Gagging or choking? How to tell the difference at the table

The first time your baby gags on a piece of avocado, your heart may leap into your throat. Their eyes water, their tongue pushes forward, they retch and splutter, and then, just as you are about to grab them, they bring the food forward, chew a bit more and carry on. Gagging is one of the most alarming normal things a baby does. Knowing how it differs from choking will help you stay calm when you need to, and act fast when you must.

Gagging: noisy, red and working

Gagging is a protective reflex. In young babies the gag reflex is triggered further forward on the tongue than in adults, which helps stop food going too far back before they can manage it. Signs of gagging include:

• Coughing, spluttering or retching sounds
• Watery eyes and a red face
• The tongue pushing forward, sometimes with food coming out
• Sometimes bringing up a little milk or food

What to do: stay close and stay calm. Do not put your fingers in their mouth to fish the food out, as this can push it further back. Let your baby work it through. A calm face and voice from you helps. Gagging usually becomes less frequent as your baby gets used to textures.

Choking: silent and struggling

Choking happens when something blocks the airway. Signs include:

• Being unable to cry, cough or make much sound, or a weak, ineffective cough
• Struggling to breathe, or high-pitched noises when breathing in
• A frightened, panicked look
• Lips or face turning blue or grey
• Becoming floppy or unresponsive

The simplest rule: if your baby is coughing hard, encourage them to keep coughing. If they are silent and cannot breathe, act now.

First aid for a choking baby under one

1. Back blows: lay your baby face down along your thigh or forearm, supporting their head, with their head lower than their bottom. Give up to five firm back blows between the shoulder blades with the heel of your hand. Check their mouth after each one, and remove anything you can clearly see with your fingertips. Do not sweep blindly.
2. Chest thrusts: if that has not worked, turn your baby face up along your thigh or arm, head lower than their bottom. Place two fingers in the middle of their chest, just below the nipple line, and push sharply downwards up to five times. Check the mouth again.
3. Call for help: if the object has not come out, call your local emergency number (999 in the UK, 112 in Nigeria), or ask someone else to call while you continue. Take your baby with you to the phone if you are alone.
4. Keep going: repeat cycles of back blows and chest thrusts until help arrives or the object is cleared.
5. If your baby becomes unresponsive, the emergency operator will guide you to start CPR.

Even if the object comes out, your baby should be checked by a doctor afterwards, especially if you used chest thrusts. A baby first aid course is one of the best gifts you can give your family. Organisations such as the British Red Cross, St John Ambulance and the Nigerian Red Cross run them, and many are short and practical.

Serving food safely

• Always seat your baby upright to eat, never lying back, in a car seat, in a buggy or while crawling about.
• Always stay with them during meals and snacks.
• Offer food soft enough to squash between your finger and thumb.
• Cut grapes, cherry tomatoes and other small round foods lengthways into quarters.
• Never give whole nuts. Use smooth nut butters or ground nuts instead.
• Cook or grate hard foods such as raw carrot and apple.
• Shred meat finely, remove skin from sausages and cut them lengthways, and check fish for bones.
• Avoid popcorn, hard sweets, marshmallows and chunks of hard food.
• Do not force food into your baby's mouth, and let them feed at their own pace.

Fear thou not

For many parents, mealtimes in these months feel like holding your breath. Isaiah 41:10 offers a word for those moments: "Fear thou not; for I am with thee: be not dismayed; for I am thy God." That is not a promise that nothing will ever go wrong; it is a promise of presence. God is with you at the high chair, in the calm and in the scare. Learn the steps, prepare well, and then let yourself enjoy the messy, joyful work of teaching your child to eat.

A prayer for steady hands

Lord, when fear rises at the table, steady my heart and clear my mind. Help me to know the difference between learning and danger, and to act quickly and wisely if I ever need to. Thank you that I am never alone with my baby. Amen.