Choking, the fear is real.
Choking is without a doubt the number one concern parents raise at our Baby Weaning Classes. It’s understandable to feel nervous about giving your milk drinking baby a spear of broccoli; I felt the same way with my first baby. However, armed with the correct information you can minimise the risk of choking whether you’re using a 100% baby led weaning approach or offering some finger foods alongside spoon feeds.
Does Baby-Led Weaning Increase the Risk of Choking?
Research conducted in New Zealand showed that “Infants following a baby-led approach to feeding that includes advice on minimising choking risk do not appear more likely to choke than infants following more traditional feeding practices”. However, they also report that “a large number of children in both groups offered foods that pose a choking risk is concerning”.
The key here is that parents were offered safety advice before starting weaning, something which is, unfortunately, missing from much baby-led weaning (BLW) resources. Also, although not recommending BLW exactly, both the Irish and the UK weaning guidelines now recommend soft finger foods as being safe from 6 months alongside spoon-feeding.
The bottom line: With the right precautions, BLW appears to be a safe way to introduce foods.
Gagging or Choking
Before you start your baby on finger foods (or baby-led weaning), it’s important to know the difference between gagging and choking.
“Loud and red, let them go ahead. Silent and blue, they need help from you”
While gagging isn’t fun to watch or hear, rest assured that it’s nature’s way of protecting your baby’s airway. Gagging is very common in all babies, whether self-feeding or not. This is because your baby’s gag reflex is triggered farther forward on the tongue than in an adult. It moves back as your baby grows.
Even before introducing foods to your baby, help them to control the activation of the gag reflex by encouraging them to ‘mouth’ toys with a variety of textures. By about nine months, only the back third of the tongue will stimulate a gag, so gagging while eating will reduce. Choking, on the other hand, happens when food (or non-food items) obstruct the airway. Choking can be extremely dangerous.
Solid Start Safety Checklist
Here’s what you need to know to keep your baby safe while offering the benefits of early self-feeding.
Wait until your baby is six months of age and developmentally ready for solid foods
Know the difference between gagging and choking
Test foods before they are offered to ensure they are soft enough to mash with the tongue on the roof of the mouth (or are large and fibrous enough that small pieces do not break off when sucked and chewed, e.g. strips of meat) especially in the early months
Avoid offering foods that form a crumb in the mouth
Make sure that the foods offered are at least as long as the child’s fist, on at least one side of the food
Make sure your baby is always sitting upright when he or she is eating, never leaning backwards. Choosing the right highchair is vital
Never leave your baby alone with food; always have an adult looking at your baby when he or she is eating. Never sit your baby on your lap to eat, you won’t be able to see what’s happening
Never let anyone except your baby put food into her mouth; your baby must eat at her own pace and under her own control
Don’t offer toys or TV while eating. This isn’t a good habit anyway, but it’s better if your baby concentrates on eating without distractions
Take a Paediatric First Aid Course and or the least watch these First Aid Videos from the NHS and St John’s Ambulance. Babies can potentially choke on any food, even those considered safe, so knowing what to do if the worst happens is vital.
Foods to avoid or modify when starting solids
|Food||Why||Reduce the risk|
|Apples||Small and hard||Peel, cut into wedges and steam, microwave or roast. Once your baby has developed their pincer grip at about 8 months, you can grate and offer raw.|
|Butter Beans, Kidney Beans and Chickpeas||Small and hard||Chickpeas: peel and cut in half
Kidney beans: squash or serve as a spread
|Celery||Stringy||Avoid raw until 5+. You can cook until soft.|
|Citrus Fruits like oranges and mandarins||Fibrous||Peel each segment. Tinned mandarins are already peeled! Choose in juice rather than syrup|
|Corn||Small and hard||Cook until soft in a stew, offer corn on the cob or cut in half|
|Dried Fruit||Small and hard||Soak in boiling water and chop finely|
|Fruit with stones and large seeds or pips (e.g., watermelon, small stone fruits)
|Small and round||Remove stones from fruits
|Hard raw vegetables||Can break off into small hard pieces||Cook until squashable. Once your baby has a developed pincer grip, you can grate and serve raw|
|Leafy greens||Can form flap over the airway||Finely chop and cook until very soft|
|Nut butter||Sticky||Spread thinly or mix into wet foods like yoghurt/cereal|
|Nuts and seeds (pumpkin, sunflower)||Small and hard||As smooth butter or ground/milled|
|Chunks of meat||Compressible and can get stuck in the airway||Offer long strips before your baby has teeth so they can just suck. However, avoid ‘chunks’ of meat, slow cook to tenderise and then shred.|
|Peas||Small and hard||Squash with a fork|
|Pineapple||Stringy||Slice thinly across the grain of fibres
|Popcorn||Compressible and can get stuck in the airway||Avoid until 5+|
|Sausages and hot dogs or other foods cut into rounds or ‘coins’||Compressible and can get stuck in the airway||Don’t offer to under 1s due to salt content. After this, always but lengthways and to the size of your child’s pinkie nail.|
|Sweets/Lollies/Marshmallows||Small round, oval shapes and can be compressible||Not recommended to babies anyway! Avoid until age 5+|
|Whole grapes, cherries, cherry tomatoes, large blueberries, blackberries and raspberries||Round or oval shaped||Slice lengthways into quarters. Squash blueberries before serving.
Half raspberries and blackberries.