Gagging vs. choking with BLW - put your mind at rest with everything you need to know from medical p
- Rachel Wood
- Feb 23, 2017
- 7 min read
I recently carried out a small survey among Baby-led Weaning mums and those considering starting BLW. I asked them what information would have been most useful to them at the start of their BLW journey so that I could put together a useful guide for them. Overwhelmingly (and unsurprisingly) the topic which raised most often was choking. The most common questions were "how can I tell if my baby is choking?", "how can I tell the difference between choking and gagging?" and "should I worry about my baby choking with BLW?".
In this blog, I am going to try to address this topic with the aim of giving you all of the information you need to make your own decision. I believe that any decisions regarding the health of your child should be based on the best information available to you. So often the only easily accessible source of information is other parents' opinions, which, while valuable, are not a source on which to base a decision of this nature on alone.
I certainly am not qualified to answer these alone (I am a parent, not a doctor), so I have carried out some research. Below are articles from medical professionals, Baby-led weaning experts and parents on the topic of choking which I'm sure you will find useful if you are looking for advice - starting with an excellent review published in the British Medical Journal in which 31 health-care professionals and 20 mothers who had used BLW were asked a series of questions. Some of the articles are a bit heavy going; so I have attempted to summarise the salient points.
1. Healthcare professionals’ and mothers’ knowledge of, attitudes to and experiences with, Baby-Led Weaning: a content analysis study. Full study available here.
My takeaways:
- The main concerns from medical professionals over BLW were increased risk of choking, iron deficiency and inadequate energy intake. Particularly that mothers may leave a 6 month old baby alone with their food when they are not able to chew effectively.
- The concerns were highest among those who had not witnessed BLW and while choking can of course be very serious, none of the mothers interviewed experienced choking which the baby couldn't deal with themselves (without intervention).
- The following paragraph nicely captures the opinions of the mothers in the study:
"Mothers were aware choking was a common criticism of BLW, and although most reported that choking did not occur, 30%...reported one or more episodes. Although choking can be very serious, all mothers who reported choking...reported that the infant independently dealt with the choking by expelling the food from their mouth through coughing and mothers did not have to intervene with first aid. All mothers who could recall the food that was responsible...reported that raw apple was the food their infant had choked on. Mothers expressed feeling more relaxed around 4 weeks after introducing complementary foods; they saw that their infant could manage different textures, and was developing more coordinated eating skills. Mothers also felt that by this time the difference between gagging and choking was more obvious and that they realised it was mostly gagging."
- Here are the results of the study, clearly stating that most of the medical professionals did not feel comfortable recommending BLW because of concerns over choking; and the contrasting view of the mothers in the study.
"Results: Healthcare professionals had limited direct experience with BLW and the main concerns raised were the potential for increased risk of choking, iron deficiency and inadequate energy intake. Although they suggested a number of potential benefits of BLW (greater opportunity for shared family meal times, fewer mealtime battles, healthier eating behaviours, greater convenience and possible developmental advantages) most felt reluctant to recommend BLW because of their concern about the potential increased risk of choking. In contrast, mothers who had used this style of feeding reported no major concerns with BLW. They considered BLW to be a healthier, more convenient and less stressful way to introduce complementary foods to their infant and recommended this feeding approach to other mothers. Although mothers did not report being concerned about choking, 30% reported at least one choking episode—most commonly with raw apple."
Also mentioned in the article, was the view of BLW founder and author Gill Rapley: Gill Rapley, disputes that a healthy 6-month-old infant would be at increased risk of choking with BLW. Rapley acknowledges gagging is common with BLW because at 6 months of age the baby's gag reflex is further forward on their tongue than it is at 1 year. However, based on her personal observations, Rapley considers choking is more likely with spoon-feeding because the baby learns to use suction to take the purée from the spoon, which causes food to be taken to the back of the throat where it is swallowed, encouraging the infant to learn to swallow food without chewing first.
2. Weaning: A complete guide to gagging and choking.
This is a really nicely written article - no need for a summary this time. You can view read it by clicking here. They've also included a video of a child gagging on a piece of broccoli which I have included a direct link to here.
3. Baby Led Weaning - babycentre.co.uk
"It's perfectly understandable to worry about your baby choking or gagging when he is trying to eat whole foods. Supporters of BLW argue that as long as babies can sit upright, they should be fine. The fact that babies can handle and control the amount they eat, and move it to the back of their mouths when they're ready, means the risk of choking is minimal. Remember that babies should never be left alone when eating. It’s important to offer soft foods to your baby and avoid hard ones, such as chunks of raw apple, until he's older.Still, whatever type of weaning you're doing, it makes sense to learn what to do just in case something does get stuck in your baby's throat."
Very helpfully, barbcentre.co.uk also provide a video guide on how to deal with choking from First Aider Danielle Bruce. You can find the video here, and an illustrated guide here.
4. What is the difference between choking and gagging - NHS.uk
There is a really useful article on the NHS website here, but there seems to be a formatting issue with the page making it difficult to read so I have re-formatted it here (I hope this isn't in breach of any copyright laws):
"Gagging is a very, very natural reflex in babies. It's designed so if there is anything in the back of the throat, they bring it up without getting into trouble. However, if they do choke, something is probably stuck in the back of the throat and can have the ability to stop them from breathing. It's important you know the difference. Look! I've got some yummy chicken!
When babies are learning to eat solid foods, often they will gag. A couple of reasons might be that the food is cold or they've got too much stuck in their mouth. It might be that they don't like that food. They have a gag reflex, which is designed to eject this food that they don't like. It's completely normal and therefore nothing to be worried about. It's not dangerous and you'll probably find yourself witnessing this all the time when your baby is learning to eat solid food.
If a child is choking partially, you might get some coughs and splutters. If it's a full blockage, there will often be no sound whatsoever. What might tell you that the child is choking are some signs. Signs like the face changing colour, often a deep puce followed by a blue. Sometimes a grey, blue tinge to the lips. They can look afraid. They can have their arms out towards you, almost like they're looking for help.
If a baby does start choking, you will need to take the baby out of their high chair, lean them faced down, so their bottom is above the level of their head, and deliver five firm, strong back blows in between the shoulder blades using the base of your palm.
Most parents are really scared to deliver back blows to their children, because they think that it might hurt them. People used to say "back slaps" when we were training, but that meant people would literally slap the back of their child, so they changed the word to "back blows." Hopefully, two of those is often enough to dislodge the object.
Always supervise your children when they're being fed or when they are feeding. Most foods are absolutely fine to give your baby when weaning. Just be aware of the problematic foods such as cherry tomatoes, whole nuts, things like olives, et cetera, and grapes.
The differences between choking and gagging are that one is life-threatening and the other one is normal. It's important to get the confidence to know the difference and act accordingly if it is choking."
5. Videos
Personally, I find the most useful guides are videos of gagging and choking that you can compare. There are a load of these on YouTube, I have included links to a few below.
Summary
So...I'm sorry if that's a bit of information overload! It seems to me that there is a choking risk associated with BLW...but whether that is a greater risk than with traditional weaning is still open for debate. As with all things in life, there are risks involved and it is up to you to weigh them up and make your own decision - I hope that I have provided enough information here for you to do that, along with a few helpful links on how to know if your child is choking, and what to do if they are.
Thank you so much for reading! I hope that this has been useful to you! If it has, please share this blog via Facebook / Twitter / anywhere else, so that parents everywhere can make more informed decisions about BLW and choking.
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