Choking occurs when food or other small objects become lodged in a child’s throat or airway (trachea), preventing oxygen from getting to the lungs and brain. Children under the age of 5 years are at the greatest risk of choking. About two-thirds of all choking victims are children under the age of 1, according to the American Academy of Pediatrics (AAP).

Food is among the objects most likely to cause choking in a child. According to the U.S. Centers for Disease Control and Prevention (CDC), about 60 percent of choking-related emergency room visits by children age 14 and younger in 2001, the last year for which the CDC released data, involved food. Nonfood items such as latex balloons, coins and toys with small parts also can present choking hazards to children.

Children who begin to choke typically cannot breathe, talk or make noise. As choking persists, a child’s face may become bright red before eventually turning blue. If the child’s airway is not cleared, loss of consciousness will follow.

Choking should always be viewed as a medical emergency. When a child’s airway becomes blocked, permanent damage and even death from asphyxiation can result. Brain damage can begin just four minutes after the organ has been deprived of oxygen.

Children who cough forcefully or who have a strong cry should be allowed to try to expel the object on their own. However, basic first-aid steps should be applied if the child does not display signs of expelling the object. Treatment options to stop choking differ depending on the age of the child and include sharp blows to the back, the Heimlich maneuver and cardiopulmonary resuscitation (CPR). Parents and caregivers are urged to learn basic life support techniques from a trained professional, as they may injure a patient if not performed correctly.

The best way to prevent choking is to try to reduce a child’s exposure to items that may present a choking hazard. In addition, children should be taught to chew food thoroughly before swallowing, and young children should not be allowed to eat foods that present a potential choking hazard.

Choking occurs when food or other small objects become lodged in a child’s throat or airway (trachea), preventing oxygen from getting to the lungs and brain. From the time children are born, choking hazards are present. Children are especially at risk once they become mobile and begin crawling and eating solid foods. Children under the age of 5 years are at the greatest risk of choking. About two-thirds of all choking victims are children under the age of 1, according to the American Academy of Pediatrics (AAP).

Normally, air and food that enter a child’s throat share the same opening before they are diverted into two separate channels. Air travels down the trachea (windpipe) and into the lungs. Meanwhile, food and liquids travel down the esophagus and into the stomach. A flap of cartilage called the epiglottis covers the trachea every time a person swallows, which prevents food from accidentally going into the trachea.

In some cases, the epiglottis does not close the way it is supposed to during swallowing and allows food or other swallowed items (such as small toys or other objects) to slip into the trachea. The body usually will react to this by coughing and forcing the item back up. However, if the item becomes lodged in the trachea, choking may result.

Choking should always be viewed as a medical emergency. When a child’s airway becomes blocked, permanent damage and even death from asphyxiation can result. Brain damage can begin just four minutes after the organ has been deprived of oxygen. Children’s small upper airways put them at even greater risk of serious health damage as a result of choking.

In 2000, 160 children age 14 or younger in the United States died as a result of inhaled or ingested objects, according to the Centers for Disease Control and Prevention (CDC). In 2001, the last year for which the CDC released data, more than 17,000 children age 14 or younger were treated in hospital emergency rooms for choking-related problems, according to the CDC.

Food is among the objects most likely to cause choking in a child, and about 60 percent of choking-related emergency room visits by children 14 years and younger in 2001 involved food, according to the CDC. Children who do not thoroughly chew their food may find that it becomes lodged in their throats. In addition, foods that might present little risk to adults – such as peanuts – pose a greater threat to children because of a child’s smaller airways and less developed molars, the teeth at the back of the mouth used for grinding. Round, firm foods present the greatest choking danger.

Nonfood items also can present choking hazards to children. Latex balloons (including broken balloons and parts of a balloon) are particularly notorious for triggering choking incidents in children. Other items that can pose a choking risk to children include:

• Coins
• Marbles
• Pen or marker caps
• Small balls
• Small batteries
• Syringes
• Toys with small parts, or parts that can be compressed
• Medications or recreational drugs in pill form (small children)

Children who begin to choke typically cannot breathe, talk or make noise. They may cough weakly and make soft or high-pitched noises when inhaling. Infants who begin to choke may be unable to cry or to make sounds. Older children who are choking may grab at their throats or wave their arms.

If choking persists, a child’s face may become bright red before eventually turning blue. If the child’s airway is not cleared, loss of consciousness will follow.

Children who cough forcefully or who have a strong cry should be allowed to try to expel the object on their own. However, basic first-aid steps should be applied if the child does not display these signs while choking. Treatment options to stop choking differ depending on the age of the child. It is very important for caregivers to learn first-aid techniques from a professional and to practice them than to try to apply them for the first time during an emergency. If performed incorrectly, these techniques could injure the child.

For infants under age 1, it is important to provide proper support to the head, as the neck muscles are not fully developed. The caregiver is urged to lay the child face down along the parent’s forearm. Using a thigh or lap for support, the caregiver should hold the infant’s chest in a hand and hold the child’s jaw with fingers. After pointing the infant’s head downward (lower than the body) the caregiver should use the heel of a free hand to give up to five quick, forceful blows between the infant’s shoulder blades.

If this fails to dislodge the object, the infant should be turned onto the back face up while firmly supporting the head and neck. Using a thigh or lap for support and cradling the baby’s head, the caregiver should place two or three fingers in the middle of the child’s breastbone (just below the nipples) and give up to five quick thrusts downward. The chest should be compressed up to one-third to one-half of its depth.

The back blows and chest thrusts should be alternated until the object comes loose or the child loses consciousness. As the child loses oxygen, air muscles begin to relax. This makes it easier to dislodge the object.

If the infant loses consciousness, the caregiver should yell for help and begin cardiopulmonary resuscitation (CPR). Another person should call 911 while CPR is administered. If no one else is present, the Centers for Disease Control and Prevention (CDC) recommends calling 911 one minute after performing CPR.

Children ages 1 and older should be treated with the Heimlich maneuver. First, the child should be asked whether he or she is choking. If the child is able to speak or coughs, nothing should be done. The child should be allowed to try to cough up the item that is blocking the airway.

If the child cannot respond, he or she should be reassured that help is forthcoming. At this point, the adult should stand or kneel behind the child and wrap arms around the child. After making a fist with one hand, the adult should place the thumb on the child’s abdomen so that it is just above the navel and well below the ribs.

The best way to prevent choking is to try to reduce a child’s exposure to items that may present a choking hazard. Caregivers are urged to get down on their hands and knees and crawl around the house so they can get a child’s perspective on potential dangers.

Children should eat at a table whenever possible. They should always sit up and should never eat when running, walking, playing or lying down. Caregivers should supervise all meals of infants and young children, and cut all foods into pieces that are no larger than a half-inch (1.27 centimeters). Children also should be encouraged to chew food thoroughly before swallowing.

The following foods are known to present a choking hazard and should not be served whole to children younger than age 4:

• Cheese chunks
• Chewing gum
• Chunks of peanut butter
• Grapes (whole)
• Hard, gooey or sticky candy
• Hot dogs
• Meat chunks
• Nuts
• Popcorn
• Raisins
• Seeds
• Raw vegetables

Other tips to prevent choking include:

• Do no feed round, firm foods to children under age 4
  
  
• Do not give old balloons or toys with small parts to children under age 3
  
  
• Keep an eye on toys of older siblings and keep them away from young children
  
  
• Teach older children not to give foods, toys or other small objects to younger children
  
  
• Follow age guidelines on packages when choosing toys
  
  
• Keep coins away from infants and young children
  
  
• Look under furniture and between cushions for potential choking hazards

Most health experts tend to advise against breastfeeding for mothers with pierced nipples due to safety concerns including injury to the baby’s lips, gums, tongue and palate as well as the infant’s risk of swallowing and choking on the jewelry. However, recent research indicates that the practice may be possible with proper education and training for the mother. Women with such concerns are urged to consult with their baby’s pediatrician or a lactation consultant for guidance and instruction.

Caregivers are urged to learn basic life support techniques such as cardiopulmonary resuscitation (CPR) so that they can aid their child during a choking emergency. Techniques such as the Heimlich maneuver also should be learned from a trained professional. While CPR and the Heimlich maneuver can saves lives, they also can injure the patient if not performed correctly.

Preparing questions in advance can help patients and parents have more meaningful discussions with their physicians regarding their or their child’s treatment options. The following questions related to choking may be helpful:

1. What are some of the household changes I can make to reduce my child’s risk of choking?
   
   
2. Where can I go in my community to receive first-aid training?
   
   
3. How can I practice these techniques?
   
   
4. Do you have tips for storing my older children’s toys that will keep them safe?
   
   
5. Is it safe to give my child a balloon?
   
   
6. How will I know when it’s safe to feed my child certain foods?
   
   
7. How old should my child be before I use the Heimlich maneuver?
   
   
8. How will I know when it’s time to call 911?
   
   
9. If my child eventually dislodges the item, should I still bring him/her to a physician?
   
   
10. How will I know if my child has suffered long-term damage due to a choking episode?