Choking Prevention & Response

It’s a scary thought – an object trapped in your throat, not allowing air to move into or out of your lungs, requiring help to get it dislodged and enable you to breathe comfortably again. The only thing scarier as a parent is watching it happen to your child. 

Choking is PREVENTABLE. Food accounts for most choking episodes in children, but small objects such as toys, buttons, coins, marbles, and other small pieces can also cause choking episodes. From the time your child begins to explore the world through putting everything in his or her mouth, which is generally around 4-6 months of age, you must be careful and attentive to what is within reach. 

Common choking hazards in young children

As mentioned, food particles cause most episodes of choking in children, and the sizes of all foods must be monitored according to your child’s age. Babies, toddlers and young children are at highest risk of choking on food particles. Foods for infants should be soft and pureed until close to 9-10 months, when they are better able to handle textures and pieces of foods. Once they reach this milestone, however, it is still important to cut their foods into small pieces that are able to be swallowed whole – remember that just because babies or toddlers have teeth, they do not necessarily use them to chew and need to have foods that can be easily swallowed whole. 

• Cut foods to sizes no bigger than half an inch – about the size of your pinky fingernail. 

• Always supervise mealtimes and snacks, and make your child sit down while eating. 

• Do not allow your child to run around or lie down with food in their mouths. 

Some foods are more dangerous than others and should be avoided in children younger than 4 years of age, including:

• nuts and seeds
• whole grapes
• large chunks of meats, cheese, or raw vegetables
• hard candies
• popcorn
• chewing gum. 

Toys are designed to be used by a particular age range. Pay close attention to warning labels and age guidelines on toys – they are usually in place due to choking hazards with small or removal parts. Pay close attention to the size of toys – if it can completely fit in his or her mouth, take it away. This commonly includes marbles, Legos, coins, doll accessories, and balloons.

Additionally, be aware of interactions with older siblings – many choking episodes are caused by “helpful” older siblings who feed the baby inappropriate foods or gives a toy designed for older children to a young sibling. 

What can you do if your child is choking?

Since children are at a higher risk for choking, it is important for parents to know how to respond and help in case of a choking emergency. These occurrences must be responded to quickly, as it only takes a few minutes for permanent brain damage to occur as a result to lack of oxygen to the brain. Death can also occur. 

If your child is having breathing difficulty due to choking but is still able to speak or has a strong cough, do nothing but and encourage them – the cough is more effective than any intervention you may give. DO call 911 in case the situation worsens. 

If your child cannot breathe at all, or if the cough is very weak, immediate intervention is needed. First, you or someone else should call 911. Then, perform the Heimlich maneuver on your child. 

• For an infant (less than 1 year), place baby facedown on your forearm so that the head is lower than the chest. Support infant’s head in your palm and rest it against your leg, but avoid covering the mouth or twisting the head. Use the heel of the other hand to give 5 back slaps between the shoulder blades. Support the baby’s head and turn him or her face-up on your thigh, keeping head lower than body. Place 2-3 fingers in the middle of the chest just below the nipple line and give 5 quick chest thrusts. Repeat this process until the object pops out or emergency help arrives.

• For a conscious child, stand behind and wrap your arms around the waist of the child. Place the thumb side of your fist on the middle of the abdomen, below the lower tip of the breastbone. Grab that fist with your other hand, and press inward with rapid, upward thrusting movements. Repeat this until the object is dislodged or your child begins to breathe or cough. 

• For an unconscious child, lower the child to the floor onto the back and open the mouth. Hold your thumb over the tongue to prevent it from falling backwards, and at the same time pull the lower jaw up with your fingers. If you can see the object, try removing it with a sideways sweep of a finger. If you cannot see the object, do not blindly sweep as you can push the object farther into the airway. If no object is found and your child is not breathing, till the head back and lift the chin. Place your mouth over your child’s mouth and pinch his or her nose shut. Give two slow breaths into the child’s mouth. If this is not successful, kneel at the child’s feet and place the heel of one of your hands between the navel and the rib cage. Place the other hand on top of the first hand and press gently but firmly into the abdomen with six-ten rapid inward and upward thrusts. Repeat these steps – finger sweep if object seen, slow breaths, and abdominal thrusts – until the child begins breathing or emergency help arrives. 

While this is a good guide for what to do if your child is choking, it is beneficial for all parents to be CPR certified. Contact your local American Red Cross or American Heart Association office for information on where these classes are offered in your community.

Further resources

Poster for choking care: 

https://www.redcross.org/content/dam/redcross/atg/PDF_s/ConsciousChokingPoster_EN.pdf

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