Gagging New
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Gagging New
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Jennifer White has authored parenting books and has worked in childcare and education fields for over 15 years.
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Lyndsey Garbi, MD, is a pediatrician who is double board-certified in pediatrics and neonatology.
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Newborns tend to be quite noisy, making a variety of sounds besides crying, like sneezing and hiccuping . Most of these noises are reactions to new sound disturbances around them and are healthy signs that their nervous system is functioning and maturing.
But, you may have also heard your newborn make a gagging or gurgling noise, and this can be understandably alarming. Besides just a normal clearing of their throat, there may be other reasons why your newborn is gagging, and it all starts with some excess fluid left in their lungs after birth.
While a newborn baby is still inside their mother's uterus, their lungs are filled with fluid. Late in the pregnancy and before birth, fluid-secreting channels begin removing fluid from the baby's lungs, preparing them to take their first breath.
The passing of the baby through the mother's birth canal further helps to clear this fluid from the lungs. Contractions compress the chest, which leads to the fluid being squeezed out from the lungs. In addition, immediately following birth, a doctor suctions out excess fluid to further clear the throat.
However, for some babies, the fluid remains in the lungs, sticking around for a few days after birth. This can cause babies to cough as they try to clear the fluid themselves. Then, when the baby coughs or gags, the fluid and mucus come up, collecting at the back of the throat. This may then lead to a gagging or gurgling sound.
When a baby is born via C-section, they will likely have extra fluid in their lungs to expel because they didn't experience the "squeeze" of passing through the vaginal canal. Preemies may also exhibit more gagging noises simply because their lungs and ability to expel excess fluid are less developed. 1 Additionally, this may occur because they likely didn’t go through labor, which triggers a mechanism for babies to get rid of the fluid from the lungs.
For some newborns, not enough fluid is cleared from the lungs during labor. These newborns may have trouble breathing, as evidenced by rapid breaths (more than 60 breaths per minute). The condition, which is normally diagnosed in the hospital soon after birth, is known as transient tachypnea of the newborn (TTN) or wet lung disease.
TTN requires monitoring in the neonatal intensive care unit (NICU) in the hospital. Most newborns respond well to treatment, with breathing difficulties usually resolving within 24 to 72 hours. 2
If your baby is gagging during feedings, there may be an issue with the force of the flow of milk or formula.
If breastfeeding, your baby may need help dealing with forceful letdown or an abundance of milk . Try pumping for a minute or two before breastfeeding your child; the flow will slow down after the initial letdown.
If bottle-feeding , be sure to choose a slow-flow bottle and nipple. Pace the feeding and break the suction periodically to give your baby a "breather."
It's also possible that your newborn may gurgle simply because of air passing through the saliva or from refluxed milk as they gulp in air while feeding. This will go away as your newborn learns to swallow more frequently instead of letting the saliva build up in their mouth between breaths.
Some newborns, particularly preemies, suffer from acid reflux , which can cause gagging after feedings. In reflux, some of the milk that gets swallowed comes back up into the esophagus, causing the baby to gag and/or spit-up.
This is a common issue many babies experience to varying degrees, and it is especially common in the first few months of life. By 12 months, about 95% of babies have grown out of spitting up. 3
Burping your baby can help them clear regurgitated milk from their throat. Keep cloths or tissues handy to catch spit-up.
You'll know your baby's gagging and spitting up is normal if it doesn't appear to bother your baby. If it makes your child irritable and/or seems to be painful, this could be a sign of an underlying issue, such as gastroesophageal reflux disease (GERD).
If your baby is making gagging and gurgling sounds, you can help them clear excess fluid by:
Persistent gagging that does not distress your baby can be evaluated by your pediatrician.
However, if your baby seems is acting abnormally or something seems otherwise wrong, go to the nearest emergency room. Choking and trouble breathing are different from gagging and need to be addressed quickly.
Call 911 or rush to your nearest emergency room if your baby experiences:
If your baby stops breathing, begin infant CPR while you wait for medical attention. If you haven't been taught how to do this, find a CPR class near you so you are prepared in case of an emergency.
While seeing your newborn gagging can be alarming, try to stay calm and allow your baby's natural reflexes to help clear their airways.
Remember that we may think of babies as being quiet, but the truth is that they tend to be noisy—and most gagging sounds are not cause for alarm.
U.S. National Library of Medicine. Transient tachypnea - newborn .
Czinn SJ, Blanchard S. Gastroesophageal Reflux Disease in Neonates and Infants . Pediatric Drugs . 2013;15(1):19-27. doi:10.1007/s40272-012-0004-2
American Academy of Pediatrics (AAP). (2011) Choking Prevention and First Aid for Infants and Children . Itasca, Illinois: AAP.
Fangupo LJ, Heath AM, Williams SM, et al. A Baby-Led Approach to Eating Solids and Risk of Choking. Pediatrics. 2016;138(4):e20160772. doi: 10.1542/peds.2016-0772.
Reuter S, Moser C, and Baack M. Respiratory distress in the newborn . Pediatr Rev . 2014 Oct;35(10):417-29. doi: 10.1542/pir.35-10-417.
By Jennifer White
Jennifer White has authored parenting books and has worked in childcare and education fields for over 15 years.
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Volume 13, Issue 4 , July–August 1963 , Pages 611-616
Author links open overlay panel Arthur J. Krol D.D.S., B.S. * 1
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2002, Journal of Prosthetic Dentistry
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Causes of gagging may be classified into psychogenic and somatogenic. Gagging that occurs during various procedures such as intraoral examination, etc., is for the most part psychogenic. Such gagging is a result of excessive fear, apprehension, anxiety, etc., and occurs only when the patient is aware of the stimulus. This gagging can be reduced in direct proportion to the reduction of the awareness of the stimulus. If the patient's attention can be sufficiently diverted (e.g., by the effort involved in keeping the foot elevated from the footrest), intraoral procedures can be accomplished successfully.
Gagging that persists after the insertion of new dentures, or develops after dentures have been worn successfully for many weeks or months, must be considered as somatogenic. A careful study of such patients showed that an exaggerated increase of the occlusal vertical dimension was the cause of gagging. When the occlusal facial height was too great, the elevator muscles no longer relaxed normally. This disturbance, in turn, most likely affected all the musculature involved in swallowing and provided the stimulus for the gag reflex. When the occlusal facial height was reduced, gagging was eliminated.
The objective of this study was to evaluate the effectiveness of acupuncture point PC6 (Neiguan) in controlling nausea during intraoral impression taking. This study was conducted in Piracicaba, São Paulo, Brazil. The sample consisted of 33 adult volunteers with nausea, who were randomly divided into control and study groups, and treated with nonpenetrating sham acupuncture and real acupuncture, respectively, at acupoint PC6. The two groups had two maxillary impressions taken, one prior to acupuncture and the other after acupuncture. The nausea assessment was made using the visual analog scale, Gagging Severity Index (GSI), and Gagging Prevention Index. Volunteers' expectation that nausea would be reduced through acupuncture was also assessed. For statistical analysis, we used the t test and the Spearman correlation ( p < 0.05). When assessed by Gagging Severity Index/Gagging Prevention Index, nausea was reduced in the real acupuncture group ( p < 0.01). In the visual analog scale assessment, similar reductions of nausea were noted in both groups ( p > 0.05). No correlation existed between the expected and the actual reductions in nausea. Our results indicate that acupoint PC6 was effective for controlling nausea during the maxillary impression-taking procedure. Patients' expectation did not influence the results.
Gagging in dental patients can be disruptive to dental treatment and may be a barrier to patient care, preventing the provision of treatment and the wearing of prostheses. This article reviews the literature on the gagging problem from English-language peer-reviewed articles from the years 1940 to 2002 found by conducting an electronic search of PubMed, coupled with additional references from citations within the articles. Dentally relevant articles have been cited wherever evidence exists, and a balanced view given in situations where there is controversy. The first section considers the normal gag reflex and factors that may be associated with the etiology of gagging, including anatomical and iatrogenic factors, systemic disorders, and psychological conditions. A review of the management of patients with an exaggerated gag reflex follows and includes strategies to assist clinicians.
The gag reflex can be a normal, healthy defense mechanism to prevent foreign objects from entering the trachea. During certain dental procedures, however, gagging can greatly complicate the final result, especially during the maxillary complete denture final impression. A modification can be made to the maxillary custom acrylic resin tray to aid in securing a clinically acceptable elastomeric final impression. This modification involves forming a vacuum chamber at the posterior extent of the custom tray to which a saliva ejector tip is embedded. When the saliva ejector is connected to the low-volume evacuation hose, the chamber will trap any excess impression material that might extrude from the posterior border of the loaded tray. This results in a reduced chance of eliciting the patient's gag reflex.
Associate Professor and Chairman, Department of Prosthetic Dentistry.
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Babies
Feeding
Feeding in the First Year
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Baby-led weaning, or baby self-feeding, is more popular than ever when it comes to starting solids . But whether your new eater is feeding himself soft pieces of avocado, sweet potato, or other squish-able options or slurping purees off a spoon, you may see your baby gag and attempt to push food out of his mouth. Gagging may seem scary, but it's a natural part of the learning process and to be expected. That said, too much gagging isn't healthy.
Gagging is nature's way of protecting your baby's airway and a normal response to new tastes, temperatures, or textures. Be thankful for that gag reflex; babies learn from it! According to Diane Bahr, author of Nobody Ever Told Me (Or My Mother) That! , a newborn will gag if something unfamiliar touches the back three-quarters of the tongue. As babies grow, the reflex shifts even farther back. But by ten months of age, something must touch the back third of the tongue to elicit the gag. As the reflex moves farther back, babies learn how to tolerate new mouth experiences and continue to explore toys, foods, and fingers with his mouth, learning every step of the way.
In infants who are breast or bottle feeding, frequent gagging may indicate a loss of control of liquid in the mouth. Signs that your baby is in distress or having trouble keeping the liquid away from his airway include frequent coughing, color change around his lips or eyes, or sudden changes in breathing patterns. Children who are being spoonfed or are self-feeding and consistently gag multiple times per meal may be having difficulty coordinating mouth movements to safely managing solids, which can lead to serious complications. Discuss any of these signs and the frequency of occurrence with your pediatrician, who may refer your child for a feeding evaluation to determine why he's having trouble.
Gagging is not a comfortable experience. Children who gag frequently on a daily basis or always on specific foods or textures will likely develop an aversion to those foods. Learning to eat should be a pleasurable experience! Think of it this way: When babies are learning to walk, they toddle with unsteady steps, stumble, and fall. It's part of the developmental process and most kids get back up and try again. But if a child falls repeatedly and it hurts, he will learn to protect his body and may not want to try again for some time, instead relying on crawling. Eating is also a developmental process, and too much gagging can cause kids to stall in that development. This can lead to picky eating, fear of food, and scary food jags, where kids become highly selective and eat only a few different options for months. Food aversions are created with repeated negative experiences around food and require professional intervention. If you notice that your baby always becomes upset after gagging or avoids certain foods that cause him to gag, consult with your pediatrician, who may refer you to a feeding specialist .
Gagging can also be a sign of frequent gastroesophageal reflux (GER), where the stomach contents rise into the throat, causing baby to wretch. GER often occurs during mealtimes, but is also seen throughout the day, especially when baby is lying down or sitting in a car seat. Should you notice your child gagging away from meals too, it's important to share that information with his physician. If food or stomach contents are inhaled into the lungs, it can be life-threatening. GER can develop into gastroesophageal reflux disease (GERD), a chronic condition that requires intervention to prevent damage to the esophagus (food pipe).
Gagging is not choking. Gagging is a reflexive attempt to push something away from the airway, while choking is caused by food or an object partially or completely blocking the airway. When babies gag, it is not foolproof protection against choking. A gag may warn you of a possible choking episode, but not in every case.
Choking has little to no sound. It's unlikely you'll hear choking, but you will see it. Your child may be open-mouthed, wide-eyed and drooling with bluish skin around his lips or eyes. Partial obstruction may include audible gasps for air or faint noises. Always stay observant when your child is eating. Babies can gag and then choke, or they can choke without gagging first.
Here are some common signs that your baby or toddler is having difficulty learning to eat age-appropriate foods and is at risk for choking:
Stay calm, and observe quietly. Just like when a toddler falls as he is learning to walk, we don't want to over-react. Your baby will gag occasionally as he is learning to eat a variety of foods, especially in the first 12 months of life. If you don't see signs of choking, just wait a few seconds, and see if baby can remain comfortable and continue eating. Older babies or toddlers can then be encouraged to take a drink of water with a narrow straw, not a sippy cup with a spout. A straw will deliver just enough water to help wash away the tickly feeling and any residual particles of food. A sippy spout, which requires a child to tilt back the cup and tip up his chin to drink, can cause pieces of food to wash into the airway. Keeping the chin level or tilted down just slightly, as with a straw, decreases the likelihood of choking. Babies who have not yet learned to drink from a straw can be offered a baby-sized open cup (held by the adult) for tiny sips of water while their chin is slightly tucked.
Melanie Potock , MA, CCC-SLP, is an award-winning author, international speaker on parenting, and feeding expert. Her fourth book, Adventures in Veggieland: Help Your Kids Learn to Love Vegetables with 101 Easy Activities and Recipes will be published in October 2017.
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