Roughly 70 children under 10 die each year from choking, and more than 10,000 ER visits are a result of choking in children 14 and under. While these statistics can be harrowing, significantly more choking incidents do not result in ER visits or fatalities, often thanks to prevention, training, and quick response. When supervising children, knowing what to do if a child chokes can save a life. Here, we discuss common causes of choking and prevention methods, and speak with local children’s medicine experts to further understand choking in children.
Causes and Prevention
Research suggests children aged 1-3 are at the highest risk of choking among children. Choking often occurs as the result of various anatomical differences between children and adults. Children’s airways are much smaller than adult airways, and children are not able to cough with the same amount of force as an adult, which makes it more difficult to dislodge an object. While children without existing medical issues experience choking, the most common risks for choking in children include neurological disorders, dysphagia (difficulty swallowing), and dental issues.
Prevention is the best approach, and thankfully, there are many strategies to prevent choking in children. Keeping small items away from children, such as small toys, pebbles, candies, erasers, gum, coins, and buttons helps mitigate the risk of choking on these items. Airway-sized foods like grapes, cherry tomatoes, apple chunks, nuts, and dried fruits are often a choking hazard, and hot dogs are the most common fatal choking hazard food in children in the U.S. Cut foods in half or into smaller pieces and supervise all eating activity, especially around children with existing medical issues that may impact their ability to chew or swallow. Research also suggests that breastfeeding in the first year prepares the neuromuscular system for future chewing, and that introducing foods that are varied in texture at the appropriate age can help “train” children to detect a non-food item (such as a bone or pit) and spit it out.
Choking Responses
Choking Response for Infants
The Heimlich maneuver, the most common choking response strategy, should not be performed on infants less than 1 year. Instead, administer five back blows followed by five chest thrusts, ideally with the infant draped over the provider’s non-dominant arm or knees. Avoid finger sweeping their throat in an attempt to dislodge the stuck item, as it may push the item further down.
Choking Response for Older Children
Children older than 1 year should receive the Heimlich maneuver, with the provider on their knees. Clench the fist and place it slightly above the belly button area, delivering quick upward thrusts to the front and back. Continue until the item dislodges itself, or until the person requires further medical attention. The Heimlich maneuver should not be done if the person is unconscious.
Life Vac
After Arthur Lih overheard a mother mourning her son who had died from a grape lodged in his throat, he set out to create a device that could clear the airway of someone choking. Along with medical professionals and colleagues, Lih extensively researched choking and developed a product called LifeVac, with the goal of saving as many lives as possible around the world. Available in home kits, travel kits, school kits, and more, the LifeVac device is placed over the choking individual’s mouth and is an easy-to-use, single-use, non-invasive suction tool that assists a choking victim after choking protocol has not been successful. Each home kit is equipped with an adult mask, pediatric mask, and practice mask. LifeVac can be used to assist others and on yourself.
According to LifeVac’s website, the device has now saved more than 4,000 lives. The device and its use have been included in many peer-reviewed studies – one study’s abstract reads, “Thus far the unit has been used successfully 100% of the time with limited to no side effects reported. The use of LifeVac has huge potential to save thousands of people from choking, including more susceptible populations such as children and the elderly.” EMS services, hospitals, schools, day care centers, restaurants, and more around the world are using LifeVac’s life-saving choking devices, often thanks to the efforts of nonprofits such as GregO2, founded after CEO Rob Creswell lost his brother Greg to choking. Creswell now operates GregO2 in his honor in Chattanooga, Tennessee, hoping to provide education and training opportunities for choking response, and have an anti-choking device installed in public places around Chattanooga and beyond to prevent choking fatalities.
Provider Q&A
To truly be prepared, the American Red Cross strongly encourages everyone to take a certified first aid and CPR course. These classes provide hands-on training in life-saving techniques that can make all the difference in an emergency. The American Red Cross offers accessible and reliable training nationwide. To find a class near you, visit redcross.org/takeaclass.” – Julia Wright
“Parents and guardians can continue to encourage the child not to put things in their mouth, and don’t offer foods to younger children unless instructed by an adult.” – Angelique Tucker, DO
Choking is one of the most preventable dangers young children face. Simple steps – like cutting food into small pieces, keeping small objects out of reach, and supervising kids during meals – can make all the difference. Prevention starts at home, and with a little awareness, caregivers can create a safer environment for children to grow and explore.” – Julia Wright
“When a child is actively choking, they may show clear signs the airway is blocked and they are in distress, which can include:
- Inability to speak, cry, or make noise
- Difficulty breathing or noisy breathing
(such as high-pitched wheezing)
- Coughing that is ineffective or silent
- Clutching at their throat or neck
(universal sign of choking)
- Blue or dusky skin color, especially around the
lips or fingertips (a sign of lack of oxygen)
- Loss of consciousness if the airway remains blocked
It’s important to differentiate choking from gagging. Gagging is often loud and indicates that the airway is still partially open. It may be uncomfortable to watch, but it’s often the body’s way of clearing the airway. True choking
is typically silent and dangerous, requiring immediate
action.” – Lorena Ferreira, MD, BDP
“Foods (round, firm foods such as grapes, hot dogs, popcorn, small bits of nuts and seeds, granola bars, raw vegetables, fruit chunks, meat that is not cut appropriately), household items and toys (balloons, coins, marbles, toys with small parts such as Lego bricks), and small button-type batteries (which is a medical emergency) are common causes of choking.”
– Angelique Tucker, DO
“Yes, it’s a good idea to have your child evaluated by a medical provider even if they seem fine afterward. Choking can sometimes cause injury to the airway or lungs, and there’s a risk that a small piece of the object is still lodged without immediate symptoms. A healthcare provider can assess for signs of airway trauma or residual obstruction and determine if the child needs imaging or observation.” – Lorena Ferreira, MD, BDP
Julia Wright
Executive Director, American Red Cross, Tennessee Region
Angelique Tucker, DO
Pediatrician,
Chattanooga Peds
Lorena Ferreira, MD, BDP
Developmental- Behavioral Pediatrician, Siskin Children’s Institute
Meet the Author
Kristen Dee, BS, MA, Summa Cum Laude
Kristen Dee is a graduate of Winthrop University where she earned a Bachelor of Science degree in integrated marketing communications, with the distinction of Magna Cum Laude and IMC Student of the Year. Following Winthrop, Kristen earned a Master of Arts in Communication from Wake Forest University. Prior to joining CMC Publications as editor, Kristen successfully fulfilled roles involving internal corporate communications. Today, Kristen leads ideation, conceptualization, and development of numerous health, wellness, and lifestyle articles published in print and online for HealthScope, CityScope, and Choose Chattanooga magazines – premier publications serving S.E. Tennessee and North Georgia.
