The facts are sobering. According to the National SAFE KIDS Campaign, airway obstruction—or choking—is the leading cause of accidental death among children under one year of age. But it’s not just infants who are at risk. Figures from the Centers for Disease Control and Prevention indicate that over 2,800 people die each year from choking. Of these, the vast majority are children aged 4 or younger.

As anyone who takes care of children can tell you, kids will put just about anything in their mouths—and quickly—often without anyone even noticing. Young children are especially vulnerable to choking because they have small airways. An object or a piece of food either can become lodged in the airway itself or can compress the airway, leading to choking. Because of this, prevention is clearly the best strategy to use to avoid airway obstruction in children.

Keeping Mealtime Safe
While most parents and caregivers can quickly name the usual non-food causes of choking in children (marbles and latex balloons, for example), the Centers for Disease Control and Prevention reports that the most common cause of nonfatal choking incidents is food. Proper food selection, proper food preparation, and proper serving practices will help to minimize the risk of choking on food.

> Choose foods appropriate for your child’s age

Babies who are just beginning to eat table foods and who may have only a couple of teeth are simply unable to chew many foods. For them, offering cooked, softer foods is important, as is making sure that everything is cut into tiny pieces (think pea-sized!). As a child ages and gets more teeth, he or she can handle larger pieces of foods, but seeds, fruit skins, and very sticky foods should be avoided. Meat is frequently difficult for children to chew properly because of its texture. Always cut meat into small pieces or slice it thinly and then cut it up. According to the American Academy of Pediatrics, children don’t learn to chew with a grinding motion until about age 4. Until then, certain foods will present more of a risk and should be avoided (see the sidebar “Potential Causes of Choking in Children” for a list of these foods).

> Supervise your child during mealtimes

As tempting as it is to use your child’s lunchtime to catch up on chores around the house, don’t do it. Children need to be watched and assisted at all times when they’re eating. A child whose airway becomes obstructed with a piece of food often isn’t able to cry or call out for help, so keep your child in sight the entire time that he or she is eating.

> Teach children proper eating behavior

When it comes to choking, how a child is eating is as important as what she’s eating. A child who is eating while lying on the couch or a child who crams giant bites of food into his mouth is at risk for choking. Learning to sit up straight, eat at a table (or in a high chair), take small bites, chew thoroughly, and not rush through the meal isn’t thrilling to a child; but these are all important rules to learn for safety reasons. In addition, young children should never be allowed to run or walk when eating. The earlier a child gets used to these rules, the faster they will become second nature, thereby eliminating some of the mealtime choking risk.

Keeping the House Safe
Another important thing to remember when minimizing choking risks at home is “babyproofing.” It is an ongoing process, even a daily one. And frankly, considering that many choking victims are no longer “babies,” the task should really be called “childproofing.” Myriad items around the home pose a choking risk to children, and it takes a keen eye and a quick hand to remove those items from a child’s surroundings before a problem occurs. In many instances, organizing one’s home so that typical choking hazards are always out of a child’s reach is the best strategy. Here are some ideas:

> Keep clutter off the floor

If you take care of young children who are pre-walkers and toddlers, you know that everything on the floor is fair game for a child’s mouth! Therefore, keeping floors as clean as possible is a priority. This doesn’t necessarily mean mopping every day, but it does mean keeping the floor swept clean of old food bits, small objects, dirt and debris, small toys, and toy pieces. Older children in the house should be taught that they may play with toys with small parts only on a table that is out of baby’s reach.

> “Childproof” reachable surfaces

As silly as it sounds, a good way to see what your child can reach is to crawl around your house and get a kid’s eye view of it. Keep in mind that if the child can see the item, he or she may be able to find a way to get to it. Find out which tables, chairs, and bookshelves your child can see and reach—then you’ll know which ones need extra policing for choking hazards. Don’t forget to check between the couch cushions and under the couch. Other good ideas:

• Keep potentially dangerous household items, such as toothpicks, extra buttons, and safety pins completely out of a child’s reach. A box in a high cupboard or on top of the refrigerator, or a locked sewing basket make good storage places.
• Home workshop materials and tools such as screws, nails, nuts, and bolts need to be kept well away from kids. A locked workroom or workbench is useful in this regard.
• Jewelry is often tempting to young children, so keep all jewelry—especially earrings and rings—away from a child’s reach and out of sight.
• Install clips or locks on lower kitchen cabinets to prevent children from opening them.

Perform Routine Checks of a Child’s Possessions
With use, many of a child’s own possessions can become unsafe. For example, buttons can become loose and fall off a sweater or jacket, the nipple on a pacifier can detach, or a toy may start to come apart. All of the things that a child uses, plays with, or wears should be routinely inspected for safety. Toys are especially apt to get damaged and become dangerous. Getting in the habit of looking at things with an eye toward safety will go a long way toward preventing a choking accident.

What if My Child Chokes?
Sometimes, despite all precautionary measures, a child will choke on something. It’s good to be prepared by learning how to help a choking victim by learning how to perform a finger sweep of the mouth and other potentially life-saving techniques. The American Academy of Pediatrics recommends that parents participate in either the American Heart Association’s Pediatric Basic Life Support Course or the American Red Cross’s Infant and Child CPR Course. Classes that teach these techniques are usually available through local hospitals or Red Cross offices. Parents and other caregivers should be familiar with these important safety measures.

Want More Information?

National SAFE KIDS Campaign
1301 Pennsylvania Avenue, NW, Suite 1000
Washington, DC 20004-1707
202/662-0600
www.safekids.org

This is the first and only national organization dedicated solely to the prevention of unintentional childhood injury—the number one killer of children aged 14 and under. The organization can provide you with information, fact sheets, and safety tips on a variety of topics (use their website’s easy search function). They also have a resource catalog listing all their materials. Call 800/289-0117 to order the catalog, or download it from their website.

American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
847/434-4000
www.aap.org

This organization provides a wealth of information on child health and safety topics. Under the “You and Your Family” section you’ll find a list of their TIPP (The Injury Prevention Program) Fact Sheets, which give safety information for children of specific ages.

SafeUSA
P.O. Box 8189
Silver Spring, MD 20907-8189
888/252-7751
www.cdc.gov/safeusa

SafeUSA is a working alliance of major public and private partners dedicated to reducing injuries and deaths from accidents in American homes, schools, work sites, transportation areas, and communities. The website offers a wide variety of fact sheets. The choking fact sheet is titled “Preventing Choking Among Infants and Young Children” and can be found in the “Home” section, or through their search function under “choking.”

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