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  • Denise Scott

Beware of Food as a Choking Hazard

Feeding your child table food and what the rest of the family eats is exciting. This article is a reminder that little ones don’t chew well and that most any food can be a choking hazard. Children should never be left unattended while eating. Preventing choking is one of the reasons we childproof our homes, don’t buy toys with tiny pieces, and require older siblings to put away tiny toys, out of the reach of younger ones. We purchase items with childproof caps, keep shiny objects such as coins, magnets, and batteries out of sight, and even get on our hands and knees to search the carpet and floor for anything that could be put in their mouths. Many choking items are obvious, but this article will focus on food as choking hazards. 


Toddler girl with a bowl of fruit showing signs of choking - in this case on a whole grape.


The Statistics:


  • Choking is the fourth leading cause of unintentional death in children under 5. 

  • Food accounts for over half of choking episodes. 

  • In the U.S., a child dies every five days from choking on food.

  • Two-thirds of choking victims are infants under a year.

  • Some children who survive a severe choking episode have permanent brain injuries.


I will review what to avoid at which ages and how to better prepare items to reduce the risk of choking. This article will include recommendations by the AAP (American Academy of Pediatrics).


Baby eating while playing. Children should not eat on the go as this increases the risk of choking.


First and foremost, a baby/toddler/child should never be fed while playing or on the go. They should be seated upright, supervised, not rushed, and without distractions. Eating while crawling/walking/running/lying down increases the risk of choking. 


I consider everything a choking hazard initially. Babies do not chew well and like to stuff their mouths - a good reason not to put too many items on their plate or tray.


The following list of foods that are choking hazards has been taken from the CDC website: (https://www.cdc.gov/nutrition/InfantandToddlerNutrition/foods-and-drinks/choking-hazards.html)


Fruits/Vegetables

  • Cooked or raw whole corn kernels

  • Uncut cherry or grape tomatoes

  • Pieces of hard, raw vegetables or fruit, such as raw carrots or apples

  • Pieces of canned whole fruit

  • Uncut grapes, berries, cherries, or melon balls

  • Uncooked dried vegetables or fruit, such as raisins


Proteins

  • Whole or chopped nuts and seeds

  • Chunks or spoonful of nut and seed butter, such as peanut butter

  • Tough or large chunks of meat

  • Hot dogs, meat sticks, or sausages

  • Large cheese chunks, especially string cheese

  • Bones in meat or fish

  • Whole beans


Grain Products

  • Cookies or granola bars

  • Potato or corn chips, pretzels, popcorn, or similar snack foods

  • Crackers or bread with seeds, nut pieces, or whole-grain kernels

  • Whole-grain kernels of cooked barley, wheat, or other grains

  • Plain wheat germ


Sweetened Foods

  • Round or hard candy, jelly beans, caramels, gum drops, or gummy candies

  • Chewy fruit snacks

  • Chewing gum

  • Marshmallows

Pictured is a variety of hard and chewy candies which are choking hazards and should not be given to young children.


Most of the above refer to children under two, especially those under a year. Some pertain to older children (3-5 years): round and hard candies, uncut round fruit, and whole nuts. The AAP recommends that children under four should not be given whole nuts. In practice, I saw several toddlers who had aspirated a nut into a bronchus (passageway to the lungs) and had to have it removed surgically.


***If an infant or toddler has a choking episode, and then develops fast breathing, coughing, or pneumonia 1-2 weeks later, aspiration is something to consider!


So besides mashing and pureeing food, what else can be done to decrease the risk of choking?


  • Hard fruits and vegetables, like apples and carrots, should be cooked until soft enough to be mashed between your two fingers.

  • Before or after cooking, remove the fat, skin, and bones from poultry, meat, and fish.

  • Cut fruit into small pieces and remove any seeds or hard pits. 

  • Cut soft food into small pieces or thin slices.

  • Any foods with a slick outer skin, like hot dogs, sausage, and string cheese, should be cut into short, thin strips instead of round pieces that could be aspirated.

  • Cut small, rounded foods like grapes, cherries, berries, and tomatoes into small pieces.

  • Make sure grains are well-cooked and soft.


Additional guidelines per the AAP:

  • Hot dogs are considered “the perfect plug” for a child’s airways and should be cut lengthwise. (Better yet, hot dogs, although loved by many, are not a nutritious food for anyone and are better avoided! - my opinion, not the AAP’s) 


Photo depicting how NOT to cut hot dogs for children! These should be cut in short, narrow strips.


  • Do not give toddlers high-risk foods, such as hard candy, nuts, seeds, and raw carrots.

  • Cut grapes in quarters; slice lengthwise, then cut again.

  • No shellfish under a year

  • Chewing gum shouldn’t be given before age 5

  • Under 4 avoid: 

    • hard, gooey, or sticky candy

    • Peanuts, nuts, and seeds

    • Whole grapes

    • Marshmallows

    • Chunks of peanut butter

    • Popcorn


Finally, learn CPR. 


Parent practicing CPR to relieve choking on an infant mannequin.


As a mom of a little one who choked frequently and suffered many back blows, I cannot emphasize enough the importance of CPR training for parents. These classes can be found through your local Red Cross and hospitals.


Witnessing choking in anyone is a frightening experience. Knowing what to do in that situation is invaluable and can be life-saving.


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