Preventing and Handling Choking

Choking is a major cause of death in infants and young children. There are many ways to prevent choking, and parents can be prepared to help.

Foods That Can Cause Choking

Children 3 and under are at risk of choking on small nonfood items as well as on food. A number of foods are especially likely to cause choking and should be avoided. These are either small, hard, round foods that can block the young child's small windpipe or semisolid or sticky foods that can get stuck on the way down. For children 3 years old and under, avoid hard candies and gum balls, peanuts and other nuts, fruits with pits or large seeds (for example, cherries and watermelon) unless the pits and seeds are removed, raw carrots and celery, peanut butter, hunks of meat, and hot dogs. The risk of choking can also be lowered by feeding a child only when she is safely seated and not on the run.

How to Handle Choking

Before your child has a choking episode, read a guide to infant CPR (such as the Children's Hospital Guide to Your Child's Health and Development). You may also want to take a CPR course from the Red Cross or a local hospital. Before 8 months, all parents will want to have instructions handy on maneuvers to help a choking baby. You'll be glad you're prepared.

If your child is able to cough up the food or object on her own, let her. If she can't give a good cough and is having trouble breathing, but is conscious, do the following: With an infant (under 1 year of age), face her belly down on your forearm, head down, supporting her head and neck firmly with your hand. With a heavy baby you many need to support that arm with your knees. With the heel of your other hand, hit her five times between the shoulder blades. If she still doesn't cough up the offending food or object, put your free hand and arm over her back and turn her over onto her back, supporting her head and neck, keeping her head below her body. Then press on the infant's chest, just below nipple level, but not at the bottom of her breastbone, up to five times with two or three fingers. Alternate these back blows and chest thrusts until the baby coughs up the piece of food or small object.

If your infant appears to be unconscious or not breathing, try to rouse her gently and then shake her shoulder. If she does not respond, shout for someone to call 911 for emergency help so that you can stay with your baby. If no one is nearby, make the call yourself, but keep your baby with you. In either case, then start infant CPR.

For a child over 1 year of age, who is conscious but cannot speak or cough, use the Heimlich maneuver first. This maneuver isn't recommended for babies under 1 year. If a child over a year old appears to be unconscious after gently tapping her and then shaking her shoulder, call for help, stay with the child, and begin child CPR procedures. (After proper positioning, rescue breaths, repositioning, and another trial of rescue breaths, the Heimlich maneuver is another step in the CPR guidelines for unconscious children.)

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