Choking vs gagging
It is important to know the difference between gagging and choking and how to react in both situations.
Gagging
Gagging is extremely common, and all babies are likely to gag as they learn how to eat. This is due to the gag reflex, a reflex we are born with and that lasts through to adulthood. The gag reflex is our body’s way of protecting us from choking. Gagging is a natural function which moves food back up into the mouth and stops the swallow reflex.
When babies are born, the gag reflex is located towards the front of the mouth and as babies grow and develop it moves further back in the mouth and becomes less sensitive. Some babies will gag more than others but as babies grow and learn how to eat, they usually outgrow frequent gagging.
The gag reflex helps your baby learn how to eat – it can teach them how to move the food around their mouth and chew properly and know when a bite of food is too big. Gagging can help babies adjust to foods that aren’t soft or pureed.
Signs of gagging include:
- Crying or watery eyes
- Retching, spluttering or coughing – their face may turn red
- They may vomit
Gagging is temporary and will resolve on its own. When your baby is gagging you should:
- Stay calm. If your baby senses you are panicked, they may become more upset.
- Keep a close eye on baby to make sure they either spit the food out or continue to chew and swallow it.
Never stick your finger in your baby’s mouth if they are gagging, as this can push the food further back into the mouth and increase their risk of choking.
REMEMBER: Loud and Red, let them go ahead
Choking
Choking is when the airway becomes partially or fully blocked resulting in trouble beathing. While a baby gagging is usually coughing or crying, true choking shows much more serious signs such as:
- Silence; unable to cry
- Look of panic
- Skin colour changes (may go blue, purple, or extremely pale)
If any of these occur it is important to call 111 immediately and begin choking first aid (see below).
REMEMBER: Silent and Blue, they need help from you
If you have concerns about your baby’s readiness to try new foods, gagging too frequently, or you think they are not eating correctly, call PlunketLine or contact your local Plunket Nurse to discuss.
Foods that can cause choking
Children can choke on food at any age, but those under five are at higher risk – and at highest risk are children under three.
The texture or shape of some foods makes them more likely to cause choking.
Avoid the following foods under the age of five:
- Whole nuts
- Popcorn
- Large seeds
- Dried fruit
- Chips/crisps
- Lollies (small, hard, round, chewy, or sticky)
- Hard rice crackers
- Marshmallow
- Bubble tea with tapioca pearls
Here are the foods more commonly associated with choking incidents, along with ways you can reduce the choking risk.
| Food | Risk | Reduce the risk |
| Small hard foods like carrot, apple, celery, taro, green bananas, cassava. | These foods are difficult for children to bite through and break down enough to swallow safely – pieces can become stuck in the airway. | Cook fruits and vegetables until soft or finely grate until your child has developed better chewing and grinding abilities. |
| Small round foods like grapes, berries, peas, cherry tomatoes, lollies. | Foods like this can get stuck in children’s airways. | Remove pips and seeds then quarter or finely chop grapes, berries and cherry tomatoes. Cook and squash peas. Avoid lollies. |
| Meat with skin or bones like fish, sausages, chicken nibbles. | Bones can easily get stuck in the airway. Skins are hard to chew. | Remove skin or finely chop. Remove bones. Cook meat until tender. |
| Fruit with skin like plums apples, pears, tomatoes, nectarines. | Food skins are hard to chew and can completely seal children’s airways. | Remove or peel skins before serving and cut into small pieces. |
| Raw leaves like lettuce and spinach. | Leaves can be hard to chew and can seal the airway. | Finely chop. Cook spinach and cabbage until soft, then chop finely. |
| Compressible and/or cylindrical foods like cheerios/ cocktail sausages, whole banana, pieces of cooked meat. | These foods can squash into the shape of a child’s throat and get stuck there. | Cut these foods into small pieces and remove skins before serving. Cook meat until it’s very tender. |
| Thick pastes like peanut butter or chocolate spreads. | Foods like this can stick to the sides of a child’s airway. | Spread thick pastes very thinly and evenly. |
| Stringy or fibrous foods like celery, watercress, rhubarb, silverbeet, bok choy and raw pineapple. | The fibres in these foods can make it hard for children to break the food up into smaller pieces to chew. | Remove the high-risk parts of the food by peeling off the skin, removing the strong fibres, or slicing these foods thinly across the grain of the fibres. |
| Chewy foods like sushi with seaweed, konjac jelly, mochi, shellfish – kina or raw mussels. | Chewy food can be difficult to break up into small pieces. | Cut these foods into small pieces and ensure it is soft. Cook meat and fish until very tender. |
What to do if your child is choking
If your baby is choking it is important to act immediately and call 111.
If your baby is unconscious, start CPR.
For babies younger than 12 months old who are conscious, perform choking first aid steps (see video below for demonstration):
- Place baby face down on your arm, resting your arm on your thigh
- Firmly support baby's head by holding jaw
- Give baby 5 quick, strong back blows between their shoulder blades using the heel of your hand
- If the object is not out, turn baby over face up with head lower than body
- Use 2 fingers to press down sharply on the middle of the chest 5 times (1 every 3 seconds)
- Only remove the object if you can see it. Do not fish for it as you may push it further into the mouth.
- Continue to repeat back blows and chest compressions until the object is out or medical assistance arrives. If baby becomes unconscious, start CPR.
Watch the video below to see how to deliver five back blows and five chest compressions on a choking baby.
We recommend all parents, caregivers, babysitters and anyone looking after children attend an infant first aid class and learn cardiopulmonary resuscitation (CPR). Our free online CPR course is a great start.
Hato Hone St John also offers a half-day Child First Aid course covering a range of life-threatening emergencies, including infant/child choking and CPR.
Steps to take if your baby is choking
Last updated: 27 May 2025
