Choking/Suffocation Prevention

Eating does not come naturally

Young children are still learning to eat solid food. From the time children are weaned from the bottle until about the age of four, children are mastering the skill of chewing, swallowing and breathing simultaneously. Mealtime should be kept quiet with no running or playing around. If a child becomes distracted or excited while eating, the food could easily be inhaled into the windpipe.

Children under age four are also more likely to choke on small, hard, smooth food because they do not have the back teeth needed to chew and grind food properly.

The most dangerous are foods such as hot dogs, chunks of cheese, hard candies, nuts, grapes, carrots and popcorn. These can easily form a perfect plug in a child's airway. Make sure that food is an appropriate size for the age of the child, it should be grated, mashed, or chopped into bite sized pieces before being fed to a child.

Peanuts and hard candy should be avoided altogether. An older child is more likely to spit out something that is too hard or large to chew. This doesn't mean a child older than four can't choke; a person of any age can choke on food.

Toys are meant to be fun

By following a few simple, yet vital safety tips, parents can assure that toys are safe. Select toys to suit the age, skills, interests, and abilities of the individual child. Toys too advanced may pose safety hazards to younger children. Be a label reader.

Look for labels that give age recommendations and use that information as a guide. Toys labeled as not recommended for children under three years of age, may contain small parts which may pose a choking hazard to young children.

Never buy vending-machine toys for small children; these toys do not have to meet safety regulations and often contain small parts. Inspect old and new toys regularly for strength and parts that could come loose and become a choking hazard. You can check the safety of a child's toy with a toy-testing cylinder or toilet paper tube. If toys can pass through the cylinder, toys or components of toys are small enough for children to choke on if the toys are placed in their mouths.

A colorful balloon is meant to brighten someone's day, but balloons pose a special hazard. It may surprise you to learn that balloons are the leading cause of choking deaths other than food, in children under the age of three and a common cause of choking up to age 8. Balloons can easily glide into the windpipe causing a complete obstruction. Keep all balloons, whether deflated, inflated or burst out of your child's grasp.

Because there are so many small objects around the house, it's important for parents to constantly be aware of objects that a child could choke on. Parents should check their child's play and sleeping area daily for small objects such as beads, buttons, jewelry, tacks, batteries, coins, toy parts, marbles, safety pins, batteries.

Parents should learn what to do for a choking child by taking a child CPR class through the local agencies. The class is usually 8 hours long and covers child safety, first aid, and CPR including the Heimlich maneuver for children of different ages. Take the time to review our CPR page.

Did You Know?

• The majority of childhood suffocations, strangulations and choking occur in the home.
• Children are more likely to suffocate during the summer months and choke during the winter months.
• Sixty percent of infant suffocation occurs in the sleeping environment. Infants can suffocate when their faces become wedged against or buried in a mattress, pillow, infant cushion or other soft bedding, or when someone in the same bed rolls onto them.
• Each year cribs are involved in more than 70 percent of all nursery productrelated deaths among infants. Cribs are responsible for about 40 strangulation and suffocation deaths each year.
• As many as 900 infants whose deaths are attributed to Sudden Infant Death Syndrome (SIDS) each year are found in potentially suffocating environments, frequently on their stomachs, with their noses and mouths covered by soft bedding. All babies should be placed on their back while sleeping to reduce the risk of SIDS.
• Children are at risk from choking on small, round foods such as hot dogs,
• Candies, nuts, grapes, carrots and popcorn. Nonfood items tend to be round or conforming objects, such as coins, small balls and balloons.
• Balloons are the most common cause of toy-related choking death among children ages 3 and under.
• Strangulation occurs among children when consumer products become wrapped around their necks. Common items include clothing drawstrings, ribbons or other decorations, necklaces, pacifier strings, and window and drapery cords.
• Children may strangle in openings that entrap their heads such as spaces in bunk beds, cribs, playground equipment, baby strollers, carriages and high chairs. In 1999, the U.S. Consumer Product Safety Commission (CPSC) voted to issue a mandatory standard for bunk beds to address entrapment hazards. The new standard restricts opening sizes and requires company identification and age-specific warning labels on all new bunk beds.

Things you can do right now....

Check toys for loose parts.

Check curtain rods, etc, and adjust them so they are out of reach of young children.

Go around all the rooms in your home and outside and remove all small objects that could choke a child.

The following is a small list of items to look out for in your household:

• Hot dogs
• Grapes
• Raw vegetables
• Hard or sticky candy
• Nuts and seeds
• Popcorn
• Spoonfuls of peanut butter
• Coins
• Marbles
• Watch batteries
• Pen or marker caps
• Cars with small rubber wheels that come off
• Small balls or foam balls that can be compressed small enough to fit in the mouth
• Broken or uninflated latex balloons
• Bean bag chairs made with foam pellets

Choking Prevention Tips

Choking can be life-threatening. Choking on foods or other objects kills as many children each year as accidental poisonings. Follow these guidelines to help prevent your child from choking.

• Do not give hard foods to children less than 4 years old. Hard foods that could be sucked into the lungs when a child takes a breath are nuts, sunflower seeds, orange seeds, cherry pits, watermelon seeds, gum, hard candies, popcorn, some corn chips, raw carrots, raw peas, and raw celery. Children under the age of 4 years don't know which foods they should spit out. They also need more molar teeth to chew the other hard foods properly.
• Chop up dangerous soft foods before you serve them. Soft foods that most commonly cause fatal choking by completely blocking the windpipe are hot dogs, sausage, grapes, and caramels (especially if a child is in a hurry).
•  Warn baby sitters and older siblings not to share these dangerous hard and soft foods with small children.
• Teach your child to chew all foods thoroughly before swallowing them.
•  Don't allow your child to fill his cheeks with food like a chipmunk.
• Clean up right away after parties. An especially dangerous time is the morning after parties, when a toddler may find dangerous foods on the floor.
• Warn your child never to chew or suck on pieces of rubber balloons. Rubber balloons are the leading cause of choking deaths resulting from objects other than foods. Most incidents occur when a child suddenly inhales a deflated balloon he has been chewing on. Even teenagers have died from inhaling a deflated balloon. Chewing on an inflated balloon is also dangerous because the balloon could burst. Mylar helium balloons are safer than rubber balloons, but rubber balloons are fine when they are used with supervision.
• Don't give a young child a toy with small, detachable parts. If you do, in a few minutes you'll find the missing part in the child's mouth (unless he has already swallowed it).
• Periodically check your child's environment for small objects that your child could choke on (anything with a diameter less than 1.25 inch, or 3.2 cm). Ask older children to protect younger siblings by checking the carpet for small pieces from toys or games. • Dispose of button batteries carefully.
• Remind your child not to run or play sports with gum or other material in his mouth.

Preventing Strangulation and Suffocation

Suffocation Deaths: Prevention

Most infant suffocations occur when babies are placed face down on a soft surface that they sink into. Infants who are 0 to 4 months old have the greatest risk of suffocating. These young infants don't have enough strength to lift their heads and turn their faces so that they can breathe. Many of these deaths occur when a baby naps at the home of a friend who doesn't have a crib or doesn't know the importance of having the baby sleep on his back.

Another cause of suffocation in young infants should be mentioned. Small babies have been smothered by mothers who inadvertently fell asleep on top of them. If you nurse your baby in your bed at night, be careful. Try to keep your baby in a crib next to your bed.

There's another reason not to let your baby sleep in your bed during the first 6 months. The mattresses in most adult beds are too soft for babies. Blankets and pillows also increase the risk of suffocation.

Suffocation deaths account for some crib deaths (sudden infant death syndrome, or SIDS). Despite extensive research, the cause of other crib deaths remains unknown. True SIDS can't be predicted or prevented. There is one exception: smoking in the house greatly increases the risk of SIDS and should be avoided.

Prevention of Suffocation in Infants

To be safe, always place your young baby to sleep on his back in a crib with a firm mattress. Also do this for naps. This is the sleep position recommended by the American Academy of Pediatrics for healthy infants during the first 6 months of life. Sleeping on the side is not an acceptable alternative because it is an unstable position and has a 2 times greater risk of SIDS then sleeping on the back. Sleeping on the tummy (face-down) has a 5 times greater risk.

Soft surfaces are unsafe for babies even if they are placed on their backs. Someone, such as another child or baby sitter, might turn them over.

You can prevent these tragic deaths by suffocation by never putting young infants down to sleep on the following soft surfaces:

• waterbeds or featherbeds
• sheepskin rugs or mattress covers
• any weak, spongy surfaces, including soft mattresses and comforters
• mattresses covered with plastic bags
• soft pillows, such as bean-bag or bead-filled pillows. Also, avoid stuffed toys, blankets, or other soft objects that could bunch up around your child's face.

Prevention of Suffocation in Toddlers

Older infants and toddlers can be suffocated by plastic bags or sheets of plastic. These accidents usually occur when they pull the plastic over their heads or crawl into plastic bags. Carefully dispose of any plastic bags or keep them away from children less than 3 years old. Examples of such products are:

• plastic dry-cleaning bags
• plastic shopping bags
• plastic trash bags.

Other Causes of Suffocation

Plastic

• The fine plastic used for packing mattresses, pillows, etc. is very dangerous. Never leave it lying around. Cut it up before throwing it away.
• Plastic bags can be lethal. Teach children never to put them over their heads – and do not allow little ones to play with them. Tie a knot in the bag for safety.
• Use waterproof sheets of heavy duty thickness.

Cords and ribbons

• Remove bibs or any clothing with ribbons or cords before putting the baby to sleep. A loose bib may cause suffocation.
• Do not attach a pacifier to a string around the baby’s neck.
• Most babies don’t need pillows. If you have to use a pillow, make sure it is thin and firm, not soft. Pillows with ventilation holes are available.
• Take care that no dangling cords, like those of Venetian blinds, are within the baby’s reach.
• Children under five years should not be allowed to play with cords, ropes, etc. unless an adult is watching.

Old fridges

• Always remove the entire door or locking device before discarding old refrigerators. Children trapped when playing in a fridge will suffocate because it closes airtight.

To reduce the chances of strangulation:

In the Crib

• Check with the U.S. Consumer Product Safety Commission before buying a new or second-hand crib to make sure it hasn't been recalled.
• Make sure the slats on your crib are no more than 2 3/8 inches apart–this is really important for second-hand cribs that are a few years old. If slats are wider than 2 3/8 inches apart, babies can slide through the slats and strangle when their heads get stuck.
• Do not use a crib with cut-outs in the end panels or with corner posts more than 1/16 inch higher than the end panels. Strangulation can occur if a baby's clothing gets caught on a high corner post or if a baby's head gets caught in a cut-out.
• Remove your baby's bib before bedtime or nap time.
• Remove mobiles and crib gyms as soon as your baby is five months old or can push up on hands and knees.

Around the House

• Pull drapery and mini-blind cords out of children's reach and away from cribs. If the cords have a loop, cut the loop and attach separate tassels to avoid strangulation.
• If your child has a bunk bed, check the guard rails on the top bunk. There should be only a very small space between the rail and the mattress or bed frame so your child's body cannot slide through.
• Don't let your child lie in or play with a hammock that doesn't have spreader bars (wooden strips at the ends of the hammock that stop the netting from bunching up). Mini-hammocks, often used to store toys and stuffed animals, are also a hazard. Your child can get entangled in them.
• Remove hood cords and drawstrings from your child's clothing. These cords can get caught in playground equipment or on crib parts and strangle your child.