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Over 12,000 children go to the ER for choking emergencies in the U.S. yearly. Parents should be aware, children ages 6 months to 3 years old are at the highest risk for choking. Small, round and cylindrical objects are the most common choking hazards.
Any household item that can be passed through an empty toilet paper roll is considered a choking hazard. So, for your child’s safety, it’s important to educate yourself about choking.
Common choking objects include, but are not limited to:
- Toys with small parts
- Hair bows, hair clips
- Rubber bands
- Pen caps
- Button batteries
- Dog food
Common foods that pose a choking hazard risk include, but again are not limited to:
- Gel candies (gummy bears, Sour Patch Kids, fruit snacks)
- Carrots/other crunchy vegetables
- Nuts (peanuts, almonds, pistachios, etc.)
- Crusty bread
- Whole hot dogs
- Whole grapes
- Cherry tomatoes
- Large blueberries
- Mango/other large whole fruit pieces
There are several risk factors that can perpetuate a choking episode. Significant risks include unsupervised eating and consumption of food that is not age appropriate.
How can you as a caregiver respond appropriately in a choking situation? Choking occurs when an object/food becomes stuck in the airway (trachea) causing blockage of air, subsequently leading to prevention of oxygen to the lungs, brain and body.
If you see a child choking, call 911 immediately.
The following are age-related recommendations to prevent choking:
- Newborn-2 months: Make sure your infant sleeps on their back, in a crib with nothing else in the crib. Avoid any breakable toys. Check pacifiers for damage often. Replace your baby’s pacifier at least every two months.
- 4-6 months: Always be aware of surroundings, specifically when visitors are over. Vacuum and sweep often. Remove suspended crib toys/mobiles at 4 months old or when your baby can push up independently.
- 6-12 months: Always stay within an arm’s reach at mealtimes. Do not let older siblings feed your baby. Give a teething ring if your baby is teething and chews on their pacifier. Chewing on a pacifier can cause cracks or small broken pieces of plastic which can lead to choking. Store toys for older sibling’s up high, out of reach. Always keep pet food off the floor when your pet is not eating. Monitor your baby when your pet is eating and close food bags tightly at all times.
- 1-4 years: Avoid magnetic toys. Properly store batteries, especially button batteries, as swallowing a button battery can lead to severe complications. Avoid the use of latex balloons. Make sure your child always stays seated while eating. Always monitor meals.
The following recommendations are especially important to abide by:
- Slice hot dogs lengthwise twice until over the age of 5 years old
- Slice grapes, cherry tomatoes, large blueberries, mango, and other large fruit into smaller pieces until after the age of 5 years old
- No nuts/crunchy vegetables until after age 5 years old
Parental education regarding choking hazards should be given by your pediatrician during Well Child Checks along with other safety practices/prevention, including car seat/seatbelt safety, smoke alarms, guns, etc. If choking prevention is not discussed at your well child check, ASK.
Studies suggest parents who watch an educational video regarding choking hazards/safety have improved and retained knowledge. Thus, they know how to provide the safest environment for their child and how to respond in an emergency. Providers should encourage parents to take a CPR/lifesaving course to be prepared in an emergency situation.
As a parent or caregiver, you can take the initiative to practice these safety measures to help keep your child as safe as possible.
- Altkorn R, Chen X, Milkovich S, et al. Fatal and non-fatal food injuries among children (aged 0–14 years). Int J Pediatr Otorhinolaryngol 2008;72:1041–6. Centers for Disease Control-Choking
- Cy, C. Preventing Choking and Suffocation in Children. Canadian Pediatric Society Injury Prevention Committee. Feb 2012.
- Chapin, MM et al. Nonfatal Choking on Food Among Children 14 years or Younger in the United States 2001-2019. Pediatrics 2013.
- Hayes,NM., Chidekel, A. Pediatric Choking. Del Med J. 2004 Sep;76(9):335-40.
- Healthychildren.org (American Academy of Pediatrics)
- Choking Prevention Environmental Hazards New AAP Policy on Choking Prevention Pacifier Safety Responding to a Choking Emergency Safety for Your Child: Birth to 6 months https://dontchoke.ubc.ca/
- Lumsden AJ, Cooper JG. Arch Dis Child 2017;102:473–474. doi:10.1136/archdischild-2016-311750