Dietitian Approved Tips for Choking Prevention and Safe Baby Led Weaning

Caroline Weeks, RDN, LD, consultant dietitian who works with Ready. Set. Food! offers tips for baby led weaning and choking prevention.

So you’ve read about baby led weaning and want to give it a try with your child. What should you do and where do you start?

The first step in safely feeding your infant solids is understanding the developmental signs of readiness to eat. This provides a safe foundation (literally and physically) so that your baby is in good postural alignment for a safe swallow—no matter whether the food is puree or soft pieces.

The size of a young child’s trachea or “windpipe” is much smaller than that of an adult. Objects that are round and small – think button batteries, coins, small toys, or beads from amber teething necklaces-- are all classic examples of choking hazards. Any food can be a choking hazard if it is not safely and properly prepared for your baby. That’s why it is important to know what the appropriate types and shapes of foods are to start with.

The Do’s and Don’t of Safe Baby Led Weaning

Chart with the do's and don'ts of safe baby-led weaning

Fruits and Vegetables:

Do’s: Safe Options

Don’ts: Choking Hazards

Fruit or vegetables prepared soft (see below for details on shape)

Raw or uncooked vegetables in small pieces

When your baby is first starting to try baby led weaning, it is safest to offer soft cooked, mashable fruits and vegetables in stick or strip shapes about 2-3 inches long. This allows for your baby to grasp the food easily in the palm of their hand. This could include steamed carrot sticks, mashed banana, avocado strips, or baked sweet potato “fries.”

Grains:

Do’s: Safe Options

Don’ts: Choking Hazards

Serve bread lightly toasted

Gummy slices of bread

Alternative soft grain like Ready. Set. Food! Organic Baby Oatmeal

Pretzels

Teething wafer

Small tough crackers

Breads are best served slightly toasted, also cut into strips. You may spread a thin layer of butter or puree with added Ready. Set. Food! Mix-Ins to moisten the bread and also serve as another vehicle to introduce top allergens. If serving oatmeal or porridges to your baby, ensure that the texture is thinned to a slurry. Offer this on a loaded spoon and allow your baby to self-feed.

Meats:

Do’s: Safe Options

Don’ts: Choking Hazards

Avoid hot dogs altogether

Hot dogs cut into coin shapes

Tender, slow cooked meats (see below for details on shape)

Tough stringy meats

Meats in general are a tricky food group to serve baby due to the fact that by nature they are tougher to manipulate in the mouth. Utilize tools like slow cookers or marinades to soften and tenderize the meat before cooking and plating. When it comes to meats, generally bigger is safer—items like a chicken drumstick or tender meatball are easier for an infant to manage. Though generally a baby led weaning method of feeding skips over purees, some parents and caregivers find comfort in pureeing meat to a fine paste or watery puree and offering either as a topping for breads or in an open cup.



What Do I Do If My Baby Chokes?

The number one fear for any parent or caregiver is introducing a new food and risking their child choking. Note that choking is a response that requires medical attention and can occur at any age, no matter the skill level of the person eating. Gagging on the other hand, is a normal physiological response to your baby being introduced to new foods, textures and flavors. Baby’s trigger point for this inherent safety gag reflex is located at the front two thirds of the tongue, making them much more sensitive to this reaction. Your baby will most definitely gag as they learn the skill of eating.

The following key warning signs and symptoms are ones to watch for as these indicate the possibility of a choking response. If your baby is exhibiting any of the following signs, contact emergency services and rapidly intervene with life support maneuvers.

  • Skin color changes – becoming blue/purple or “dusky” in the face
  • Baby becomes silent and is no longer able to make noises like a grunt or cry
  • Baby shows a look of fear
  • Difficulty breathing or wheezing

It’s important to remember:

  • For gagging, baby will spit and sputter, cough, wince or cry. This is normal and baby can keep trying!
  • For choking, baby won't make a sound, lips may turn bluer, stop feeding immediately and tend to their safety.

How to Progress with Textures

As your baby grows and practices with food you can alter the shape and sizes to not only keep them safe and help promote their skill and dexterity of fine movements.

  • 6 months – Baby is just starting to eat and will grab food with a “palmar grasp.” Stick and strip shapes are best for this age, as noted above.
  • 8-10 months and beyond – Baby will develop a “pincer grasp” and should be able to pick up smaller pieces of food between thumb and pointer finger. You may foster this skill by cutting the pieces of food you serve into slightly smaller sizes, ensuring that the texture is still soft. Examples include cubed boiled potatoes, smashed berries, or beans.

Resources and Tips for Easing Your Mind

The following resources are some you may choose to explore as you continue your investigation of the right feeding method for your family.

Medical Resources:

  • Medical professionals such as pediatric registered dietitians, speech language pathologists, occupational therapists, and doctors may be able to further support your feeding journey.
  • Look into getting certified in infant CPR. Courses taught by institutions like the Red Cross offer comprehensive lessons in first aid and rapid response for infants and adults.

Seek online support:

  • Trusted online blogs and social media accounts may be a palatable way to digest information at your own pace. Watching videos of what is “normal” or seeing other babies recover from a gag, which is a normal response, is one way to ease a caregiver’s mind.
  • If you do venture to the internet for resources, ensure that the person you choose to follow possess the appropriate medical credentials and has experience in working professionally with infants of all developmental abilities. Look for medical professionals, listed above, as a starting point.

Lean on Support Systems:

  • Some of my personal clients and previous patients felt the most impactful element of support when feeding was having a partner physically there to watch them and guide them. This could be a spouse or partner, family member, or friend who is able to serve as a second set of eyes to watch your child as they eat.

Debrief with Family:

  • Though baby led weaning is by no means a new form of feeding infants and children, it is not always well understood or supported by some. Older family members who had previous experience with puree feeding may not agree or approve of this choice, so it is important to speak openly about your own reasons for pursuing this method as well as sharing some of the positive research associated with baby led weaning.

Note it is wise to seek help from a medical professional if your child has continued gagging with every meal despite an adequate consistent time frame of practicing with a variety of foods and textures or if they vomit with every meal as this may warrant further evaluation.

Introduce Allergens Safely and Easily with Ready. Set. Food!

All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.

These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.  If your infant has severe eczema, check with your infant’s healthcare provider before feeding foods containing ground peanuts.