Gagging

Gagging is caused by the gag reflex, or pharyngeal reflex.

Usually, the reflex is activated when something touches the base of the tongue or tonsil area, but it can also be triggered by your other senses, including taste, smell, sight, and sound. That will cause you to experience symptoms of gagging that include muscle convulsions and noises. 

Continue reading to learn more about the symptoms of gagging, and when they might be cause for concern. Why gagging is so common in babies, and what you should do if your infant is gagging also are covered.

Symptoms of Gagging

The main symptom of gagging is the contraction of the pharyngeal muscles. When these muscles contract, the soft palate, located in the back of the roof of the mouth, also raises up. These muscle movements are meant to move food or anything else in the mouth toward the front of the mouth in order to avoid choking. 

Additional symptoms of gagging include:

• Coughing
• Spitting up food or vomiting
• Abdominal contractions
• Retching noises

The gag reflex is controlled in the brain stem. The brain stem also includes the vagus nerve and medulla oblongata. These areas of the brain also control cardiac activity, vomiting, and the salivary glands. So, although rare, you may experience additional symptoms when you gag, including:

• Tears flowing
• Increased salivation, which may lead to drooling
• Sweating
• Fainting 
• Panic attack

Symptoms of Gagging in Babies

Infants have a more sensitive gag reflex than older children and adults. This makes it common for them to gag when eating new foods. Usually, this is not a cause for concern but rather a normal part of learning how to eat solid foods.

Symptoms of gagging in babies include:

• Watering eyes
• Making gagging noises
• Spitting out food
• Looks of confusion or distress

If your baby gags, remember it’s a natural reaction when learning to eat. However, if your baby isn’t making noise or the baby's skin changes color, they may be choking. Perform the infant Heimlich maneuver and call 911 if that happens.

Causes

Gagging is usually harmless. For infants, it’s entirely normal. But for adults it can be physically uncomfortable and embarrassing.

Common causes of gagging include:

• Inadequate chewing of solid foods
• Swollen tonsils or adenoids
• Gastroesophageal reflux disease (GERD)
• Hypersensitive gag reflex
• Dysphagia (difficulty swallowing)
  

Gagging protects you from choking, so it is a protective response if you try to swallow inadequately chewed food or accidentally swallowed objects. Inadequate chewing can be due to having poor-fitting dentures or lack of teeth. It may also be a habit.

If your tonsils or adenoids in the back of your oral cavity are swollen, this can lead to gagging as there is more contact between them and food, drink, or saliva that can trigger the gag reflex.

In GERD, stomach acid and contents reflux back into the esophagus (food tube), which can result in gagging in infants, children, and adults.

About 10% to 15% of people have a hypersensitive gag reflex. These people might gag in various circumstances, including when they have postnasal drip or when experiencing anxiety. They’re more likely to gag at the dentist, too.

A very sensitive gag reflex can interfere with your ability to try new foods or get dental exams. In extreme cases, this could lead to nutritional deficiencies, feeding problems, or dental health concerns.

Difficulty swallowing can result in gagging. Dysphagia can be caused by stroke, Parkinson's disease, Alzheimer's disease and other dementias, neuromuscular diseases (such as multiple sclerosis and amyotrophic lateral sclerosis), head and neck cancers, and dry mouth.

What Medications Can Cause Gagging?

Antipsychotic medications can have side effects (tardive dyskinesia and choreiform tongue) that cause swallowing problems in younger people or worsen swallowing problems in older people.

Medications that cause dry mouth can also lead to swallowing problems and gagging. These include:

• Medications for high blood pressure
• Antihistamines
• Anti-anxiety medications
• Anticholinergics
  
• Diuretics (water pills)
• Muscle relaxants
• Tricyclic antidepressants

How to Treat Gagging

If a baby or child is gagging but is still able to breathe and isn't choking, give them time to clear their throat and work through their swallowing problem. Monitor them to ensure they don't begin to choke.

If choking (airway is blocked) occurs in a child over age 1 or an adult, perform the Heimlich maneuver and call 911 if you are unable to clear the blockage and restore breathing.

Treatment for chronic episodes of gagging depends on the underlying cause. The person should be fully evaluated and diagnosed and treatment recommended that addresses the cause. Some types of treatment for these causes include:

• Swollen tonsils or adenoids: Switch to softer foods and consider pain relievers appropriate for the person's age. A bacterial infection may require antibiotics, while a viral infection won't be helped by antibiotics. Tonsillectomy surgery may be considered for chronic or repeated episodes.
• GERD: Lifestyle changes may help prevent episodes of acid reflux and gagging. These include elevating the head of your bed, losing weight if overweight, quitting smoking, and avoiding foods and drinks that you find aggravate the condition. Talk to a healthcare provider about over-the-counter (OTC) and prescription medications or surgery that may help.
• Dysphagia: Swallowing therapy may be needed. The person may also need to modify their diet to prevent gagging, such as switching to softer foods, pureed foods, or thickened liquids.
• Hyperactive gag reflex: Talk to your dentist or other oral health provider before a procedure. They may suggest measures to lower anxiety. Or, they may use local anesthetic or conscious sedation for needed procedures.

Are There Tests to Diagnose the Cause of Gagging?

If you see a healthcare provider for symptoms of repeated episodes of gagging in yourself or your child, they will conduct a medical history, report of symptoms, review of medications, and physical examination. This may be sufficient for diagnosing some conditions that can result in gagging, such as GERD.

Tests that may be performed to diagnose or rule out underlying conditions include:

• Neurological examination: This test of cognitive ability, motor strength and control, sensory function, gait (walking), cranial nerve function, and balance can indicate problems of the brain and nervous system that can lead to difficulties swallowing and gagging.
• Strep test: May be done if strep throat is suspected, which can lead to swollen tonsils.
• Imaging: X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), a barium swallow, or endoscopic examinations may be done to look for structural causes, functional problems, or conditions such as cancer.
• Swallow test: A speech-language pathologist can assess swallowing for dysphagia.
  

When to See a Healthcare Provider

Gagging is normal and common, especially in infants. However, a child or adult that frequently gags beyond infancy might have an underlying health condition.

Talk to your healthcare provider if:

• Your child is gagging frequently after infancy.
• Gagging is triggered by anxiety, postnasal drip, or other unusual causes.
• Gagging or worry about gagging begins to interfere with your normal routines or dental care. 

Summary

Gagging is a reflex that causes the throat and palate to spasm. This is meant to cause objects in the mouth to move toward the front to prevent choking. Gagging is common among babies who are learning to eat and less common among older kids and adults.

Other causes of gagging include inadequate chewing, difficulty swallowing, swollen tonsils, GERD, and having an overly sensitive gag reflex. If you gag frequently, talk to a healthcare provider.