Choking in early childhood

The Federal Hazardous Safety Act and the Child Safety Protection Act ban any toys that are intended for toddlers less than 3 years of age if the toy could cause choking. Toddlers under 3 or 4 years old are at the greatest risk for choking. Toddlers under 2 years old account for half of those seen in emergency rooms for choking.  

A recent study,* showed that an average of 12,435 choking events occurs yearly. Forty percent of those were under a  year of age, with the number dropping off for each year until 7 years of age. Children 4 years and under were almost 3 times as likely to have choking incidents compared to 5-9 year olds.

Choking hazards

Hard candy caused 15.5 percent of the choking episodes with other candies causing another 12.8 percent. Meat and hot dogs caused 14.8 percent, with bone causing 12 percent. These varied by age with bone-related choking usually in older children, of 7.6 years old. Infants can choke on breastmilk or formula at an average of 4 months of age. Choking is not uncommon when raw fruits and vegetables are introduced to infants. 

The reasons for choking vary by age. Molars, which grind food, don't erupt until 2 years of age. Until 3-4 years of age, children are still learning to chew and swallow effectively. As children grow up, they can become distracted and their high activity levels may interfere with the attention needed to avoid choking

BOTTOM LINE AND RECOMMENDATIONS: 

• Children of all ages choke, with those at younger ages at higher risk.  
• Cut soft raw fruits and vegetables into small pieces
• Avoid hard candy  for those under 5 years (as the AAP recommends)
• Don't let your child play, run or lie down while eating . Instead sit down with them and enjoy the time together while you supervise their eating behaviors.

*MM Chapin et al. Pediatrics 132:275-281, 2013