Preventing Choking (0-36 Months): Risky Foods and Small Objects

When your baby starts solids, and later in that curious stage when everything goes into their mouth, the fear of choking sits in the back of many parents' minds. The good news: most choking risks can be greatly reduced with simple precautions. This guide is based on recommendations from the NHS and the American Academy of Pediatrics (AAP).

Why are young children at higher risk? According to the AAP, the highest risk is in babies and young children, because they explore the world by putting everything in their mouths and their airways are small. When they cannot chew their food well, they may try to swallow it whole. The AAP notes that balloons, balls, marbles, toy parts and small round foods cause the most choking deaths.

High-risk foods: The AAP recommends not giving the following foods, or giving them only in a changed form, until age 4 or later depending on your child's development:

• Hot dogs and meat sticks
• Hard, sticky or gooey candy and chewing gum
• Nuts and seeds (especially sunflower seeds)
• Whole grapes
• Raw vegetables such as carrot sticks, and raw fruit chunks such as apple pieces
• Popcorn
• Thick globs of peanut butter and other nut butters
• Marshmallows
• Chunks of meat, cheese cubes and string cheese

How to cut them? According to the AAP, round, firm foods such as hot dogs or grapes can be given when they are chopped completely into small pieces. The AAP recommends cutting food for babies and young children into pieces no larger than half an inch (about 1.3 cm) and teaching your child to chew their food well. Give nut butters such as peanut butter spread in a thin layer, not by the spoonful or in globs.

Eat sitting down and supervised: The AAP recommends always supervising babies and young children at mealtimes, having children eat at the table or sitting down, and never letting them run, walk, play or lie down with food in their mouth. The AAP also reminds parents that many choking incidents happen when older siblings give a younger child a dangerous food, toy or small object; explain this to your older children too.

Small objects: According to the AAP, objects around the house that can cause choking include:

• Balloons (according to the AAP, the risk lasts until age 8)
• Coins and marbles
• Toys with small parts and small balls
• Pen and marker caps
• Medicine syringes
• Toys that can be squeezed small enough to fit entirely in the mouth

The AAP recommends following the age guidance on toy packaging and regularly checking under furniture and between couch cushions for small objects such as coins and batteries.

Button batteries: Always an emergency. According to the AAP, a swallowed button battery or lithium coin battery can cause life-threatening injuries and can burn tissue within 2 hours if it gets stuck in the esophagus. These batteries are found in remote controls, thermometers, car key fobs, watches, musical greeting cards and light-up shoes. Make sure battery compartments are securely closed, and keep items that use these batteries out of your child's reach. The AAP reminds parents that even dead batteries can be dangerous. If you suspect your child has swallowed a battery, do not wait for symptoms: call your local emergency number right away or go to the nearest emergency room, and tell the doctors it may be a lithium coin battery. Do not try to make your child vomit, and do not delay emergency care for any reason. According to the AAP, a button battery in the nose or ear also needs emergency treatment.

Magnets are an emergency too: According to the AAP, swallowing more than one strong magnet can be life-threatening, because the magnets can attract each other inside the digestive system and cause serious damage. Symptoms such as tummy pain, vomiting or fever can be missed because they look like ordinary illnesses. If you suspect your child has swallowed a magnet, even if you do not know how many, do not wait for symptoms: go to the nearest emergency room right away or call your local emergency number. The AAP notes that delaying treatment can lead to severe damage to the stomach and intestines, even death, and that surgery may be needed. The AAP recommends removing strong magnets from the home and regularly checking toys for loose magnets.

Gagging or choking? According to the NHS, gagging is a normal reflex when starting solids, and it is noisy. A gagging baby's face may turn red, their eyes may water, they may push their tongue forward or they may vomit. Choking, on the other hand, is silent. In babies with lighter skin, the skin may start to turn blue; in babies with darker skin, the blue color is seen more on the gums, the inside of the lips or the nails. According to the AAP, being unable to breathe, wheezy or gasping breaths, being unable to talk, cry or make any sound, turning blue, grabbing at the throat, panic and going limp and losing consciousness are choking signs that need help right away.

If they are coughing, stay with them: According to the NHS, if your child is coughing loudly, encourage them to keep coughing to bring up whatever is stuck, and do not leave them alone. If their cough is silent or they cannot breathe properly, call for help right away. The NHS also reminds parents not to put their fingers blindly or repeatedly into the child's mouth, because this can push the object further in.

Take a first aid course: First aid for a choking baby or child is different for babies and for children over 1, and it is best learned through hands-on training. The AAP recommends that parents take a certified first aid and basic life support course. Taking an infant and child first aid course before your baby is born or before starting solids helps you know what to do if it ever happens.

When to see a doctor, when to call your local emergency number? The NHS recommends:

• If the object does not come out and your child cannot breathe, is coughing silently or cannot cough at all, shout for help and call your local emergency number right away. If someone is with you, have them call while you take care of your child; if you are alone, put the phone on speaker and do not leave your child.
• If your child loses consciousness, call your local emergency number right away.
• Even if the object has come out, take your child to a health care provider; part of it may still be inside.

If you suspect they have swallowed a button battery or a magnet, do not wait for symptoms either: call your local emergency number or go to the emergency room right away.

Dear mom, cutting up every bite and picking every little piece up off the floor can feel tiring at times. But these small habits quietly protect your child every day. A first aid course will also give you confidence at the moment you are needed most.