Can Toddlers Choke On Vomit While Sleeping? All The Things To Know To Keep Your Peace Of Mind

Toddlers choking on vomit during sleep is a myth that parents need to stop worrying about. Toddlers choking on liquid is normal, harmless, and temporary. What parents should look after are the signs of true choking, which is dangerous for the little ones.

Even babies are born with innate reflexes that are necessary for their survival. For once, they have a gag reflex preventing them from choking on whatever food or object that may touch the back of their mouths.

This gag reflex changes as the baby grows older. They also have a swallowing reflex for them to easily gulp back regurgitated milk.

What is the gag reflex?

Gagging is a protective natural reflex that produces the rhythmic contraction of the pharynx. It brings food up the mouth to prevent the baby from choking. This response is working even when the baby is sleeping to keep him safe from spit or vomit that may pool inside his mouth.

Gag reflex changes with the baby’s age and becomes a challenging stimulus once the toddler starts on solid food.

Newborn babies up to the 7th or 9th month of age have a sensitive gag reflex. It is positioned near the front of the mouth up to his middle tongue. This reflex keeps the baby safe from choking on objects.

Hence, nothing will get past his middle tongue as he quickly pushes anything out of his mouth. If he vomits while sleeping, his body will either naturally push the debris out of his mouth or swallow it to clear his air passages.

As he gets older, this gag reflex moves to the back of the tongue near his throat. It works by pushing out objects and clearing his airways with something that he cannot swallow.

It is always on full alert that sometimes babies will gag even with breastmilk, especially if you have a strong milk let-down. Even if the baby/toddler has a GERD and is sleeping on his back, there is absolutely no risk of choking at all.

Swallowing reflexes

The swallowing reflex is another natural protective stimulus that healthy babies are born with. It pushes food and liquid back into the pharynx and the esophagus to prevent clogging of the airways.

When babies regurgitate their food and milk back to their mouths while sleeping, these involuntary muscles work to keep them safe.

A baby’s swallowing reflex is on top effort when babies sleep on their backs. That is why the windpipe is located above his food pipe. Food or vomit at the lowest part makes it easier for kids to swallow it back.

Conversely, when he sleeps on his stomach, he is at high risk of aspiration or choking on food or liquid that pools in his airways. The same thing is true when he is sleeping on his side.

So do not fear thinking that babies and toddlers can drown in vomit while sleeping on the back. It is the safest position to put your child that also lowers the risk of SIDS.

Safe sleeping

A toddler boy is safely sleeping in his crib.

Now that we mention SIDS (sudden infant death syndrome), here is our brief guide on safe sleeping. Choking on sleep is also not the reason some babies suffered or succumbed to SIDS.

Babies who sleep on their backs and intermittently wake up are safe from it. Their built-in body reflexes are also working to keep them from sleeping too soundly and not waking up.

According to Boston’s Children Hospital, you can lower the infant’s risk of SIDS through:

  • Letting the baby sleep on his back
  • Setting the right room temperature
  • Provide a firm sleeping surface and without all fluffy stuff
  • Avoid smoking near the baby
  • Breastfeeding

Gagging vs choking: How to differentiate one from the other

Seeing your baby turning red and coughing while spitting up can be worrisome as it happens. But do not freak out since it is just a normal and natural response that healthy babies are equipped with.

Choking happens when your baby’s airways are blocked or obstructed. If you are worrying whether he is gagging or choking, here are their distinguishing signs.

A baby is gagging when he is:

  • Coughing, gurgling or sputtering loudly
  • Spitting food
  • Vomiting

True choking happens when:

  • Baby’s face is turning blue or ashen
  • Inability to cry
  • Silent coughing
  • Breathing difficulties
  • Produce high-pitch sounds
  • Look of terror on baby’s face

If you think that your baby is choking, do not waste time calling 911 and administering first-aid. The leading causes of choking in toddlers are food and tiny toys.

Always supervise your baby when eating and give them age-appropriate toys. Keep away all choking hazards to prevent such accidents from happening.


How do I prevent the baby’s vomiting or spitting up while sleeping?

Burping your baby after every feeding will get rid of excess air that causes them to spit up, become gassy, and colicky.

When should I worry about my baby’s gagging?

If spitting up and gagging makes your child irritable and in pain, contact your pediatrician. Spit-ups that bother your baby can be a sign of other underlying issues like GERD.  

How can I prevent choking and gagging when introducing solid foods?

Babies do not have a chewing reflex. It is an oral motor development that they need to learn as they grow. The safest way of introducing food is starting on soft and mashed ones. You can eventually introduce thicker textures and lumps to encourage their chewing and munching skills.


The involuntary reflexes that are born with your baby are their unique protective biological safeguards against hazards. Toddlers are less likely to choke on their vomit, especially when they are sleeping on their backs.

Regurgitated milk and food are either pushed back or out of their mouth to keep their airways clear.

Choking happens only when they take in objects or foods too big or hard for them to swallow. Proper supervision and avoiding hazardous foods, toys, and objects are protective measures for keeping your little one safe all the time.

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Ann Marie is a licensed nurse in the Philippines. She experienced handling and assisting deliveries of newborns into the world. She also trained in labor rooms and pediatric wards while in nursing school - helping soon-to-be mothers and little kids in the process. Though not a mother by nature but a mother by heart, Ann Marie loves to take care of her younger cousins as well as nephews and nieces during her free time.

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