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A. Choking

Some foods are easy for young children or older people to choke on when swallowing because they are the same size and shape as a child’s airway. Older people sometimes choke when they try to swallow food that causes them problems. There is much more research on choking of children than seniors. 

For example, peanuts may block the lower airway. A chunk of hot dog or a whole grape may completely block the upper airway. Avoid serving foods that are as wide around as a nickel, which is about the size of a young child’s throat. Foods likely to cause choking come in many shapes, sizes, and textures.

Child care providers should not offer to children under 4 years of age foods that pose the highest risk for choking. These include foods that are round, tube-shaped, small, hard, thick and sticky, smooth, slippery, or easily molded to stick to the airway.

Prevent choking by avoiding these foods or by changing their shape, size, and texture before offering them to children during meals and snacks. What are some common foods that may cause choking and should not be fed to young children under age 4?

What type of foods pose choking risks?

► Firm, smooth, or slippery foods that slide down the throat before chewing, such as:

● Whole grapes, cherries, berries, melon balls, or cherry and grape tomatoes

● Whole pieces of canned fruit

● Hot dog-shaped foods, including sausages, meat sticks, cheese sticks, or toddler hot dogs (even when cut into round slices)

● Peanuts and nuts

● Whole beans

● Hard or round candy, jelly beans



A1. Swallowing Process    Detailed Process   

A2. Vidio on Swallowing

B. Prevention

Choking Prevention Choking is a leading cause of unintended injury in children under age 4. Injury and death from choking are preventable. The risk of choking depends on the size, shape and consistency of the object, as well as the developmental age of the child or the health stage of the senior.

The most common items on which children choke are food, coins, balloons, and other toys. If an item can fit inside a cardboard toilet tube roll, it can become lodged inside a child’s airway. *Caregivers should be educated about choking hazards.

Steps to Avoid Choking Include: 1. Learn CPR (basic life support). 2. Be aware that balloons pose a choking risk to children of any age. 3. Insist that children eat at the table, or at least while sitting down. They should not walk, run, play, laugh or lie down with food in their mouths. 4. Cut food for infants and young children into pieces no larger than one-half inch, and teach them to chew their food well. 5. Supervise mealtimes for infants and young children. 6. Be aware of older children’s actions. Many choking incidents occur when older siblings give dangerous foods, toys or other objects to younger children. 7. Follow the age recommendations on toy packages. Age guidelines reflect the safety of the toy based on possible choking hazards as well as a child’s physical and mental abilities at various ages. 8. Check under furniture and between cushions for small items that children find and put in their mouths. 9. Do not let infants and young children play with coins. 10. Do not prop bottles. This can cause choking and aspiration. 11. Don’t feed children while driving. It is difficult to drive and supervise eating. 12. If using a rub-on teething medication, watch toddler closely as the medicine can numb his throat and interfere with swallowing.

Tips To Make Food Safer • Cut into quarters lengthwise, then into small pieces. • Peel fruits and cut in half lengthwise. • Chop finely or into thin strips. • Spread peanut butter thinly on crackers or bread. • Avoid round or tube-shaped foods.

Remember: never leave children unattended while eating. Never Let Young Children Play With Latex balloons Coins Marbles Small balls Pen or marker caps Small button-type batteries Medicine syringes Jewelry Toys with small parts Crayon pieces Toys that can be compressed to fit entirely into a child’s mouth

Dangerous Foods Do NOT serve these foods to children under 4 years of age: Hot dogs Sausages Chunks of meat or cheese Whole grapes Fish or meat with bones Raisins Marshmallows and marshmallow fluff Popcorn Hard, gooey or sticky candy Chewing gum Chunks of peanut butter Lollipops Raw vegetables Nuts and seeds Whole olives Ice cubes Potato / corn chips Pretzels This list is provided for information purposes only. Please consult resources on the back of the brochure for more information about dangerous food and non-food items.

For Addition Information: Caring for Our Children, National Health and Safety Performance Standards, Guidelines of Out-of-Home Child Care (3rd Ed.). American Academy of Pediatrics, American Public Health Association, and National Resource for Health and Safety in Child Care (2011). American Academy of Pediatrics http://pediatrics.aappublications.org/content/125/ 3/601.full http://www.aap.org Center for Disease Control and Prevention. National Center for Injury Prevention and Control: www.cdc.gov/injury/ . USDA Food Safety: www.foodsafety.gov Department of Early Education and Care.

C. Steps in Prevention

Young children and older people 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:

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

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

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.

D. Heimlich maneuver on self

 If you are choking on something, you can perform the Heimlich maneuver on yourself. Follow these steps:
  1. Make a fist with one hand. Place your thumb of this hand below your rib cage and above your navel.
  2. Grasp your fist with your other hand. Press your fist into the area with a quick upward movement.

You can also lean over a table edge, chair, or railing. Quickly thrust your upper belly area (upper abdomen) against the edge.

If you need to, you should repeat this motion until the object blocking your airway comes out.

See also: Choking first aid

E. Heimlich Maneuver

Choking – adult or child over 1 year

 Choking is when someone is having a very hard time breathing because food, a toy, or other object is blocking the throat or windpipe (airway).

A choking person’s airway may be blocked so that not enough oxygen reaches the lungs. Without oxygen, brain damage can occur in as little as 4 to 6 minutes. Rapid first aid for choking can save a person’s life.


Choking can be caused by any of the following:

  • Eating too fast, not chewing food well, or eating with dentures that do not fit well
  • Drinking alcohol (even a small amount of alcohol affects awareness)
  • Being unconscious and breathing in vomit
  • Breathing in small objects (young children)
  • Injury to the head and face (for example, swelling, bleeding, or a deformity can cause choking)
  • Swallowing problems after a stroke
  • Enlarging tonsils or tumors of the neck and throat
  • Problems with the esophagus (food pipe or swallowing tube)


When an older child or adult is choking, they will often grab their throat with the hand. If the person does not do this, look for these danger signs:

  • Inability to speak
  • Difficulty breathing
  • Noisy breathing or high-pitched sounds while inhaling
  • Weak, ineffective coughing
  • Bluish skin color
  • Loss of consciousness if blockage is not cleared

First Aid

First ask, “Are you choking? Can you speak?” DO NOT perform first aid if the person is coughing forcefully and is able to speak. A strong cough can dislodge the object. Encourage the person to keep coughing to dislodge the object.

If the person cannot speak or is having a hard time breathing, you need to act fast to help the person. You can perform abdominal thrusts, back blows, or both.

To perform abdominal thrusts (Heimlich maneuver):

  1. Stand behind the person and wrap your arms around the person’s waist. For a child, you may have to kneel.
  2. Make a fist with one hand. Place the thumb side of your fist just above the person’s navel, well below the breastbone.
  3. Grasp the fist tightly with your other hand.
  4. Make a quick, upward and inward thrust with your fist.
  5. Check if the object is dislodged.
  6. Continue these thrusts until the object is dislodged or the person loses consciousness (see below).

To perform back blows:

  1. Stand behind the person. For child, you may have to kneel.
  2. Wrap one arm around to support the person’s upper body. Lean the person forward until the chest is about parallel to the ground.
  3. Use the heel of your other hand to deliver a firm blow between the person’s shoulder blades.
  4. Check if the object is dislodged.
  5. Continue back blows until the object is dislodged or the person loses consciousness (see below).

To perform abdominal thrusts AND back blows (5-and-5 approach):

  1. Give 5 back blows, as described above.
  2. If the object is not dislodged, give 5 abdominal thrusts.
  3. Keep performing the 5-and-5 until the object is dislodged or the person loses consciousness (see below).


  • Lower the person to the floor.
  • Call 911 or the local emergency number or tell someone else to do so.
  • Begin CPR. Chest compressions may help dislodge the object.
  • If you see something blocking the airway and it is loose, try to remove it. If the object is lodged in the person’s throat, do NOT try to grasp it. This can push the object farther into the airway.


  1. Wrap your arms around the person’s CHEST.
  2. Place your fist on the MIDDLE of the breastbone between the nipples.
  3. Make firm, backward thrusts.

After removing the object that caused the choking, keep the person still and get medical help. Anyone who is choking should have a medical examination. Complications can occur not only from the choking, but also from the first aid measures that were taken.


  • DO NOT interfere if the person is coughing forcefully, is able to speak, or is able to breathe in and out adequately. But, be ready to act right away if the person’s symptoms get worse.
  • DO NOT force open the person’s mouth to try to grasp and pull out the object if the person is conscious. Perform abdominal thrusts and/or back blows to try to expel the object.

When to Contact a Medical Professional

Seek medical help right away if you find someone unconscious.

When the person is choking:

  • Tell someone to call 911 or the local emergency number while you begin first aid/CPR.
  • If you are alone, shout for help and begin first aid/CPR.

After the object is successfully dislodged, the person should see a doctor because complications can arise.

In the days following a choking episode, contact a doctor right away if the person develops:

  • A cough that does not go away
  • Pneumonia and fever
  • Shortness of breath
  • Wheezing

These could be signs that the object entered the lung instead of being expelled.


To prevent choking:

  • Eat slowly and chew food thoroughly.
  • Make sure dentures fit properly.
  • Do not drink too much alcohol before or during eating.
  • Keep small objects away from young children.


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