WHAT YOU NEED TO KNOW ABOUT CHOKING

WHEN STARTING SOLIDS

#1 It is totally normal to feel anxious when starting solids.

You are not alone! Starting solids is a new chapter for you and your baby, so it is okay to feel nervous
as you get started. In working with thousands of families, the one thing that we find really helps
parents get over their fear of choking when starting solids is education! The more you understand
the research and latest best practices surrounding baby-led feeding and self-feeding, the more
confident you will be serving food to your baby.

The purpose of this guide is to walk through the main topics you need to understand about choking
before starting solids. This information has helped other parents, so we hope it helps you too.

#2 Research shows baby-led feeding does NOT increase risk of choking.

Parents often assume baby-led feeding and finger foods increase the risk of choking, and we’re hear
to tell you that there have been two research studies conducted recently that prove that is not true.

The first research study was completed in 2016 and was known as the “Baby-Led Introduction to
SolidS (BLISS)” trials. The conclusion states that “Infants following a baby-led approach to feeding
that includes advice on minimizing choking risk do not appear more likely to choke than infants
following more traditional feeding practices.”
You can read the study summary here: https://pubmed.ncbi.nlm.nih.gov/27647715/

A follow-up study was conducted in 2018 and found similar results, “Baby-led weaning was not
associated with increased risk of choking and the highest frequency of choking on finger foods
occurred in those who were given finger foods the least often.”
You can read the full summary here: https://pubmed.ncbi.nlm.nih.gov/29205569/

Most parents are not aware these studies were conducted, and although additional research
could take place, it is reassuring that it has been tested and no increased risk of choking was found.
As stated in the second study, children who had finger foods the least often were at increased risk.
This is why we encourage parents who are thinking of starting with purees to consider a combination
approach of serving finger foods and purees so that baby can begin to learn to chew earlier rather
than later. More information on teaching your baby to chew later on in this guide.

#3 Self-feeding reduces the risk of choking.

We encourage parents to allow their baby to self-feed from day one for many reasons, one being
that it actually decreases the risk of choking. When babies are in control of WHEN and WHERE food
is placed in their mouth, whether that be purees or finger foods, their brain is much more aware of
what’s happening. This cognitive understanding helps to protect baby. For example, if a piece
of food is placed in baby’s mouth, it could easily fall into the back of their mouth without much
acknowledgment. But when baby is touching and bringing that piece of food to their own mouth,
they are 100% in control. The example we give parents is try having someone pour water into your
mouth, see how hard that is to coordinate? You would likely gag if they poured it too quickly.
Feeding yourself is much more natural and gives you complete control.
 WHAT YOU NEED TO KNOW ABOUT CHOKING
WHEN STARTING SOLIDS

#4 Understanding the difference between gagging and choking.

Whether you start with purees, finger foods, or a combination approach, understanding the
difference between choking and gagging is really important when starting solids.

When babies are first introduced to solid food around 6 months of age, their gag reflex is more
forward in their mouth than it is for an older child or adult. This is a protective measure to prevent
choking. It is common and normal for babies to gag when starting solids as they are not used to
having food in their mouth. As we introduce a variety of textures to baby, their gag reflex will move
further back. A great tip for helping desensitize baby’s gag reflex is allowing them to chew on a soft
silicone spoon, or by serving food in stick shapes, as we recommend in our program.

You will know baby is gagging when they are coughing, making retching sounds, have their
mouth open with tongue sticking out, or have watery eyes. It is best to let baby work out the
gag themselves. Do not hit or pat baby on the back. Instead, remain calm and encourage baby
to cough by coughing yourself, or sticking out your tongue. If baby has a large piece of food in their
mouth, do not attempt to remove it with your fingers. Rather, get down below baby’s eye level
and place your hand under their chin, encouraging them to spit out the food. Spitting out food
is a skill that baby needs to learn. Just remember if baby is coughing and able to make sounds, they
are not choking and it’s best to let them be. Stay calm and let them spit out the piece of food.

Choking is very different than gagging, and needs immediate attention. We always encourage
parents and caregivers to sit with their baby as they eat so they can identify quickly if baby needs
their help. Choking is silent and leaving baby unattended as they eat is not advised. Signs that baby
is choking includes inability to make noise (i.e. cough or cry), although a high-pitched wheezing
sound can also indicate choking, or if they are having difficultly breathing. This is when you need to
intervene and start infant CPR / choking response with strong back blows as soon as possible.

By taking an infant CPR course, you will learn even more about when you need to intervene and
help baby.
 WHAT YOU NEED TO KNOW ABOUT CHOKING
WHEN STARTING SOLIDS

#5 Taking an infant CPR & choking response course is NOT optional!

Although choking is rare, all parents and caregivers should take an infant CPR & choking response
course before starting solids. Even if you think you know what to do by reading something online, we
encourage you to take a full infant CPR & choking response course taught by a certified instructor so
you can have peace of mind that you know what to do in an emergency situation. It is important to
note that the CPR & choking response maneuvers do change based on who you are assisting, from
infant to toddler to child to adult. Please make sure you are familiar with all of these.

Because safety is the #1 priority when starting solids, we’ve partnered with Safe Beginnings to offer
the 101 before one community their best-selling Infant & Toddler CPR Online Training Course at
20% OFF. Holly Choi is a nationally-certified first aid instructor and has taught thousands of families
through her online courses and in-person classes. We have personally taken her class and can attest
that it is very detailed and the video demonstrations are helpful to see each step visualized.

You can also take an in-person class in your local area to get hands on experience as well. Either
way, in-person or online, getting this training completed will make you feel more at ease at meal
time!

Click here to learn more about the Safe Beginnings Online Course
Use code 101beforeone at checkout for 20% OFF

#6 Avoid serving baby high-risk choking hazard foods.

There are a number of foods that are not safe to serve infants and toddlers, so it is important that
you memorize this list of foods and educate family members and caregivers as well.

High-risk choking hazard foods include:

Raw fruits or vegetables, such as raw apple or raw carrots
Whole grapes, berries, cherries, tomatoes, or melon balls
Dried fruit, such as raisins
Whole nuts, seeds, or hard beans
Cooked or raw whole corn kernels
Popcorn
Hot dogs
Large chunks of cheese, especially string cheese
Hard or sharp foods, such as potato chips or pretzels
Hard candy, jelly beans, or chewing gum
Large globs or spoonfuls of nut butters, such as peanut butter
Cubes of meat or seafood, such as steak or shrimp
Marshmallows

Other foods that are round, sharp, or firm can also be choking hazards

Note: Any food can be a choking hazard, but we have listed some of the top high-risk foods above.
 WHAT YOU NEED TO KNOW ABOUT CHOKING
WHEN STARTING SOLIDS

#7 Know how to properly prepare and serve food to baby.

If you are following the baby-led feeding style of introducing solids, you want to make sure you are
serving each food correctly. Generally speaking, we serve food as sticks to babies from 6 to 9
months and the move to smaller pieces after 9+ months. There are quite a few differences between
serving various types of food, which is why our program goes into detail on how to serve vegetables,
fruit, meat, egg, seafood, beans, legumes, grains, nuts/seeds, and dairy. For more information on
how to serve food properly, please see our Online Program.

#8 Babies learn to chew with chewable solids.

Babies already know how to swallow when they are born, but they do need to learn how to chew.
The purpose of baby-led feeding is to teach baby to chew much earlier than the traditional
spoon-feeding/purees method. We go into more detail in our program, but essentially serving
stick-shaped finger foods are developmentally appropriate for a 6 month old to hold, bring to their
mouth, and activate their jaw to bite down, thus learning how to chew.

Since purees are almost like a liquid, baby is naturally going to suck and swallow. With finger foods,
baby has to learn to chew these foods, and the best way to teach baby to chew is to serve
chewable solids! Of course we also want to make sure we are serving the food correctly,
as noted in #7.

#9 Set up a safe environment for feeding.

The last topic is to make sure your baby is set up in a safe

feeding environment. The safest place for baby to eat
is sitting in an upright highchair that is not reclined.

As noted in the photo to the right, the 90-90-90 position

is ideal when baby’s hips, knees, and feet are all in this
position. Babies do not have a lot of core strength,
which is why we want to give them a place to rest their
feet. Having a footrest aids in stability and also swallowing.
When baby is comfortable with their feet planted, they
can focus on eating and not sitting.

We also want to share that eating on the go, whether that is letting baby eat while walking around
or in a car seat or stroller, can increase the risk of choking. Always keep baby stationary while eating.

#10 Ready to learn more?

We hope this guide has helped ease your stress of starting solids, and if you are ready to learn even
more about baby-led feeding, feel free to join our Online Course!