Facts about newborns gagging in their sleep

Choking is a medical emergency. If your baby is choking, start baby CPR and call 911.

Do babies have a gag reflex?

The gag reflex is activated when any object — like a finger, food, or a spoon — touches a sensitive area in the back of the throat. Stimulation of this area leads to an automatic muscle contraction that pushes the object in the opposite direction, out of the mouth. In this way, the gag reflex is protective and can help prevent choking.

Babies usually have a strong gag reflex through about 6 months of age, around the time when they start solids. Some babies have a more sensitive gag reflex and may gag more often.

Gagging vs. choking: how do I know the difference?

Gagging is not the same as choking. If your baby is gagging, they may:

• Be noisy, or make coughing, gargling, or other sounds
• Spit up or vomit
• Thrust their tongue forward

If your baby is gagging, it’s important to let their body get rid of the object on its own. Do not place your fingers or any other object in your baby’s mouth to try to remove what they are gagging on. You may accidentally push the object further into their throat.

Choking is a quiet emergency. Choking happens when your baby’s airway is partially or completely blocked. Therefore, air cannot get through and your baby may not be able to breathe.

Signs your baby is choking include:

• Quietness
• Inability to cough or cry, or an attempt to make these sounds unsuccessfully (A partial cough means at least some air is able to get through and this is likely a partial blockage.)
• Face or lips turning blue or purple
• Struggling to breathe

If your baby is choking, perform baby CPR right away and call 911. Ensure you’re prepared for this type of emergency ahead of time by taking a baby CPR class from the American Heart Association or the American Red Cross. The American Red Cross also provides a general overview of how to perform infant choking CPR.

Can an infant choke on vomit or spit?

According to the American Academy of Pediatrics (AAP), the risk of a baby choking on their own spit or vomit is low, in part due to their gag reflex. It’s helpful to ensure you and any of your baby’s caregivers are trained in baby CPR.

Why does my newborn gag during sleep?

Newborns may gag in their sleep due to:

• Saliva: It’s normal for babies to cough or gag on their spit from time to time.
• Being sick: When your baby is sick, they may have thicker mucus or spit than normal, which may make them gag in their sleep.
• Reflux: Babies with reflux may spit up more often, which can lead to gagging or coughing.

Keeping your baby upright for about 30 minutes after feeding can help reduce reflux symptoms and make them less prone to spit up and gag during sleep.

What if my newborn spits up while sleeping?

All babies have reflux or “spit up” at some point. This is known as gastroesophageal reflux (GER) and is common in babies under 2 years old. Gastroesophageal reflux disease (GERD) is a more long-term, serious condition where reflux leads to continued symptoms or complications. 

A baby’s gag reflex is triggered by spit up or vomit, which causes them to spit it out or swallow it. Research shows that the risk of choking is low even with babies being placed on their backs to sleep. This applies to babies with reflux also. According to the AAP, the risk of SIDS outweighs the risk of your baby choking on their spit up or vomit.

The AAP does not recommend placing items in your baby’s sleeping space to elevate them or prop their heads up. Elevating your baby’s head may not work to prevent reflux symptoms and is not safe since the baby can roll into an unsafe position.