What is the Difference Between Gagging and Choking?
- City First Aid
- Aug 3
- 4 min read
Updated: Aug 17
Few things make a parent/grandparent's/caregiver's heart race faster than seeing a child cough, splutter or struggle while eating.
It's one of the most common questions/fears we get on our first aid courses here in Christchurch.
This article reflects current New Zealand Resuscitation Council guidelines and is general information only, not a substitute for medical advice or first aid training.
First aid training gives you the confidence and hands-on practice to act quickly in an emergency.
If a child is choking, call 111 immediately.
Gagging vs Choking: At a Glance
Gagging and choking are not the same thing.
If you notice... | It is more likely to be... | What should you do? |
Loud coughing, spluttering or retching | Gagging or an effective cough | Stay with them, encourage coughing and watch closely. |
Unable to cough effectively, cry or speak | Severe airway obstruction | Call 111 and begin choking first aid. |
What is gagging?
Gagging is a normal protective reflex. It helps move food forward, away from the throat, so it can be chewed again or pushed out of the mouth.
Babies can suck and swallow from birth, but eating solid food requires learning how to bite or chew, manage different textures, move food around in their mouth, and control it before swallowing.
In young babies, the gag reflex is triggered further forward in the mouth than it is in adults. As babies grow and develop their eating skills, it gradually becomes less sensitive and is triggered further back.
Some babies gag more often than others when learning to manage solids and new textures. Gagging should generally become less frequent as this skill develop.
A child who is gagging may cough, splutter, retch, cry, have watery eyes, go bright red in the face, or even vomit. These are common signs of gagging, but coughing and noise can also occur when the airway is partly blocked.
Ask yourself "is this cough effective"? or "Is there enough force in the cough to clear the obstruction?"
What is choking?
Choking can present differently depending on how much air is still getting past the obstruction. If the cough is strong and effective, air is moving and the body is working to clear the airway itself, so noise here is reassuring, but not a cue to walk away.
But if the cough becomes weak, silent, or stops altogether, that's the sign of a severe obstruction, and they need immediate choking first aid.
What should I do?
If they are coughing effectively
Encourage them to keep coughing.
Reassure them and stay with them.
Watch closely to make sure they continue to move air.
Do not give back blows while the cough remains effective.
If they cannot cough effectively, cry, speak or breathe (severe airway obstruction)
Infant or Baby Choking (under 1 year)
Call 111 (or send someone else to call).
Support the baby face down with the head lower than the chest.
Give up to 5 back blows, checking after each one to see if the object has come out.
If still blocked, turn the baby face up, keeping the head lower than the chest.
Give up to 5 chest thrusts (same position as CPR, but sharper and slower). Check after each one to see if the object has cleared.
Continue alternating 5 back blows and 5 chest thrusts until:
the object comes out,
the baby becomes unresponsive, or
help arrives.
If the baby becomes unresponsive, start CPR: 30:2. 100-120 bpm, 1/3 depth of their chest. Deliver compression with 2 fingers in the centre of the chest. Before giving the rescue breaths, look in the mouth and remove anything you see.
Child choking (1 year old and up)
Call 111.
Give up to 5 back blows, checking after each one.
If unsuccessful, give up to 5 chest thrusts, checking after each thrust to see whether the obstruction has cleared.
Continue alternating 5 back blows and 5 chest thrusts, and checking after each one, until the obstruction clears, the child becomes unresponsive, or help arrives.
If they become unresponsive, begin CPR: 30:2. 100-120 bpm, 1/3 depth of their chest.
Can Choking Be Prevented?
As children learn to eat, offer foods that match their stage of development, supervise them while they're eating, encourage them to sit rather than walk or play with food, and be aware that hard, round, sticky and chewy foods are more likely to cause choking.
We are so lucky to have the Whānau Āwhina Plunket service here in Aotearoa New Zealand. They have a range of practical resources about feeding and introducing solids.
They also have a simple way to remember the difference between gagging and choking:
"Loud and red - let them go ahead."
"Silent and blue - they need help from you."
Practice Builds Confidence
Hopefully, this is knowledge you'll never have to use.
But if you're anything like me, I'd rather know what to do before I'm standing in the middle of an emergency.
That's why we spend time practising choking management in every first aid course we teach. Reading about it is one thing. Having someone coach you through it, answer your questions and give you the chance to practise builds confidence.
If you're looking for a course that's designed specifically for parents, grandparents and caregivers, take a look at our Little Ones, Big Questions course. It's a relaxed, practical session where we cover the everyday situations families ask us about most.
You can download the New Zealand Resuscitation Council Choking poster here
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