What is gagging?

Newborns are born with a natural gag reflex. This reflex is triggered when something (like a finger, food, or a spoon) touches the sensitive area at the back of the throat. The body responds with an automatic muscle contraction that pushes the object forward and out of the mouth. This protective response helps keep babies safe by reducing the risk of choking.

Why do newborns gag?

Newborns have a strong gag reflex, which is most active during the first few months of life and usually remains strong until around 6 months of age, when babies start eating solid foods. This reflex is a normal part of development and acts as a built-in safety mechanism to help prevent choking.

Some babies have a more sensitive gag reflex than others, which means they may gag more frequently, even from small amounts of milk or saliva. Over time, as your baby’s nervous system matures and their swallowing and eating skills improve, the gag reflex usually becomes less sensitive.

Why do newborns gag during sleep?

You may notice your newborn gagging in their sleep. This is because it’s normal for babies to cough or gag on their spit while they sleep. This is especially true when they’re sick and may have thicker mucus or more spit up in their mouth. Babies with reflux may spit up more often, which can lead to gagging or coughing.

If you notice your baby gagging in their sleep, keep them upright for 30 minutes after feeding to help reduce reflux symptoms during sleep.

What’s the difference between gagging and choking?

Gagging and choking may look similar at first, but they are very different. Gagging is usually noisy and protective, while choking is often silent and dangerous.

When your baby is gagging, you may notice that they:

• Cough, gag, or make other noisy sounds

• Spit up or vomit

• Push their tongue forward or make exaggerated facial movements

When a baby is choking, their airway is blocked, and they may:

• Be unable to cry, cough, or make sounds

• Have trouble breathing

• Appear panicked

• Turn bluish in color (lips or face)

If your baby is choking, perform baby CPR right away and call 911. Ensure you’re prepared for this type of emergency by taking a baby CPR class from the American Heart Association or the American Red Cross. The American Red Cross also provides a general overview of how to perform infant choking CPR.

Gastroesophageal reflux vs. gastroesophageal reflux disease

All babies spit up, but some spit up more than others. When babies spit up, also known as reflux or gastroesophageal reflux (GER), the content in their stomach moves in the esophagus and into the mouth. GER is normal and is common in babies under one year old

Reflux is temporary, and most babies outgrow reflux as their digestive system matures, between 4 to 6 months. Gastroesophageal reflux disease (GERD) is a more long-term, serious condition where reflux leads to continued symptoms or complications, such:

• Refusing feeds or drinking very little milk

• Crying, fussiness, or arching their back during feeds

• Spit-up that contains blood or looks green

• Increasing frequency or intensity of spit-up over time

• A swollen, hard, or distended belly

• Breathing issues such as wheezing, coughing, or trouble breathing

How to help babies sleep with reflux

If your baby spits up often at night, the good news is that it’s temporary. Here are safe sleep practices that can help protect your baby with reflux:

Always place your baby on their back

Parents worry that placing babies on their back to sleep may increase their risk of choking on spit up. This is a myth. Thanks to their gag reflex, babies swallow or cough up fluid to keep their airway clear, which prevents choking. Babies placed on their backs to sleep are not at an increased risk of choking. Back sleeping is the safest sleep position and significantly reduces the risk of sudden infant death syndrome (SIDS). 

Use a firm, flat sleep surface

Put your baby to sleep in a crib, bassinet, or pack n play with a fitted sheet. If your baby falls asleep in a stroller, swing, or car seat, transfer them to a safe sleep surface.

Avoid wedges and sleep positioners

While they may be marketed for babies with reflux, wedges and sleep positioners are not safe sleeping solutions. Semi-inclined positions do not reduce reflux and may increase the risk of your baby sliding into a dangerous position that could inhibit breathing. Similarly, elevating the head of the crib is not effective or safe.