Choking is a leading cause of death in children under age 4, and in the majority of cases, children choke on food items.
It’s important to avoid hard, sticky, or slippery foods in the first 4 years of a child’s life.
You can protect your child from choking by preparing their food the right way, creating a safe environment for eating, and avoiding known choking hazards.
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Anyone who’s been around a teething baby has observed their instinct to put anything they find in their mouth. This is a normal behavior and is important for children’s learning and development. But this also means that young children are especially vulnerable to choking hazards.
Some choking hazards are easy to spot — a coin, for instance. But others might surprise you — like sunflower seeds. While the rates of accidental choking have gone down in the last few decades, choking remains the fourth leading cause of injury and death in children under age 4. Read on to find out about how to keep foods safe for your kids at every age and stage.
The most common things that children choke on are foods, coins, and toys. About 60% of choking episodes are caused by foods. While toys are often labeled to help parents know what is age appropriate, no such labels exist for foods. According to a 2008 study, the top 10 food choking hazards for children younger than 15 are:
Hot dogs: The squishy consistency of hot dogs and the fact that they are often cut into coin-like shapes make them very lethal choking hazards. They can easily get stuck in a child’s trachea (breathing tube).
Peanuts/nuts: Nuts are often round and firm and can easily become lodged in a child’s throat.
Carrots: Raw carrots are too hard for children to chew safely, so it’s important to steam them and other raw vegetables.
Candy: Even though candy is marketed for children, the combination of hard and sticky food makes candy especially dangerous for young children.
Meat: If you do offer meat to your children, it’s important to cut it into small pieces.
Boned chicken: Children can bite off pieces of chicken that are too large, especially when it’s boned chicken.
Sunflower seeds: Since children have trouble removing the hard shell, it’s easy for them to swallow it whole.
Raw fruit: The peel of an apple, for example, can be hard for children to swallow, so it’s better to peel apples before giving them to a child. Mash or cut blueberries and similar fruits.
Fish with bones: Fish bones can easily get lodged in a child’s throat.
Popcorn: Children often don’t notice when they swallow a kernel, which can get stuck in a smaller airway.
Most non-food choking hazards are objects found throughout the home and even in common children’s toys. It’s important to be aware of the risks of these common choking hazards:
Coins: Coins are dangerous for kids, partially because they are so common, so it’s easy for your child to accidentally find and swallow them. It’s best to keep these far away from little ones.
Balloons: These are the number one cause of fatality from non-food choking episodes. Latex balloons pop easily — especially if children put them in their mouths. A child can inhale a piece of the balloon, which will then cover their airway.
Small toys: Most toys that are choking hazards are labeled as such, but make sure that toys don’t have small parts that can fall off. It can also be a challenge to avoid exposure to smaller toys when a younger child has older siblings around. It’s important to look for ways to keep an older sibling’s smaller toys out of reach at all times.
The way that you prepare and serve food to children can make it safer or more dangerous. Here, we’ll provide some tips to help minimize choking hazards with food:
Steam hard foods like carrots so that they’re soft enough to pierce easily with a fork. (A rough rule of thumb is that if it’s soft enough for you to hide with your finger and thumb, an infant can mash it with their gums.)
Peel apples and other fruits.
Cut foods lengthwise so that you don't give children food in circle shapes. Foods like hot dogs and grapes should be cut lengthwise and then into quarters. Try to cut food into small pieces (half an inch or less).
Make sure that your child is sitting upright in a high chair. Don’t feed your baby while they are lying in a car seat or propped up on a pillow.
Be sure to watch them while they eat. Just like at bath time, children should not be left unattended while they eat.
Remind older children to swallow their food before talking or laughing.
Don’t give young children sticky foods like toffee or caramels.
Don’t give them hard foods like hard candy, nuts, and seeds.
Don’t give them popcorn.
Make sure that children aren’t running or playing while eating.
First, check to see if your child is truly choking. Signs of choking include:
Putting their hand to their chest
Suddenly being unable to speak
The child’s lips and/or skin turning blue
A sudden stop in crying (in infants)
If your child is coughing or gagging but still able to breathe, you can wait a few seconds (up to 10) to see if they can clear the food on their own. Often, their cough reflex will be powerful and effective enough to clear the object within seconds. If your child is turning blue or appears to be having trouble breathing, you should act immediately.
For an older child, ask them, “Are you choking?” If they nod, stay calm, and tell them that you can help. If your child is unable to clear their airway or you can see that they are choking, first have someone call 911, or call as you go to administer help. Do not blindly do a finger sweep, as this can push an object more deeply into the throat.
For a child older than 1 year:
Stand behind the child.
Wrap your arms around their waist, and make a fist (thumb side in).
Place your fist in the middle of their body between their navel and ribs.
Press into their abdomen with a quick upward jab (inward and upward).
Repeat until the food or object comes out.
Once the object comes out, take your child to be evaluated by their healthcare provider. Sometimes, there might be a small part of the object still lodged in their airway.
For infants less than 1 year:
Place the baby face down on your forearm.
Rest your arm on your thigh.
Use the heel of your other hand to give the baby five quick, forceful blows to the area between their shoulder blades.
If this fails, turn the infant on their back so that their head is lower than their chest.
Place two fingers in the center of their breast bone, just below their nipples.
Press inward five times quickly.
Continue until they expel the object or help arrives.
It is always best to have these maneuvers done by someone trained in them, so if you have young children at home, it is a good idea to get CPR training. For new parents, nannies, or other caregivers of infants, The American Heart Association offers an at-home CPR training kit with an online tutorial that provides excellent hands-on training for infant CPR and choking relief skills. In-person training is preferable whenever possible so that a trained professional can check your maneuvers and offer corrections. Check here to find a CPR certification course in your area.
There are choking hazards throughout every home, most often in the form of food. While choking is a leading cause of death in children under age 4, learning about the most common causes can help you keep your home safe and your child more protected. Getting CPR training can also help you take simple, clear steps to help your child if they ever have a choking episode.
CDC. (2021). Choking hazards.
Committee on Injury, Violence, and Poison Prevention. (2010). Prevention of choking among children. Pediatrics.