Preschool age children less than 3 years of age are at a high risk of choking and foods--even healthy ones--can be a choking hazard.

The Centers for Disease Control and Prevention (CDC) reports that in 2001, 17,537 children 14 years and younger were treated in U.S. emergency departments for choking episodes. Nearly 60 percent of these cases were caused by food while more than 80 percent of these involved preschool children.

During choking, the airway is blocked, creating a real risk of permanent brain damage and even death to the child. Childcare staff should know how to provide early treatment for children who are choking and have an understanding of what foods can cause choking.

Proper food selection, food preparation, and serving practices will help to minimize the risk of choking on food. While both physical and developmental factors put young children at risk for choking, simple common sense and preparation may prevent most cases.

Choking and Young Children

Why are preschool age children more likely to experience choking emergencies? Some choking problems relate to the physical development of the child.

Young children tend to have more difficulty swallowing and chewing than do older children because of late eruption of the back teeth needed for thorough chewing, or delayed muscle development in their jaws. Many young children also have problems with tooth decay, which can affect chewing.

Infants who are learning to self-feed often stuff large amounts of food into their mouths. They also may not thoroughly chew.

Toddlers might take large bites of foods served whole (such as sandwiches) or pocket pieces of chewed food in their checks.

Other choking hazards stem from the social interactions of feeding. The busy three-year-old might grab some food and take off running. The social preschooler might be in deep conversation with his or her peers, not paying attention to eating and talking at the same time.

The way food is presented to the young children plays a significant role in choking risks. Food that is cut too small or is difficult to handle may make it easier for children to choke.

Controlling the Feeding Environment

For young self-feeders, place small quantities of finger foods in front of children. This will decrease the potential of putting too much into small mouths. Make certain the food has been chewed and swallowed before giving more.

For all self-feeders, confine eating to a designated spot at a table with an appropriate seating arrangement. This might be the dining table, on a blanket during snack time, or under a tree when picnicking.

The risk of choking increases when a child is allowed to walk around while eating. The risks spiral when the child is running or playing with food in his/her mouth.

Suggest that children take their time to chew their food. They may wish to eat and get back to playing; but in their haste, they become more vulnerable to poor chewing and swallowing.

Mealtimes are social occasions, but ensure that children are not being physical with each other (pushing or tickling). Children love to share scary and funny stories. They enjoy making each other laugh and squeal.

A chuckle or giggle makes mealtimes enjoyable for all. But watch out for children who begin to laugh uncontrollably--they might easily choke.

Avoid Choking-Risk Foods

The American Academy of Pediatrics (AAP) recommends that children younger than age 4 not be fed any round, firm food unless it is cut into small pieces no larger than one-half inch.

Some foods are more likely to cause choking than others. Slippery or round foods can slide down the throat before being chewed (peanuts, hot dogs, ice). Other foods are tough (meats) or dry (popcorn or pretzel sticks).

Almost any food that is too large or too hard for a small mouth to handle can create a hazard. With young children, watch out for these foods:

• Round-shaped foods (raw peas, whole grapes, raw baby carrots, seeds, nuts, cut up hot dogs, and hard candy).
• Slippery foods (peanuts, ice, or other wet foods).
• Dry foods (dried fruits, chips, pretzel sticks, popcorn, and marshmallows).
• Tough foods (chunks of meat, jerky, dried fruits, and sausage or hot dogs with skin).
• Sticky foods (raisins, spoonfuls of nut butters, nut butters on soft bread, and gummy candy).
• Hard foods (carrots, broccoli, cauliflower, candy).
• Nonedible parts of foods (fish bones, poultry bones, and fruits with pits such as cherries or dates and with seeds such as watermelons or oranges).

Modify Foods to Reduce the Risk

Many of the foods listed above are healthful and nutritious, so it is fine to continue serving these to young children. However, simple techniques to change the shape and texture of the food will make these foods safer for children to eat.

Round-shaped foods. Chop, slice, grind, grate, or dice these foods to change the shape. Carrots and hot dogs can be cut lengthwise down the center and then sliced.

Slippery foods. Chop or grate them.

Dry foods. Serve with liquids (such as water or milk) for children to sip on. Serve pretzel rings instead of pretzel sticks.

Tough foods. Chop, grind, or grate the meat to change the texture. Soften tough foods with liquid before serving. Remove skins before serving sausages or hot dogs.

Sticky foods. Spread nut butters thinly on crackers or wheat bread. Blend nut butters with applesauce or jam before spreading.

Hard foods. Grate, dice, or grind raw vegetables. Steam vegetables then slice or dice.

Nonedible parts of foods. Remove seeds and bones before serving the food. Purchase seedless varieties of fruits.

Before you serve any food, ask yourself: “Can I make this food safer for children to eat?” If the answer is yes, do it!

Madeleine Sigman-Grant,PhD, RD
Professor and Area Extension Specialist

Internet Resources

American Academy of Pediatrics, www.aap.org/publiced/BR_Choking.htm

Centers for Disease Control and Prevention (CDC), www.cdc.gov/ncipc/duip/spotlite/choking.htm

International Food Information Council, www.ific.org/foodinsight/2002/jf/chokingfi102.cfm

Seattle and King County Public Health Department, www.metrokc.gov/health/childcare/choking.htm

U.S. Food and Drug Administration, www.fda.gov/fdac/features/2005/505_choking.html