’s the sign of an emerging eating skill, rather than an established one.
But does this skill being in a state of emergence mean that you should not expand beyond purees in early eating days? Not at all!
In fact, we want to encourage the tongue to move around! And we do this by offering large pieces of food – ideally long, skinny sticks (like a French fry) or larger pieces (like a in a triangle shape). This gives the child a handle to use to move food around their mouth, munch on it (especially as they put it along the sides where their molars will be), and explore flavors and textures in their mouth. This also gives them control, as well as the ability to move the food away if they get a place to where they gag (which very well may happen in this exploration). Just remember: as long as they are remaining calm and happy, they may carry on! And as those skills expand, they will become much more proficient in their ability to eat small pieces of foods.