Choking Prevention for Infants and Young Children

Why young children are prone to choke

baby chewing on toy

A child will explore the world by putting anything and everything into his or her mouth.

American Academy of Pediatrics (2020)

The tendency of babies and toddlers to put objects in their mouths as they explore the world with their senses occurs during a stage when their airway (trachea) and ability to chew and swallow are not fully developed. This mismatch in activity and development levels makes them highly vulnerable to choking.

Babies have a natural ability to suck and swallow, and their involuntary reflexes—gag, cough and glottic closure—help prevent aspiration. But a small airway is easily obstructed.

“It takes time for babies to master the ability to chew and swallow food, and babies might not be able to cough forcefully enough to dislodge an airway obstruction” (Mayo Clinic, 2019).

Chewing abilities remain relatively incomplete throughout early childhood (AAP, 2020):

  • Tooth eruption begins at 6 to 12 months of age.
    • Incisors and canines are first to erupt.
    • Molars, which are necessary for chewing and grinding food, erupt at 12 to 19 months of age.
  • Infants and toddlers may bite off a piece of food, but without molars they are unable to grind it for swallowing.

The anatomy and function of the airway makes babies and young children vulnerable to choking on a piece of food or foreign object:

  • The airway’s small diameter increases the chance it can be blocked.
  • Even a small reduction in airflow can effectively form a seal around a piece of food or foreign object and make it difficult to dislodge. Proper methods to dislodge food from a choking child are discussed later in this course.

The shape, size, consistency and other characteristics of a piece of food or foreign object contribute to the choking risk. The most dangerous objects that present a choking hazard are cylindrical, airway-sized and compressible, allowing them to wedge tightly into a child’s hypopharynx and occlude the airway.

“Uninflated and pieces of broken latex balloons pose a particular hazard because of their ability to conform to the child’s airway and form an airtight seal” (AAP, 2020).

True or False?

Infants and young children can always dislodge an airway obstruction by coughing.

Children with special health-care needs

Many children with developmental and neurologic disorders or disabilities “do not have the cognitive skills, behavioral control or experience to chew well and eat slowly” (AAP, 2020).

In addition to anatomical and developmental explanations for choking dangers in very young children, behavioral factors play a significant role.

  • Young children are easily distracted while eating. Diversions include watching television or videos and playing with a toy or other object.
  • Young children are restless and like to be on the move. Crawling, walking, running, laughing, crying, babbling and talking while eating increase the risk of choking.