Anyone who provides care to babies and young children must be aware of the risks of choking. Babies and young children are at high risk of choking because they:

• Have less practice controlling food in their mouths
• Do not always chew food into small enough pieces
• Have small airways
• Explore the world by putting small objects into their mouths

If a child has a medical condition that affects chewing or swallowing, they are at an even greater risk for choking. Talk to the child's parent or a health care provider to find out what foods are safe for that child.

What is choking?

Choking is when something becomes stuck in a person's airway, making them unable to breathe. If the airway is partly blocked, the body tries to clear the airway by coughing. If the airway is completely blocked, the stuck item must be removed or the child will not be able to breathe and could die.

Choking can also happen when foods or objects get stuck in the voice box, vocal chords, lungs or esophagus.

What do I do if a child chokes?

If a child is turning blue and cannot speak or cough, follow your organization's health and safety procedures. Call 9-1-1 or take the child to the emergency room right away.

If a child is coughing and able to talk, stay calm and encourage them to cough the object or food out. However, you should take the child to the emergency room right away to make sure nothing remains stuck in the airway.

Go to the emergency room right away or call 9-1-1 if the coughing continues, or if a child has symptoms such as retching, vomiting or wheezing. Tell the emergency staff what you think the child choked on.

A child needs immediate medical attention in an emergency room if they have swallowed or choked on batteries (including a button battery), dried peas or beans, even if they seem fine. Batteries contain strong chemicals that can burn a child if they are swallowed. Dried peas and beans swell when they absorb water, causing a more complete airway blockage.

What are common causes of choking in children?

Foods:

• Round foods such as hotdogs and grapes can completely block a child's airway
• Fruit poppers, also called gel candies, can also completely block a child's airway. These are sold in mini-cups with a small piece of fruit in the middle
• Peanuts, other nuts, seeds such as sunflower and watermelon, popcorn, and dried fruit like raisins
• Raw carrots, apples, celery
• Fish bones, small chicken bones
• Hard candies

Objects:

• Coins are the most common cause of choking in young children. It is not usually fatal but the child may need surgery to remove the coin
• Plastic toy parts, buttons, earrings, small magnets, metal hardware and fishing tackle are also common choking hazards
• Balloons are particularly dangerous because they can completely block the child's airway
• Disc batteries and other batteries. Disc batteries are used in watches, calculators and handheld games

How can I make eating safer for a child?

Until children are at least 4 years old:

• Do not offer foods that are round, hard, sticky and difficult to swallow. These include whole peanuts, nuts and seeds, popcorn, marshmallows, olives with pits, dried fruit like raisins, hard or gel candies, gum and chewable vitamins. Do not offer snacks served on toothpicks or skewers
• Cut grapes, cherry tomatoes, large berries (especially blueberries) and hot dogs lengthwise and into small pieces
• Grate or finely chop raw carrots and apples
• Remove pits and seeds from fruits
• Finely chop stringy foods such as celery or pineapple
• Spread smooth peanut butter or other nut and seed butters thinly on crackers or bread. A chunk of nut or seed butter can form a "plug" that can block the child's airway
• Remove bones from chicken and fish before serving

Always supervise babies and young children when they are eating.

• Offer food in small amounts to prevent children from putting too much food in their mouths
• Offer foods in textures that are safe for babies and young children
• Make sure the child is awake and alert before offering them food
• Do not prop or leave a baby alone with a bottle. The liquid can come out too fast and cause choking
• Have children sit up while eating and drinking
• Do not give children anything to eat or drink while they are walking, playing, or sitting in a moving car, bus or stroller
• If a child is laughing or crying, wait for them to settle before offering them food. Have them sit down and eat in a calm, quiet environment
• Teach children to chew their food well. Sit down and eat with them. Be a positive role model – take small bites, chew food well and eat slowly
• Teach older children not to give food or small toys to younger children
• Discourage children from tossing food and trying to catch it in their mouth

How can I make play safer for a child?

• Teach the child not to put small objects between their lips or in their mouth. For example, pins, needles, nails, screws or tacks
• Check the child's play area often for choking hazards and quickly remove them
• Make sure the toys are in good condition and are age appropriate
• Be extra watchful at parties and holidays when balloons or small toys may be around

How can I be prepared to help a child if they choke?

Anyone who cares for young children should be trained in infant Cardio Pulmonary Respiration, also known as CPR. This includes what to do if a child is choking. Contact a local public health nurse or first aid training institute for information on infant CPR training.

Each child cared for in a licensed care facility in B.C. must have immediate access to an employee with a valid first aid and CPR certificate. This employee must be able to communicate with emergency workers.

For more information

• Be Smart, Don't Choke https://dontchoke.ubc.ca
• Toddler's First Steps www.healthlinkbc.ca/pregnancy-parenting/toddlers-first-steps
• Rules for operating a licenced child care facility www2.gov.bc.ca/gov/content/family-social-supports/caring-for-young-children/space-creation-funding/rules-operating-licensed-day-care

Contact your public health dietitian or licensing officer, or call 8-1-1 and speak to a registered nurse or registered dietitian.