Preventing choking on food by children

Child Care Health Program
Preventing choking on food by children: Safe practice guidelines for child care facilities

grapes Young children can be at risk for choking on food. Although children can choke on any food, foods that are hard or tough to chew, slippery, small and round, or sticky present an increased risk.

For example, toddlers (children learning to walk, typically 1 to 2 years old) have limited control of their mouth muscles and lack back teeth to grind up hard food. Food may slide back into the throat before it is completely chewed.

Children 3 to 4 years old may have back molars but are still learning to chew. They are often easily distracted while eating - a potential risk for choking.

Children choke either because a large object closes off the throat or because smaller objects block the airway into the lung.

What to look for when choosing foods for children

Many nutritious foods can be hazardous for young children unless cooked or cut into bite size pieces. Here are some foods that may cause problems:

	SIZE Both small and large pieces of food may cause choking. Small hard pieces of food may get caught in the airway if they are swallowed before being chewed well. Larger pieces, more difficult to chew, are more likely to completely block the throat.
		Nuts
		Raw carrots, raw broccoli, raw cauliflower, etc.
		Hard fruit especially with peels such as crisp apples
	SHAPE Food items shaped like a tube may cause choking because they are more likely to completely block the throat than other shapes.
		Hot dogs
		Link sausage
		Whole carrots
		Grapes
		Frozen banana pieces
	TEXTURE Foods which are firm, smooth, or slick may slide down the throat into the airway.
		Hard candy
		Whole kernel corn
		Peanuts, especially Spanish peanuts
	Dry, hard food may be hard to chew yet easy to swallow whole.
		Hard pretzels
		Tortilla chips
		Popcorn
	Sticky foods can stick to the back of the mouth or roof of the mouth and block the throat. They are difficult to remove.
		Nut butters alone
		Processed cheese chunks/slices
		Gummy bears, marshmallows
		Fruit roll-ups
	Hard to chew foods which are fibrous or tough.
		Bagels
		Steak, roast, other fibrous meats
		Meat jerky
		Toddler biter biscuits

Be aware that teething medications can sometimes numb mouth and throat muscles. Check directions carefully.

Teething medications given to children in child care need to be authorized in writing by a parent and health care provider. (WAC 388.150.230)

Prevention is the Best Solution

Always supervise eating
Children do best when sitting to eat. It lets them concentrate on chewing and swallowing. Join the children at the table. Eating or drinking while running or playing is a distraction and can cause choking problems.
Decrease outside distractions
Such as television, games, pets, etc. during meals and at snack times.
Cut food into bite size pieces or thin slices.
Grind or mash tough food.
Cook food until soft, especially beans, pasta and rice.
These foods are favorites but need to be soft enough to chew easily.
Steam vegetables, such as carrots and broccoli.
Eating in cars/buses may also cause problems.
It is hard for the driver to safely pull over fast enough if a child is choking.
Serve small amounts of food at a time.
Keep portion size small. With babies be sure the mouth is clear before giving the child another spoonful of food.

Staff trained in CPR and First Aid must be present when children are eating.