Gagging vs. choking

Gagging: noisy, and normal

Gagging is very common when babies start solid food. They’re learning how much food they can manage, and how to move it around their mouth, chew and swallow.

When your baby gags, you may see them:

• cough or sputter loudly
• push their tongue forward or out of their mouth
• retch to bring food forward, or vomit
• get watery eyes

What to do: stay calm and stay close. Let your baby work the food forward on their own. Don’t put your fingers in their mouth, because that can push food further back.

Choking: quiet, and an emergency

Choking means the airway is blocked. A choking baby often can’t make much sound at all.

Signs of choking:

• weak or no cough
• can’t cry
• high-pitched squeaking, or no sound
• struggling to breathe
• pale or blue skin
• a panicked or surprised look

If your baby is coughing loudly, encourage them to keep coughing and don’t leave them. If the cough is silent or they can’t breathe in, act now.

First aid for a choking baby under 1

Shout for help, and have someone call 911. If you’re alone and your phone is with you, call on speaker and start back blows straight away. Don’t leave your baby to find a phone.Shout for help. Start back blows and chest thrusts straight away. If the blockage hasn’t cleared after one round of each, call 999 (on speaker if you’re alone) and keep going.Shout for help, and have someone call your local emergency number (such as 112 in Europe or 000 in Australia). If you’re alone and your phone is with you, call on speaker and start back blows straight away.

If you can clearly see the object and can easily pick it out, remove it. Never poke blindly or repeatedly with your fingers: that can push it further in.

1. Back blows

• Sit or kneel, and lay your baby face down along your forearm, resting on your thigh, with their head lower than their body. Support their head and jaw with your hand, keeping your fingers off the soft part of their throat.
• Give up to 5 firm back blows between the shoulder blades with the heel of your hand.
• Check after each blow whether the object has come out.

2. Chest thrusts

• Turn your baby face up along your forearm or thighs, head lower than their body.
• Place the heel of one hand in the middle of the chest, just below the nipple line. The 2025 AHA and AAP guidelines recommend the heel of one hand for choking babies, because it pushes deeper than 2 fingers.Place 2 fingers in the middle of the chest, just below the nipple line (NHS).Place 2 fingers (NHS) or the heel of one hand (2025 AHA and AAP guidelines) in the middle of the chest, just below the nipple line, as your local first aid course teaches.
• Give up to 5 quick chest thrusts, about 1½ inches (4 cm) deep. Check after each one.

3. Repeat back blows and chest thrusts until the object comes out, your baby can cough or cry, or help arrives. Don’t leave your baby. If back blows and chest thrusts haven’t cleared it and no one has called yet, call or have someone call 911999your local emergency number now (on speaker if you’re alone), and keep going.

If your baby becomes unresponsive, lay them on a firm, flat surface and shout for help. Make sure the emergency call has been made (on speaker), and don’t leave your baby. Open their mouth: only remove an object if you can clearly see it and easily grab it. Never sweep blindly with your finger. Then start infant CPR as you were taught. US guidance (Red Cross, AHA and AAP) begins with chest compressions. Look in the mouth again before giving breaths.The NHS begins with 5 rescue breaths, then gives 30 chest compressions to every 2 breaths. For a baby under 1, the NHS describes compressions with the tips of 2 fingers.Follow the method your local first aid course teaches. Look in the mouth again before giving breaths. For why US and UK steps differ, see choking first aid.

Even if the object comes out, get medical help. Part of it may still be stuck, or your baby may have been hurt.

These steps are for babies under 1. Children over 1 get back blows and abdominal thrusts instead (see below).

First aid for a choking child over 1

If your child is coughing loudly, encourage them to keep coughing and don’t leave them. If the cough is silent or they can’t breathe in properly, shout for help and act now.

Have someone call 911. If you’re alone and your phone is with you, call on speaker and start back blows straight away. Don’t leave your child to find a phone.Start back blows and abdominal thrusts straight away. If the blockage hasn’t cleared after one round of each, call 999 (on speaker if you’re alone) and keep going.Have someone call your local emergency number (such as 112 in Europe or 000 in Australia). If you’re alone and your phone is with you, call on speaker and start back blows straight away.

If you can clearly see the object and can easily pick it out, remove it. Never poke blindly or repeatedly with your fingers.

1. Back blows

• Lay a small child face down on your lap, as you would a baby. If that isn’t possible, support your child leaning forward and stand behind them.
• Give up to 5 firm back blows between the shoulder blades with the heel of your hand.
• Check after each blow whether the object has come out.

2. Abdominal thrusts

• Stand or kneel behind your child. Put your arms under their arms and around their upper tummy.
• Make a fist and place it between their belly button and their ribs. Grasp it with your other hand.
• Pull sharply inwards and upwards, up to 5 times. Check after each one.
• Don’t press on the lower ribcage, as this can cause injury.
• Abdominal thrusts are for children over 1 only. For babies under 1, use chest thrusts (above).

3. Repeat back blows and abdominal thrusts until the object comes out or help arrives. Don’t leave your child. If back blows and abdominal thrusts haven’t cleared it and no one has called yet, call or have someone call 911999your local emergency number now (on speaker if you’re alone), and keep going.

If your child becomes unresponsive, lay them on a firm, flat surface and shout for help. Make sure the emergency call has been made (on speaker), and don’t leave your child. Open their mouth: only remove an object if you can clearly see it and easily grab it. Never sweep blindly with your finger. Then start child CPR.

Even if the object comes out, get medical help. Part of it may still be stuck, or your child may have been hurt by the thrusts.

An infant and child first aid and CPR class is the best way to feel ready. The American Red Cross and local hospitals run them, often online or in a single session.St John Ambulance and the British Red Cross run baby first aid courses, including online.Your national Red Cross or Red Crescent society, or a local hospital, may run one near you.

Lowering the risk of choking

• Sit your baby upright, in a high chair if you can, and stay with them the whole time they eat.
• Serve foods soft enough to squash between your fingers, in one of two sizes: long pieces about the size of an adult finger that your baby can hold in their fist, or small pieces no bigger than about 1 cm (just under ½ inch). Avoid in-between chunks.
• Cut grapes and cherry tomatoes lengthwise into quarters, and squash blueberries flat.
• Under 1, skip hot dogs, sausages and meat sticks altogether. For toddlers, cut them lengthwise into thin strips, then into short pieces, never round coins.
• Don’t give babies whole or chopped nuts and seeds, spoonfuls of thick nut butter, popcorn, whole grapes, hard raw vegetables or fruit (like raw carrot or apple), chunks of meat or cheese, or hard, sticky or gooey candy.
• Keep mealtimes calm: no eating in the car, while walking, or while lying down.