What do I need to know about choking?

According to the Centers for Disease Control and Prevention (CDC), choking rates are highest for babies under one year old.  The majority of kids’ choking injuries are caused by food.  There are three basic steps in keeping kids safe from choking:

• Keep a watchful eye on children when eating and playing.
• Keep dangerous toys, foods, and household items out of reach.
• Learn how to provide early treatment (first aid/CPR) for children who are choking.

How can I feed my baby safely?

• Your baby should sit up while eating, and be supervised at all times.
• Teach babies from an early age to “chew” (or gum) food well.
• Don’t hurry your child when eating—allow plenty of time for meals.
• Only put a small amount of food on the tray at a time.
• Avoid peanut butter—it’s a greater allergy risk at early ages, anyway.
• Avoid round, firm foods and chunks (hot dogs, nuts, meat/cheese chunks, whole grapes, hard or sticky candy, popcorn, raw carrots, other firm, raw fruit or vegetable chunks).
• Hot dogs are not healthy or safe for babies.  If your toddler likes hot dogs, get a nitrite- and nitrate-free variety, and cut it in long, noodle-like strips.
• Avoid stringy foods like string beans and celery.
• Avoid commercial white bead products—they can form pasty globs in your baby’s mouth, and aren’t healthy anyway.
• Offer only a few pieces of food at a time.
• Cut meat and poultry across the grain, and into tiny fingertip-sized pieces.
• Food pieces should be no larger than one-half inch in any direction.  If in doubt, cut food into smaller pieces. 

What are some suggestions for safe and healthy finger foods?

• O-shaped cereals
• Well-cooked carrots
• Whole-wheat toast (remove crust)
• Scrambled egg yolk
• French toast (without egg white)
• Cooked peas (no pod)
• Very ripe pear chunks
• Well-cooked apple chunks
• Cooked pasta pieces (consider using whole-grain pasta)
• Tofu chunks
• Avocado dip or chunks
• Soft-cooked peas and beans

Find out more about feeding babies and feeding kids.

How can I feed my children safely, and what do I do if they choke?
Kids under age five can choke on food and small objects.  Believe it or not, a lot of the choking prevention advice for babies still holds for children up to 4 to 7 years old!

• The American Academy of Pediatrics says that children under 4 years old should not eat:
  • hot dogs
  • nuts and seeds
  • chunks of meat or cheese
  • whole grapes
  • hard, gooey or sticky candy
  • popcorn
  • chunks of peanut butter
  • raw vegetables
  • raisins
  • chewing gum
• Children under age 7 should not be given nuts, because they are still at risk for choking.
• Make sure your kids eat at the table, or at least while sitting down.  No running, walking or lying down while eating.
• Mealtime needs to be supervised by adults.  Older brothers and sisters are often not aware of what foods may cause a younger sibling to choke.  Many choking accidents happen when older siblings give dangerous foods to younger children.
• Learn CPR and first aid for choking.  Find a CPR course in your area.

What are the non-food choking hazards?

• Latex balloons:  Believe it or not, balloons cause more childhood deaths than any other toy.  Any substance that can take the shape of a child’s windpipe or airway (like balloons or disposable diaper stuffing) is a more dangerous choking hazard than a hard, solid object.  Children ages 3-8 are still at risk for choking on balloons.  Choose mylar balloons instead of latex rubber, keep uninflated or broken balloons out of kids’ reach, and supervise children under age eight when they are around balloons. 
• Small, loose, or broken toys and parts.  A small toy or part can easily become lodged in a child's ear, nose or throat. Children can be seriously injured or killed from inhaling, swallowing or choking on objects such as marbles, small balls, toys, or parts of toys that can be compressed to fit completely into a child’s mouth.
• Other hazardous items:  Coins, pen or marker caps, small button-type batteries (like watch batteries), or medicine syringes.

How do I childproof my house to prevent choking?

Each time before you set your crawler or toddler loose, get down on the ground and look for dangerous items.  Remember to check under furniture and between cushions.  If you have older kids, make sure your younger child can’t get to the toys with small parts.  While you are expecting a new baby, start training your older child to keep dangerous toys in the designated “small parts” area.  Supervise kids when they are playing.  Make sure your older kids don’t give dangerous toys or objects to your younger kids.  Follow age recommendations on toy packages—they often are based on possible choking hazards.

Be aware also of other kinds of airway obstruction injuries such as suffocation, strangulation and entrapment and how to prevent them and other injuries. 

What do I do if my child chokes?

Learn how to respond to an emergency by taking a first aid/CPR class.  Find a CPR course in your area.

Where can I learn more about related topics?

• YourChild:  Feeding Your Baby and Child
• YourChild:  Feeding your Child and Teen
• YourChild:  Food Safety
• YourChild:  Safe at Home: Childproofing

References:
American Academy of Pediatrics (AAP).   Choking:  common dangers for children.  Available at URL:  http://www.aap.org/pubed/ZZZ8QH03B7C.htm?&sub_cat=1.  Accessed 14 February 2005

AAP.  Choking Prevention.  Available at URL:  http://www.aap.org/pubed/ZZZSEN9YA7C.htm.  Accessed 14 February 2005.

CDC.  Nonfatal choking-related episodes for children 0 to 14 years of age—United States, 2001.  MMWR 2002.  Available at URL:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5142a1.htm.  Accessed 14 February 2005.

CDC National Center for Injury Prention and Control.  Choking epsodes among children.  Available at URL:  http://www.cdc.gov/ncipc/duip/spotlite/choking.htm.  Accessed 14 February 2005.Pl

National SAFE KIDS Campaign (NSKC).  Airway Obstruction Injury Fact Sheet.  Washington (DC): NSKC, 2004.  Available at:  http://www.safekids.org/tier3_cd.cfm?content_item_id=991&folder_id=540.  Accessed 16 February 2005.

Written and compiled by Kyla Boyse, R.N.  Reviewed by faculty and staff at the University of Michigan

Updated May 2008

U-M Health System Related Sites:
U-M Pediatrics

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The information and links we provide are reviewed by University of Michigan developmental and behavioral pediatricians and child psychologists who are experts in child behavioral health. In choosing the links we provide, we use strict criteria to ensure that the information is accurate, and the source is reputable. As much as possible, we focus on information that is based on research. In areas where there is inadequate research, we include information compatible with prevailing expert opinion.

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