Safe Feeding Practices to Prevent Choking
Any parents greatest fear is something happening to their child(ren).
We cringe when we hear of some dangerous or God-forbid fatal accident happening to another's child and we do everything in our power to prevent it from happening to our own. This is in our intuitive, protective nature as parents.
Minimize risk. Maximize well-being.
I hesitated to ever share on the topic of Baby Led Weaning (BLW) because it is such a new, somewhat unfamiliar, and yet increasingly trendy topic. Veggies and Virtue never intends to jump on and off bandwagons arbitrarily nor to generate hype over content that I would not endorse with my own kids.
My concern and thus motivation in sharing this multi-part introduction on BLW instead lies in the root of wanting to protect my own kids and others from the dangers of unsafe feeding practices. For any family considering BLW with their infants, this post is especially important to consider.
Feeding with Caution
As a dietitian, I cringe at the subject of choking. I know too many families have had to face their greatest fears of it happening in their own homes. Even in the fortunate instances when the child is okay, I know the lingering concern and proceeding caution with feeding their kids is real for parents.
This post will highlight safe feeding practices for families of children who self-feed.
Whether you are using BLW as the approach for introducing your infant to solids or you are in the process of transitioning a spoon-fed infant to finger foods, the following considerations all apply. While the developmental readiness at the ages these exposures occur may differ, the overarching concern of choking and recommendation to feed with caution applies to everyone.
Safe Feeding Practices
Allowing such oral motor skills to develop for self-feeding can be scary, especially for the first time parent (and grandparent!). Many parents shy away from BLW for this very reason. The concern for choking is a valid and evident one by parents and health practitioners alike. It requires the attention of any parent who wishes to use a self-feeding approach like BLW. To minimize the risk of choking and maximize safe feeding practices, there are a few actionable steps all parents can take.
Avoid Choking Hazards
The American Academy of Pediatrics says that children under 4 years old should not eat such foods (due to increased risk of choking): hot dogs or sausage; hard, gooey or sticky candy; whole peanuts, nuts, and seeds; whole grapes; chunks of meat or cheese; marshmallows; thick gobs of peanut butter; popcorn; chunks of raw fruits or vegetables (such as apples or carrots). Since young children's windpipe is only about the diameter of a regular straw, such foods could block a child airway if inhaled. For this reason, it is best to avoid such raw, hard foods or round, coin-shaped foods.
Offer Safe Finger Foods
What exactly the finger foods look like for an infant fed with BLW can vary. In general, most foods are shaped into a "finger-like" piece, about two inches in length and a half inch across. This makes them manageable for little hands to hold for self-feeding. The texture of such foods should be either naturally soft (like avocados, peaches, and mangoes) or cooked in a way that allows for safe eating (like steaming or roasting hard vegetables like broccoli, potatoes, and green beans). Thin sticks of firmer foods like cucumber, cheese, bread, and meat may also be given.
Even when offering appropriate finger food options, parents should ALWAYS supervise their child with food. Parents will learn how to understand the infant's ability to self-feed safely, while also recognizing if and when there is a reason to intervene in the case of an emergency.
Minimize Distractions While Eating
Beyond offering safe finger foods, parents can help establish a safe feeding environment by setting certain ground rules for meal times. While the table is to be an enjoyable place for meals, minimize any rough-housing, intentional attempts to get others to laugh, or moving around while eating. Each family member should assume their seat until a meal is finished, sitting in an upright position. This minimizes the risk for choking and promotes an environment where it will be obvious if indeed something unsafe does occur.
Understand Gagging in Infancy
By far one of the hardest things for parents doing BLW to come to terms with is the concept of gagging versus choking. With spoon-feeding purees, there is little concern that the infant will choke on the foods offered (even if they do indeed gag on it). With BLW however, the infant is self-regulating the amount of food they put in their mouths while also consuming a piece of food large enough to hold the potential for danger. This has the tendency to cause infants to gag at first, especially in the early days of solids being introduced.
The difference between gagging and choking however, is explained by Dr. Rapley as:
"These two mechanisms are related, but they are not the same thing. Gagging is a retching movement that pushes food away from the airway if it is too big to be swallowed...the reflex is triggered much farther forward on the tongue of a six-month old baby (compared to an adult's gag reflex), so not only is it activated more easily in a baby than in an adult, it also operates when the piece of food that has caused the gagging is much farther away from the airway. So when babies six or seven months gag on food it doesn't mean the food is too close to their airway and it rarely means they are in danger of choking."
Furthermore, research on infant feeding practices reminds us that gagging is very common among all infants, regardless of how they are introduced to solids. During a babies first year, "The place in the baby’s mouth where the gag reflex is triggered moves back, so that generally children can eat finger foods with little or no gagging at about 8–9 months (source)." This is why the gag reflex works so effectively in young infants to negatively reinforce the repetition of behaviors that caused such gagging to occur. Instead, infants who have been given the opportunity to try BLW with safe feeding practices often learn to self-correct such behaviors as putting too much food in their mouths and/or pushing it too far back very quickly.
Here is an example of what gagging may look like in an infant fed using BLW:
Recognize Choking Early
Although one study did find that 30% of parents reported one or more episodes of choking with BLW, parents also reported that the culprit was a hard piece of food (like apple). In each case reported with BLW, infants were able to independently deal with the choking by expelling the food from their mouth through coughing, requiring no first aid intervention from their parents.
While it should go without saying, it is important for parents to always watch and listen to their infant while eating. When the airway is partially blocked, parents may be alerted to the incident by their baby coughing to clear the object. This is usually effective and no intervention by the parent is needed. A total blockage of the airway however may not allow the infant to cough or make any sounds at all. While a total blockage is rare with proper BLW approaches, such situations do require someone else to dislodge the object from blocking their airway.
Educate Caretakers on CPR Readiness
There are certain rights of passage all parents look forward to. Performing the Heimlich maneuver on your child is never one of them. Despite this, all parents and caregivers should be equipped to provide this life-saving technique should a situation ever arise where it needs to be used. There are several classes available for infant CPR that are worth enrolling in prior to your child's arrival. After your sleep-deprived season with a newborn fades and feeding your child becomes on the forefront of your mind, refreshing the concepts of infant CPR with YouTube videos can be helpful.
Additionally, it is a good idea for every kitchen to have easy-to-understand infographics up for any caregiver to reference in the case of an emergency. Pinning this up inside the pantry door is a simple way to have this information easily accessible amidst a very stressful situation.
Run a Finger Swipe
As a general precaution, it is a good idea to do a quick finger swipe of your infant's mouth after a meal is finished. Using a clean finger, run it along the roof and sides of an infant's mouth. While an infant's tongue is still developing the strength to fully clear foods from its mouth, this helps to ensure that no pieces of foods got stuck during meal time.
A Final Note of These Precautions
Some parents may feel like this whole conversation is unnecessary. With traditional spoon-feeding techniques, the concerns mentioned above may seem avoidable. The reality is though that these precautions will always apply to feeding young children. When you begin to demonstrate such caution and concern however may vary depending on the feeding approach you choose to use during infancy.
Regardless of whether you spoon-feed your child or adopt BLW feeding principles, be sure to apply these principles to establish safe feeding practices in your own home immediately:
- Avoid choking hazards
- Offer safe finger foods
- Minimize distractions while eating
- Understand gagging in infancy
- Recognize choking early
- Educate caretakers on CPR readiness
- Run a finger swipe
We have no guarantees that our child won't run into an issue with eating, but it is both our role and responsibility to establish a safe feeding practices from the start.
From One Parent to Another
What about BLW or allowing your infant to self-feed in general worries you the most?