June is National Safety Month for children so I'm starting this month with an article on choking.
Most parents likely know that anything can be a choking hazard for little ones. This is why we childproof, don’t buy toys with tiny pieces, and implore the older siblings to put away such toys out of reach of the 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. This article will focus on edibles.
Young girl grabbing at throat and gagging
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 that 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. My previous article “Baby-Led Weaning - One Pediatrician’s Perspective,” posted 1/11/23, touched on this. This article will explore this topic further and include recommendations by the AAP (American Academy of Pediatrics).
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.
Babies should not eat while playing
My bias is that 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)
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
Many raw vegetables are too hard for toddlers
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
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
Chewy round candies are choking hazards and bad for the teeth!
Round or hard candy, jelly beans, caramels, gum drops, or gummy candies
Chewy fruit snacks
Most of the above are for 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.
Whole nuts and seeds should not be given before age 4
***If an infant or toddler has a choking episode, then develops fast breathing, coughing, or pneumonia 1-2 weeks later, aspiration is something to consider!
So other than 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.
Vegetables and grains should be sautéed or boiled until soft
Additional guidelines per the AAP:
Hot dogs are considered “the perfect plug” for a child’s airway 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!)
This is NOT the way to cut hot dogs. They should be cut into short strips lengthwise.
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
Chunks of peanut butter
Parent learning CPR on a baby mannequin
As a mom of a little one that choked frequently and suffered many back blows, I cannot emphasize enough the importance of CPR training for parents. These courses are offered by the American Red Cross and the American Heart Association with online versions. There are also online classes offered by Tinyhood (https://www.tinyhood.com/classes/infant-cpr-choking), InfantCPR.com, and the National CPR Foundation.
Witnessing choking in anyone is a frightening experience. Knowing what to do in that situation is invaluable and can be life-saving.