Dealing with Gaging

A gag response is a normal reaction of the mouth and throat. In young babies, its purpose is to ensure that foods or foreign objects are not swallowed or breathed into the airway. Gagging pushes things forward off the back of the tongue and throat.

Newborns typically have a gag response when touched halfway back on their tongues. As babies spend time with nipples, fingers, toys, and spoons in their mouths, they usually become less sensitive, and the place on the tongue that sets off the gag moves farther back

The gag response continues to change as children develop. As children move from eating only liquids to runny strained foods, to thick strained foods, to soft lumpy foods and cracker pieces, it usually takes more and more to make them gag.

However, some children continue to gag very easily long after they should, to the point where it may interfere with their eating and drinking. This article looks at some of the possible causes of excessive gagging, and what can be done to help your child.

Hypersensitive Gag
A hypersensitive or overreactive gag is an exaggerated reaction compared to the response that would be expected. A child may gag when the spoon touches the tip of the tongue instead of the back of the tongue. Or a tiny lump may cause a gag well after the child's tongue and throat should be able to handle it.

Aversive Reaction
An aversive reaction goes one step beyond the hypersensitive reaction. It is a stronger, emotional reaction. The child will cry, fuss, pull away, push food away, or refuse even to let you near or in the mouth. Gagging may turn into vomiting in an aversive reaction.

Other Senses
Children can have hypersensitive and aversive gag reactions to a variety of factors, including food textures, smells, tastes, temperature, and even color. Once a cycle of these reactions is begun, all the senses can get involved.

Medical Testing
It is important to understand the cause of your child's hypersensitive gag, so that proper treatment can be determined. For most children, hypersensitive gagging is due to a general or oral (mouth) oversensitivity to touch or changes in touch. Treatment is designed to relax or calm down the overreaction

For some children, however, the reaction is due to an abnormal structure of the throat or esophagus (the tube that leads from the throat to the stomach), which makes it hard to swallow most foods. In other children, the esophagus does not efficiently move food toward the stomach. This can lead to collection of foods in the tube and gagging as it becomes too full.

Some children gag when they're stressed. Others gag when they have foods backwash up from the stomach with reflux. Still others gag as a response to unpleasant oral medical experiences. Still others use it to control the mealtime and the feeders. Your child's doctor can help pinpoint the exact cause of your child's problem.

Treatment Options
If medical testing shows any structural problem in the throat or oesophagus, the doctor will help you understand the next steps in medical treatment or Medications

Distractions
It often is easier to present new food textures and touches around the face and mouth and in the mouth itself if your child is distracted. Playing games while doing these things may help divert attention to the toy and away from the worry over the food or touch about to happen

Let Your Child Have Some Control

When you present new food textures, always start the meal with familiar,easytextures. Playfully tease your child with the spoon until the child leans forward and opens up to get a new mouthful. When eating seems to be the child's idea rather than yours, the overreaction often relaxes. Instead of pulling back and away from the presentation, the child is leaning forward in anticipation.

Summary
Gagging is an issue that upsets parents and children alike. Whether the treatment is medical, sensor)', or just a matter of changing food textures in a different way, gagging can be lessened. Gagging and vomiting can significantly interfere with your child's nutrition, and therefore, with growth and health. A team approach with your child's doctor, feeding therapist, speech therapist, occupational therapist, physical therapist, psychologist, and dietitian may help. The process may be slow, but together you will work it out. Reference
Wolf. L. S., and R. P. Glass. 1992. Feeding and swallowing disorders in infancy: Assessment and management. Tucson, AZ: Therapy Skill Builders.