Childcare settings offer unique opportunities for young children to try new foods. However, caregivers should be aware that the majority of childhood choking injuries and deaths are associated with food items. Most choking incidents can be avoided. Most children over the age of one year can digest almost any type of food safely, provided it is prepared and served in a way that helps them chew and swallow it properly.

Children under the age of four and children with chewing and swallowing difficulties are at the greatest risk of choking on foods because:

• They do not chew long enough to make food small enough to go down the throat;
• They may not yet have the back teeth they need to grind foods;
• They may try to swallow too much food at one time;
• They may have difficulty swallowing liquids and solids together.

Another choking risk for young children may be caused by too much activity during eating. If children run and play, laugh, or cry while eating they are at greater risk of choking on their food. Children should eat meals and snacks while sitting in a designated place such as at the table, on a blanket, or under a tree at snack time. Mealtime conversation is encouraged, but avoid tickling, teasing, or uncontrolled laughter. Encourage children to eat slowly, even if the temptation of returning to play time is causing them to rush.

Caregivers should also look at what and how foods are served to young children and to children with special health care needs. Many nutritious foods can cause choking if not served properly. Children may swallow small and slippery foods like peanuts and hotdogs before they have had a chance to chew them. Tough foods like meat or sticky foods such as peanut butter can get stuck in a child's throat. Popcorn, marshmallows and other foods that are dry or difficult to chew may be swallowed whole. Each of these situations can cause choking.

Each child is unique in his or her ability to handle different foods. For example, while Mei is 33 months old and has no back teeth, Juwan is 26 months old with a full set of teeth. Some children over the age of three still cannot chew foods very well because their muscles are not fully developed. Some children with special health care needs may require baby foods or pureed foods and may need extra assistance at meal time.

Foods to watch out for

How do we reduce the risk of choking on foods? Here are foods that most often cause choking for toddlers and preschool children or for children with chewing or swallowing difficulties:

• Round-shaped foods (raw peas, whole grapes, raw carrots, seeds, nuts, hotdogs, round candies);
• Slippery foods (peanuts, ice, or other wet items);
• Dry foods (marshmallows, dried fruits, pretzel sticks, chips, popcorn);
• Tough foods (chunks of meat, dried meats);
• Sticky foods (spoonfuls of peanut butter or peanut butter on soft bread, clumps of raisins);
• Hard foods (broccoli, cauliflower, hard candy);
• Foods with non-edible parts (fish with bones, fruits with pits).

But wait-many of these are nutritious foods, and foods that children like! You can serve them to children but they must be prepared and served properly.

Food preparation safety tips

Here are some suggestions to modify potentially hazardous foods to reduce the risk of choking and make them safer for children:

• Remove the skin from hotdogs, sausages, and frankfurters; cut them lengthwise, then cut them into small pieces or thin strips.
• Chop, grind, or dice meats.
• Chop nuts and grind seeds finely.
• Dice or grate raw vegetables.
• Steam, then slice or dice vegetables.
• Remove the pit, then dice fruits like cherries, apricots, and peaches.
• Spread peanut butter thinly over crackers or wheat bread.
• Blend peanut butter with applesauce or jam before serving.
• Serve bow-tie pretzels instead of pretzel sticks or potato chips.
• Remove the bones from fish or serve fish pieces that have been boned.
• Include plenty of liquids such as water, milk, or juice at meal and snack times and encourage children to sip in between mouthfuls.

If you have questions about whether a food item presents a choking risk, ask yourself, "What can I do to make this food item safer?" Chances are that one of these safety tips can do the trick.

Resources

The American Academy of Pediatrics (AAP) has available printed fact sheets on chocking prevention and first aid available in quantities of 50. For information, contact the AAP Publications Dept. P.O. Box 747, Elk Grove Village, IL 60009-0747; 888-227-1770; www.aap.org

City of Phoenix, phoenix.gov/FIRE/choking.html

Kid Source, www.kidsource.com/safety/prevent.choke.html

FDA, www.fda.gov/fdac/features/2005/505_choking.html

Safe USA, www.safeusa.org/home/choke.htm