Injury Prevention

Study Highlights Need for Education on Choking Hazards

By: Scott Schoem, MD, MBA and Kevin Borrup, DrPH

Choking is a major cause of death particularly for children 4 years old and younger. In 2016, 255 children in the United States died from a choking incident and there were even more nonfatal incidents. More than 15,000 children are treated each year in emergency rooms due to choking hazards. For a child, their natural instinct is to put things in their mouth because developmentally that is how they are learning about the world around them. So, when a baby sees a penny lying on the floor the baby’s instinct is to put the penny in their mouth. Children are at higher risk for choking for a few reasons: 1) many children are unable to tell if an object is food or not (so, they eat it), 2) young children do not have molars (without these teeth they cannot grind or chew food), and 3) they have significantly smaller airways (as small as that of a straw!).

It has been shown that parental knowledge of choking hazards can help protect children from choking. We recently completed a study along with co-authors Kathryn Bentivegna and Meghan Clough, published in the International Journal of Pediatric Otorhinolaryngology, which sought to evaluate the effect of an educational video on parental knowledge of choking risks. We found that the educational video intervention increased the overall knowledge of parents regarding choking. As a result, we believe that providing even brief education to all parents on choking dangers could help to reduce child choking deaths and the need for emergency department visits.

Practically speaking, if a parent knew that hot dogs were one of the most dangerous choking hazards they would cut a hot dog into small pieces for their child. Pediatricians are recommended to have a discussion with parents regarding choking hazards involving food or toys with small parts at the 6-month, 1, 2 and 3-year well-child visits. However, pediatricians are so busy at each well-child visit speaking with parents on many important issues that choking hazards are rarely highlighted as key elements of those visits.

Parents and caregivers should be aware that mealtimes can be dangerous, with food accounting for over 50 percent of choking episodes. They should keep foods such as grapes, hot dogs, raw carrots, or peanuts away from babies and toddlers under 4 years of age. They should also cut food for babies and young children into pieces no larger than half an inch and encourage children to chew their food well before swallowing. They should also supervise mealtimes and insist that children sit down while eating rather than running around, playing or lying down with food in their mouths. In addition, many choking incidents are caused by older children giving dangerous food or toys to younger children.

The AAP lists the top food choking hazards as:

  • hot dogs
  • nuts and seeds
  • fruit chunks
  • whole grapes
  • raw vegetables
  • chunks of meat or cheese
  • popcorn
  • hard candy
  • chunks of peanut butter
  • chewing gum

Important non-food choking hazards include balloons, marbles, coins, small toy parts, pen caps, and small batteries.

Connecticut Children’s Injury Prevention Center will continue its work with Connecticut Children’s Division of Otolaryngology to ensure that pediatricians address choking dangers in young children by providing educational materials to pediatric primary care.

Scott Schoem, MD, MBA is division chief of Otolaryngology at Connecticut Children’s Medical Center.

Kevin Borrup, DrPH, JD, MPA is associate director of Connecticut Children’s Injury Prevention Center.

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