This past week I had the opportunity to observe a session at the intensive pediatric feeding program at U of M. This is one of four programs in the state and I was so grateful to have a chance to ask questions, observe and learn from some of the best feeding specialists out there.
My visit to the clinic came at the perfect time, because I’ve had some new families come along with feeding difficulties over the past several months and the more information I can share with families to help treat and also prevent feeding difficulties, the better!
Visiting the U of M Pediatric Feeding Clinic
After my visit, I shared a few bits of information on my Instagram and Facebook stories regarding the differences between gagging, coughing and choking.
The feedback was great, so knowing that people were interested in hearing more, I wanted to share the information in a blog and a few extra resources to help deepen your understanding of the differences between gagging, coughing and choking as well as some resources for learning more about feeding and picky eaters in general.
Gagging vs. Choking
I frequently hear, “he’s choking” or “don’t choke!” when a baby is coughing or gagging. I want to ensure you that if your baby is gagging or coughing, these are overall good signs! This means that your baby’s safety nets against choking are functioning properly.
Gagging
Gagging is typical for babies, especially as they are just being introduced to solid or softened foods and eating utensils. You may notice them gag on a toy they put in their mouth too. The gag reflex is a protective mechanism that moves the tongue forward to propel food forward as well. This protects the airway from foreign objects.
As your baby gains more exposure to putting things in his mouth, the gag reflex should continue to move back on the tongue until it becomes uncommon.
Feeding Littles is a great resource that I’ve followed for awhile now and is led by an Occupational Therapist and Registered Dietitian Nutritionist team (basically, they’ve got this feeding thing down!). According to their experience in their blog post: Why Gagging with Baby-Led Weaning is Good - As Long as It Improves!, you can expect gagging to occur for approximately 1-2 weeks if you’re doing Baby Led Weaning method. After those first couple weeks, it should begin to reduce as your baby is exposed to more and more textures, densities, etc.
If gagging continues even after repeated exposure to foods and eating utensils, it may be a good idea to seek a professional opinion, starting with your pediatrician who will make a referral to a speech-language pathologist, occupational therapist and/or feeding specialist for further assessment.
If you’re unsure, it’s always best practice to get a professional opinion. Definitely don’t wait if you’re feeling something is not quite right!
Coughing
Coughing is also a protective mechanism for ensuring that the airway remains clear. When coughing occurs, the vocal cords open a touch wider to increase airflow through them and air moves upwards and out of the airway at approximately 100mph (see video here for more). This helps to propel foreign matter (food, dust, liquid, etc.) out of the airway to prevent choking or sickness.
If coughing is happening frequently after or during eating and/or vomiting is occurring as well, then this may be a sign that your baby may need additional support while feeding, so I definitely recommend touching base with your pediatrician for a referral to one of the professionals listed above!
Choking
Choking is when the airway is partially or fully obstructed. A sign of choking is if the baby, child or person are unable to clear the airway through gagging, choking, etc. and air is not being released. You can find a list of foods to avoid or modify so that choking is less of a hazard when eating here.
The CDC lists several foods, however this is mostly concerning the size, skin and/or hardness of them. Fruit and veggies can always be cooked to soften, cut into a thin strip and skin can be removed as well.
For instance, apples can be skinned, cut into thin, longer pieces and cooked slightly to soften them for safer eating. Same goes for carrots, broccoli, etc.
Grapes and hot dogs can also be skinned, however I still recommend smaller bites of these. These are two items that seem so easy to give little ones, but can be the most dangerous of all foods. So definitely take precaution when these are on the menu.
Our Response Matters
Feeding disorders and "picky eating" are typically listed under a "behavioral disorder" and after speaking with the team of specialist at U of M, they would agree that one of the greatest factors in working with children in their clinic or a child who is resistant to eating by mouth is the anxiety surrounding food coming near them, touching their mouth, etc.
When you are introducing foods to your child, it's important to remember that they "feed" (hehe) off of your energy. Kids pick up on the energy of the world around them far quicker than grownups do and they are much more likely to match that energy or emotion.
When a new food is introduced, don't oversell it. It's okay to be excited and encouraging, however sometimes it's best to just introduce the food and let them decide if they are going to try it. Often times, they will push it away or accidentally put their hand in it, smear it around and then make a choice to give it a whirl. Stay calm and neutral as much as possible.
Try to stay away from words such as, "mmm...you don't like that!" or even sharing with others what your baby enjoys. Babies will often appear to "not like something" by their facial expressions, when in fact, they are simply trying the food and texture out for a bit before deciding if they'll go back for more. Also, it takes a lot of exposure for a child to decide what feels and tastes good to her. Feeding Littles shares that it can take 20+ times of introducing a food to a child before she will in fact eat and enjoy it!
If your child does gag or cough, let them know you see them by looking at them with a calm face. Try and remind yourself that this is typical when introducing a new food and that as long as they are coughing, gagging and breathing everything is okay in this moment. (see next section if these symptoms continue).
Stay calm friend!
When should I be concerned?
Here’s a short list of symptoms that may be cause for concern when observing your child while eating. If your child is experiencing any of these symptoms, I highly encourage you to make an appointment with your pediatrician and ask for a referral to a professional who specializes in feeding such as a speech-language pathologist, occupation therapist, nutritionist, etc. Please note that when possible, these professionals typically work together and include a team.
Gagging continues and does not improve despite several weeks of exposure to foods
Coughing and/or vomiting occurs during most meals or while drinking liquids
Vomiting occurs after eating, even several hours following a feeding
Child regularly spits out food or does not show interest in eating as well as touching or playing with food
Child is exhausted and falls asleep while eating frequently at different meal times
Child is not gaining weight and/or losing weight
Child is consistently showing signs of distress during meal times
You can find more information below! For more on feeding disorders including symptoms, diagnosis, and treatment check out the C.S. Mott’s Children’s Hospital article, link below.
Additional Resources
C.S. Mott Children’s Hospital has a wonderful article on feeding disorders and the symptoms of a feeding disorder. The article also goes into further detail about what the diagnosis process looks like and treatment as well.
Infant Feeding: Baby-led Way! By Feeding Littles is an online course that can be taken at your own pace that covers baby-led feeding from 6-12 months
Feeding Littles: Toddlers! Is also by Feeding Littles and is a second online course that focuses on feeding after the one year mark, up until age 7. This course is for parents who have a child who is showing signs of picky eating or want to help make sure their child does not develop picky eating. I have yet to take this course, but after enjoying the information, tips & tricks and videos to observe from the infant feeding course, I will definitely be taking this one as well.
Melanie Potock was recently recommended to me by another speech-language pathologist (thanks Marcie!) who really enjoys her tips & tricks. Melanie is a certified speech-language pathologist who specializes in pediatric feeding. She has three course offerings including:
**Melanie's courses require you to finish the course within a one month time frame. You can pick and choose how you complete it, however your subscription lasts one month only.
Her books include the following:
I appreciate your feedback and hope you found some helpful information throughout this post! Enjoy those messy meal times!
Michelle St. Aubin MS CCC-SLP
Michelle Lynn Therapy PLC
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