Gagging and the Tongue Thrust Reflex – Weaning Difficulties

Oral reflexes

Infants are born with a number of oral reflexes that facilitate safe and effective feeding from birth. As your baby grows these reflexes either integrate to become movements that your baby controls more actively. Or they disappear, as they are no longer required. The gagging and swallowing reflexes adapt or mature and stay with us for life.

Tongue thrust and gag reflex

You might have heard of two of these reflexes specifically in relation to weaning your baby. The first is the tongue thrust reflex, which slightly confusingly has other names too such as extrusion reflex or tongue protrusion. The second is the gag reflex.

The tongue thrust reflex is stimulated with touch to the lips or tongue causing it to stick out. This movement may push food out of the mouth at the start of weaning and is a sign that your baby is not quite ready for solids. It is usually present until between 4-6 months after which is gradually fades.

The second of the two is the gag reflex. The gag reflex is designed to protect your baby from choking. In infancy, touch to the mid section of the tongue causes gagging: it gradually moves back in the mouth from 4-6 months. By around 9 months gagging will be triggered by touch to the back section of the tongue rather than farther forward.

Introducing solid foods and reflexes

The UK NHS guidance recommends that introduction of solid foods begins at around 6 months of age. This is dependent on your infants’ readiness for oral feeding. Amongst other developmental readiness cues, it is recommended that your baby has lost their tongue thrust reflex. i.e. when offered food on a spoon they do not instinctively push it back out with their tongue.

So in theory as you start weaning, both the tongue thrust and gag reflexes should be diminishing. However in some cases the tongue thrust remains, raising questions as to when and how to proceed with solids? Or the gag reflex is very much present and very pronounced. So what to do?

Managing the tongue thrust

Don’t panic! Stop and try again in a week or so. If you try again and your baby is heading towards 7 months and showing all the other developmental cues (see blog) then you can begin to wean regardless. Here are my tips for weaning with a tongue thrust reflex.

  1. If your baby has a dummy it’s time to ditch it as it will encourage forward tongue movements. This is the same if your baby sucks their finger or thumb. The digit sucking can be hard to break but if you are able to remove it from your baby’s mouth when you see them sucking that is a start.
  2. Make sure your baby is sitting well supported in their highchair. Having a stable body will support your baby with the fine movements needed to develop their oral motor skills. This means their body is at a 90-degree angle at the hips and knees. The highchair should have a correctly positioned tray and a footrest.
  3. If you feed your baby with a spoon be sure to sit at their eye level, keeping their head and neck in a neutral position. Which will in turn support their tongue to be positioned correctly in the mouth.
  4. Place the food at the side of their mouth. When your baby feels touch to the side of their gums where their molars will develop, their tongue will automatically move to the side of their mouth. This will stop their tongue protruding forward and will facilitate lateral tongue movement, which is required for chewing. Place pureed foods on your finger or small spoon and deposit it on the gums. For finger foods you can offer soft, dissolvable foods into the baby’s mouth at the side. They will bite and move their tongue towards it.
  5. Switch from a beaker to a cup with a straw. The shorter the straw the better. Sucking on a straw causes the tongue to retract (move back in the mouth), which again will help eliminate the tongue thrust reflex.

 Ready To WeanHelp with gagging

Again, don’t panic! Gagging is a normal protective reflex and should be expected in the early stages of weaning. If, however your baby is gagging more than you would expect, if it persists longer than you would expect or if your baby is becoming very distressed by it then here are my tips.

  1. Encourage your baby to mouth hard toys. Ideally they should be shaped so that they can go towards the back /sides of the mouth. If they gag try not to pay too much attention. Most babies won’t be bothered by this and will just continue to play. I like these from Ark therapeutics.
  2. You can do the same at mealtimes with very hard solid foods such as whole raw carrots. These can’t be actually eaten by baby. Ensure your baby can sit upright and is well supported in their chair. If doing this worries you then it is fine to skip this step and stick to practicing with non-foods. These first two tips help to push the gag reflex further back in the mouth.
  3. Give your baby opportunities to play with pureed food and encourage them to then take their hands to their mouth to eat it. This can be particularly helpful if their gagging is related to a sensory issue.
  4. Give home cooked foods, particularly if you are weaning your baby using a traditional spoon fed method. Pre-made purees are so finely blended that it can be very challenging to move a baby with a sensitive gag on from them.
  5. This leads me to the final tip, which is not to get stuck on smooth puree.  Even if your baby is gagging it is important to move through the textures. This may need to be done gradually, starting by making it slightly thicker and then grainier, lumpier in small steps and slow increments.

There are many reasons why your baby may continue to struggle with the tongue thrust and gagging reflexes as they wean. For some it is nothing more than those reflexes just needing a little bit more time and help to become less prominent. However, for others an underlying issue may mean that they require further assessment and support from a feeding and swallowing specialist speech therapist (SLT). If you have any concerns about your infant’s physical abilities to eat or drink then please do seek specialist SLT advice. You can do this via your GP who can refer within the NHS or contact Stacey directly for private support. Stacey@feedeatspeak.co.uk

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This blog was written by Stacey Zimmels, Paediatric Speech and Language Therapist and Lactation Consultant (IBCLC). Find out more about Stacey via her website or find her on Instagram.

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