Health Advisory: Prevention of Choking Among Children

September 1 , 2010


Healthcare Providers, Hospitals, and Local Health Departments


New York State Department of Health Bureau of Injury Prevention

Health Advisory: Prevention of Choking Among Children

Please distribute to staff in Primary Care, Family Medicine, Pediatrics, and Emergency Medicine.>

The New York State Department of Health (NYSDOH) is sending this advisory as an important reminder to pediatricians, family physicians, and other infant and child health care professionals of their critical role in preventing choking among children.


Choking is an important public health problem for children, especially those aged 3 years or younger. Food, coins, and toys are the main causes of choking-related injury and death. In New York State, between 2006 and 2008, an average of 45 deaths due to choking occurred annually among children ages 0-19 years. In addition, each year an average of 288 children were treated at hospitals due to choking, 127 of whom sustained injuries serious enough to require hospitalization.

Choking Prevention for Children

The injury or death of a child due to choking is a tragedy that can be prevented. Health care providers should provide parents and caregivers choking-prevention counseling as an integral part of anticipatory guidance activities.

The following are key messages for parents and caregivers on how to reduce the risk of children choking on foods:

  • Children should sit up straight when eating, should have sufficient number of teeth, and the muscular and developmental ability needed to chew and swallow the foods chosen. Even though children start to get teeth at an early age, they often cannot grind hard, smooth foods until age four. Children with special health care needs are especially vulnerable to choking risks.
  • Never leave a small child unattended while eating. Direct supervision is necessary.
  • Children should have a calm, unhurried meal and snack time.
  • Children should not eat when walking, riding in a car or playing.
  • Cut foods such as grapes and other fruits, meat, cheese and raw vegetables into small pieces and shapes that won't block airways. Remove any seeds or pits.
  • Cook or steam vegetables to soften their texture.
  • Cut hot dogs lengthwise and widthwise.
  • Use only a small amount of peanut butter when the child is ready and use with jelly, or cream cheese on whole grain breads.
  • Offer plenty of liquids to children when eating, but solids and liquids should not be swallowed at the same time. Offer liquids between mouthfuls.
  • Think of shape, size, consistency and combinations of these when choosing foods.
  • Parents and caregivers should model safe eating habits and chew food thoroughly.

In addition, the following are key messages for parents and caregivers on how to reduce the risk of children choking on items other than foods:

  • Keep small objects away from children. This includes items such as balloons, coins, marbles, button-type batteries, medicine syringes, small stones, tiny figures, screws, rings, earrings, crayons, erasers, pen or marker caps, toys with small parts, and holiday decorations including tinsel, ornaments and lights.
  • Look for manufacturers' age guidelines when selecting toys for children.
  • Inspect all toys regularly for breakage or loose parts.

Parents and caregivers can prepare for choking emergencies by learning life-saving measures such as child choking first aid, cardiopulmonary resuscitation, use of Automated External Defibrillators (AED) or calling 911.

Additional Information

Additional information can be found on the NYSDOH Choking Prevention web site at:

This web site includes a fact sheet on child choking prevention and contains links to other web pages with information on choking hazard product recalls (including pictures of recalled items), cardiopulmonary resuscitation (CPR) and a choking first aid poster.

If you have any questions regarding child choking prevention, please contact your local health department or the NYSDOH Bureau of Injury Prevention at (518) 473-1143.