How to Prevent the Most Common Cause of Choking in Kids

When we think about children and choking, coins or toys usually come to mind. And while indeed those objects can be hazardous for children, it turns out that most choking episodes that send children to emergency rooms involve food, not toys.

In a recent study in the journal Pediatrics, researchers looked at records of emergency room visits to see which foods children choked on at different ages. What they found was interesting — and is useful information for parents to have.

Here are the top 10 foods:

1. Hard candy
2. Other candy
3. Meat
4. Bone
5. Fruits and vegetables
6. Formula/breast milk
7. Seeds, nuts and shells
8. Chips, pretzels and popcorn
9. Biscuits, cookies and crackers
10. "Multiple unspecified foods"

A child's age, of course, makes a difference. There aren't many school-age children choking on breast milk.

• Infants — Breast milk and formula were at the top of the list for infants under 1 month, peaking at 4 months. Fruits and vegetables came in second. Biscuits, cookies and crackers were third.
• Toddlers — Fruits and vegetables were in first place. Seeds, nuts and shells  were second. Other candy (not hard candy) was third.
• Older children — Candy (hard and other) topped the list, with meat and bone following.

To prevent choking, it's important to know what children of each age can handle.

Infants are just figuring out the whole swallowing thing. That's why even a liquid like breast milk may be a problem. By 4 to 6 months, infants will reach for foods and show interest in what their parents and others are eating. This doesn't mean they are ready to eat those foods. Infants may not have teeth to chew, but it's amazing what little toothless gums can do! So they should have purees at first.

After 6 months you can slowly work up to small pieces of soft solid foods. That's why it's not surprising that fruits, vegetables, biscuits, cookies and crackers are a problem for them — many times, these foods are not small or soft enough. Toddlers have figured out chewing and swallowing, but they are easily distracted. And not always that coordinated. So while it's okay to give them harder foods, parents still need to be careful, especially with raw food, nuts and candy.

Parents need to stay vigilant no matter how old their children are. In the study above, the mean age of the children seen in the emergency room for choking was 4.5 years. Here's some excellent advice from the American Academy of Pediatrics to help prevent choking:

• Encourage children to chew their food well.
• Supervise meals. (Family mealtime has other benefits. Children are less likely to be overweight and more likely to eat healthy foods.)
• Insist that kids sit down when they eat (no snacks while they climb on the jungle gym or head out to sports practice).
• Don't let children run, play or lie down with food in their mouths.

It's a good idea to learn the Heimlich maneuver to help a choking person. Even better, take a CPR course. Talk to your doctor about where courses are offered in your community.

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Claire McCarthy, M.D., a senior medical editor for Harvard Health Publications, is an assistant professor in pediatrics at Harvard Medical School. She is an attending physician and Medical Communications Editor at Children's Hospital Boston.