Restarting baby-led weaning after an actual choking

Question

My daughter choked on mango one month into baby-led weaning (and yes, I do mean choked: reddening, wide-eyed, silent). We banged the mango out and she was fine. I however, am far from fine.

I have been sliding back into purees since. She feeds herself (pincer or spoon), but the food is still chunky, over-the-counter puree; soft lumps like rice or grits; or baby fingernail size bits like cheese. I have been unable to get passed this fear of a choking encore.

I am frustrated trying to find support for my particular case. The "official" BLW sites go on at length about the difference between choking and gagging, so it's hard to separate good information on "how to prevent choking by appropriate sizing" from all the noise of "that's NOT choking". Seriously people, if you can hear it, don't fear it. You will know choke face.

So here's the deal. 11 month old, who has choked once, who still has no teeth, who shoves as much as she can in at once. Exactly what shape and consistency should "sticks" or "pieces" be? Can I get concrete examples of banana, avocado, gourds, chicken, and any other foods you think would be good?

Answer 1

That sounds like my one year old. He has a few teeth - 4 of them - but really doesn't make much use of them; incisors aren't that helpful at proper chewing (and he only got the bottom two a month or two ago). He's been shoving food into his face since he was 4 months old, never liked purees. Definitely have had a bunch of choking incidents, although all but one were quickly handled by him (undoubtedly some were 'gagging', but some were definitely choking). The one that we had to help with wasn't too bad, I think a piece of chicken.

Speaking to the psychological factor, I don't really have a good suggestion; you may have to just figure it out yourself with some time. You're a good parent, you were watching very carefully, and you took care of business. If it happens again, you'll do the same. Your baby will learn how to handle solid foods, but the only way she'll learn is by having them and working it out. On the other hand, if you delay things a few weeks, she's not going to be any worse for the wear (as long as it's not several months).

In terms of strategies for the baby, I recommend limiting the amount of food on her plate/tray. Sometimes our youngest does the same thing - overstuffs his face - and we generally remove his food from his tray at that point until he slows down, and then add a bit back at a time. You also could introduce the fork, if you haven't yet; our 12 month old can use a fork more-or-less, and really enjoys it. It serves the dual purpose of taking food to the mouth AND limiting how much can go up at once - especially if you let her feed herself with it rather than helping too much.

Foodwise, the foods you listed sound good (except for gourd, I don't know that I know what that is like). Banana and avocado are excellent, good sources of nutrition both (particularly avocado). I would give relatively large pieces of either; as long as the banana is pretty ripe, she can probably have that whole, and treat it like a lollipop; or if it's easier, cut it in half lengthwise. Avocado we usually slice in thin strips, sort of the size of sliced chicken breast on a chicken caesar salad.

Meats we try to cook in a way that they end up moist and fall apart tender. Braised beef or chicken is probably best, or a pot roast cooked in its juice. Chicken also can be poached at length. In any of those dishes, the meat should end up so tender that you can cut it with a fork, and it turns stringy. Cut it into one inch or so lengths, and use the fork to break it up some. Hamburger works very well - cut it up finely with a fork, make sure it's not overcooked. Crumble is what your'e aiming for. Lunchmeats also work pretty well (she's old enough now not to worry too much about listeria); one inch squares are probably about right if it's thin-sliced or shaved, just don't let it get too piled up.

Breads are also good options. Slice them with no crust if the crust is hard (otherwise don't worry) into long strips. If needed, give one at a time. Bread is very easily gummed.

Other things that might work if supervised, and might especially work when she does teethe, are vegetables, whole or in large slices. Cucumber for example, if you can get a mini-cucumber like Costco around us carries, are great - they are teething helpers AND they eventually fall apart into mush rather than being a chocking risk. Whole carrots or whole celery, same.

Answer 2

I have 4 children and am a Registered Nurse. After seeing my friends use the BLW fad I am really concerned. With this method "Gagging and Choking" are considered normal and one which the child will "get better at" after around 10 months. My friends have been told by the BLW activists that this is very normal and that gagging, and choking is managed well by a baby. Gagging and choking are NOT OK, it indicates that the baby is having difficulty with what they are eating and are trying to clear their airway from whatever it is causing them to gag and choke.

The new mothers that I know are reluctant to use the traditional method of weaning onto solids because of the peer pressure they experience from other mothers who are sold on the BLW process, who think that gagging and choking often is OK. This new fad reminds me of the time many, many years ago, where the trend was to put a baby on their tummy to sleep. That fad lasted for many years and resulted in many baby deaths.

It is evident that BLW will increase the risk of aspiration pneumonia, choking and death. I would like to see a thorough assessment of this BLW FAD by a group of Independent Speech Pathologists. I am sure that the verdict will be "too high a risk" to do. Babies even at 6 months who are introduced to foods in the form recommended by the BLW activists have a very high risk of choking because they are not developmentally capable of eating chunks of food safely. I don't know about your experience but it is very difficult sometimes to dislodge a piece of food out of a baby's airway and I hope that you never have to experience this. With a sensible approach to introducing solids you minimize the risk of choking and baby can have a "pleasant" introduction to solids. I can't imagine that it is pleasant to gag and choke on food.

The BLW craze is gaining momentum. My advice is to see a Speech Pathologist who are specialists in swallowing before you try BLW.

Answer 3

I found this article helpful because it describes the kind of consistency the food should be. Baby should be able to mash the food against the top of the mouth.

http://edition.cnn.com/2016/09/20/health/baby-led-weaning-choking-risk/index.html

Also this study finds that choking is a serious hazard regardless of the approach used to introducing solids. It is not higher with BLW.

I read the BLW book and got excited but as we started with our daughter I am realizing the book is no substitute for exercising one's own judgement as a parent and we need to consider the motor skills of our babies since they all develop differently. Those things all have to kind of line up together for BLW to work well regardless of whether or not you have exactly the right size food.

I will also admit the book gives insight to avoid choking but then kind of waffles by saying the baby can just have what you are eating. One part says give them sticks or slices of things so they can hold it. Another part says chip sizes are fine. It is confusing. That is why I like the fact the cnn article talks about the consistency of the food.

Answer 4

I think Joe has answered the bulk or your question so I won't repeat his answers, but I think it's worth mentioning that choking can happen irrelevant of your chosen weaning method. So even if you decided to revert to spoon feeding pureé you're not going to completely cut out any risk. If baby is unbothered by what happened, you just have to get on with it. :)

In terms of recommended foods... for me the advantage of going down the BLW route was basically feeding baby what I eat: so curries, spaghetti bolognese, pies, puddings, the full works. The only thing you need to avoid is whole nuts and honey. If you stick to strips and sticks you're just limiting yourself.

Answer 5

We started our little one with baby-lead weaning when she was about 6 months old. We gave her soft fruit (kiwi, mango, watermelon) cut into pieces she could hold in her hand. Sometimes the mango had skin on it, sometimes it didn't.

She had the kinds of problems you'd expect, some gagging, choking a couple of times, but she just loved eating proper food, so we never stopped. We just made sure we were watching her at all times when she was eating and that we knew what to do when she was choking.

In the end, this is how she learned to eat properly. Now 2 years old, she'll still do something silly like put too much ham in her mouth, and she'll almost choke, but magically she'll manage to spit the whole mouthful out.

So my advice is to persist, and keep an eye on your little one.

Answer 6

To the OP - i feel you. I'm in the exact same position. My son choked on a leaf early on and i am terrified of an encore. I was aiming for BLW but a combination of the choking event and a toothless 9 month old that shoves way too much food in his mouth at once has stopped that. I would also LOVE concrete answers to size and texture of "pieces" of food to try with my son. Here's what has worked for us: roast fingers of sweet potato, potato and zucchini, then cut into cubes the size of a fingernail. My son squishes them with his pincers before popping into his mouth. The pieces are very smooshy. Same size pieces of mango, banana, mandarin, stewed pear and apple, smooshed blueberries.

Answer 7

I did puree weaning with my daughter but my second child, my son, his dad was adamant it will only be blw!! It puts the fear of God into me tbh.

I'm doing it as well as the lumpy/chunky puree food about 50/50 I'd say. He is as good as gold. So maybe I'm lucky he doesn't choke (not wanting to speak too soon!) he did choke on a strawberry a while back. He turned purple couldn't breathe etc but I made sure I'd read up on my baby first aid beforehand and no problems the strawberry came up. It shook me a lot, hence why I do 50/50 blw/slw.

He's 7 months old and eats what we eat with us most of the time and I tend to just give him porridge etc puree food to bulk out his diet as (be warned it's messy!) He drops quite a bit feeding himself as he shovels food in so fast.

I tend to slightly blanch the harder veggies and cut all foods into strips about the size of my baby finger. So far so good. I stay away from anything (obviously) dangerous or too hard. Just be careful if you want to try it. Obviously never leave your baby unattended while eating.

Try them with softer foods and nothin too fleshy i.e tomato etc. Babies really do cope well instinctively with gagging but at the end of the day your little one is precious so if you're not comfortable doing it simply don't.