On a bright morning last March, Tara Chazen’s 2-year-old son was toddling around his neighborhood park and munching on a graham cracker when a piece of it suddenly got stuck in his throat. Chazen was at work, and by the time his babysitter noticed that something was amiss less than a minute later, the cracker shard had moved from his trachea into his lung. The boy’s face turned purple and he fell to the ground, unconscious. An ambulance arrived while his babysitter frantically performed CPR. When Chazen got to the hospital and laid eyes on her son—pale and still, and dependent on a ventilator to breathe—she thought he was dead. It was hard to believe that a simple snack had caused his devastating condition.
Tragically, a child loses his life after choking on food approximately every five days in the U. S., and 34 children a day are admitted to emergency departments for the same reason, according to a study in Pediatrics. Sixty percent of these incidents happen to children under age 6. Of course, the problem is actually even bigger than that because many kids who choke never go to the hospital, and the numbers in this study didn’t include choking incidents unrelated to food. Nearly two thirds of those choking fatalities (from items like balloons, coins, plastic toys, and batteries) occur in children under age 4. Since a child’s airway is small, it can be obstructed more easily than an adult’s, says Michael W. Cater, M.D., a pediatrician at St. Joseph Hospital in Orange, California.
Chazen’s son’s lung had filled with fluid and become perilously inflamed, and doctors worried he had suffered brain damage due to lack of oxygen. But miraculously, the little boy fully recovered after a weekslong hospital stay. Today he’s a thriving 3-year-old who is back to playing at the park. Understandably, Chazen is still shaken by the experience. “I know I should be able to look away when he plays, but I can’t,” she says.
It would be impossible, not to mention pretty anxiety-provoking, to keep tabs on every single thing that could find its way into your child’s mouth. But that doesn’t mean you are powerless to keep him safe. Experts share smart guidelines to implement today for babies, toddlers, and preschoolers.
1. Insist on good posture. Sitting in a high chair or a booster seat with a firm back is great, but for your child to dine safely, his feet should rest on something too—even if it’s just a cereal box taped to his high chair, says Melanie Potock, a pediatric feeding specialist and coauthor of Raising a Healthy, Happy Eater. (Think of how wobbly you feel when you’re on a bar stool and your feet dangle.) Shopping for a high chair? Consider Potock’s picks: Graco Blossom 4-in-1 High Chair Seating System, Fisher-Price SpaceSaver, and Keekaro Height Right.
2. Toss the tray. Instead, pull the high chair up to the edge of your table. This will keep her food directly in front of her, help you watch her more closely, and prevent her from over-rotating to the left or right, which can cause her to lose control of the food that’s in her mouth.
3. Provide utensils. Forks, spoons, and chopsticks all help young kids eat slowly because they’re challenging to use. “Eating with his hands makes it easy for a kid to put too much food into his mouth at once,” says Potock. Even an infant practicing baby-led weaning (a feeding method that largely skips purees) can learn to use a child-size spoon or fork. And of course, watch your child carefully as he eats, regardless of what kind of utensil he is—or isn’t—using.
4. Serve dips on the side. When guacamole or hummus binds with a dry cracker or chip, it helps the food slip down a little easier.
5. Teach your child not to talk with her mouth full. “Kids are more likely to breathe in food that way,” Potock says. Even a very young child can learn to hold up a finger when she’s eating to show that she needs a minute. This will also help her learn a slow, natural rhythm of eating.
6. Limit distractions. No eating in front of a screen. “Kids should be mindful when they chew,” says Potock. “Have a designated eating time and sit down for it.”
7. Be careful in the car. The bumpy motion can push too much food down a little throat when your attention is on the road instead of on your child. “To lessen this risk, offer foods that quickly melt, dissolve, or crumble—and make sure your child has the self-control to not shove an entire cup of puffs into her mouth at one time,” says Alisa Baer, M.D., pediatrician and cofounder of The Car Seat Lady blog. “Choking risk increases when a child’s mouth is too full to properly chew and swallow.”
8. Prepare food with care. Young kids are still learning how to eat. By 18 months, they have molars to help chew and grind food, but they aren’t pros at doing so. In fact, kids don’t truly master chewing until age 4. Even if a child tries his hardest to cough up a too-big piece of food on his own, he may not be able to dislodge it, says Dr. Cater.
Foods that are round and hard, sticky and gooey, or dry and tricky for little tongues to manipulate can get lodged in immature airways. The American Academy of Pediatrics’ list of choking hazards includes: hard or sticky candy, hot dogs, chunks of meat, chunks of raw veggies, nuts and seeds, hunks of cheese, globs of peanut butter, popcorn, whole grapes, and chewing gum. While a few foods—namely, hard candy, nuts, seeds, raw carrots, and popcorn—should be flat-out avoided, others can be made into a safe snack by altering size (aim for pea-size pieces) or texture (keep everything soft). If you’re doing baby-led weaning, cut food into pieces about the length and width of an adult pinky finger, and make sure it’s soft enough to easily smash between your thumb and forefinger.
9. See what your child sees. “Get down on your hands and knees and look at your home from your kid’s perspective. Do this often, not just once,” advises Colleen Driscoll, executive director of the International Association for Child Safety. That will help you notice choking hazards like a paper clip or a thumbtack before your toddler does. “As a general rule of thumb, any object smaller than your child’s fist is a hazard,” says Danelle Fisher, M.D., chair of pediatrics at Providence Saint John’s Health Center, in Santa Monica, California.
10. Stay on top of older sibs’ stuff. Store big-kid toys separately from your younger child’s playthings and check often for broken or missing parts, like darts, arrows, magnets, and button batteries—all of which could end up in a child’s mouth. Small toys, particularly spherical ones like marbles and small balls, are also big dangers. Balloons are by far the worst: They are the leading cause of choking fatalities in kids under 6. “Uninflated and broken pieces conform to the airway and form an airtight seal,” says Tuan Nguyen, M.D., assistant medical director of Orange Coast Memorial Medical Center’s Emergency Pavilion, in Fountain Valley, California.
11. Break out the baby gates. No parent’s house is spotless 24/7, especially when you have a toddler. “But you can maintain a safe ‘kid zone,’ ” says Susan Baril, vice president of Safe Beginnings, Inc. “Install safety gates to keep him out of rooms that house choking hazards and other unsafe items, like an older sibling’s bedroom or a home office.”
12. Gather loose change. Take coins out of your pockets as soon as you come home, and set up a consistent, dulllooking place to put them that’s out of reach.
13. Keep bags out of the way. Instead of dropping your handbag or backpack next to the front door, put it somewhere off-limits, such as high up on a shelf or in a hallway closet. Your purse’s contents—lip gloss, keys, coins, cough drops, pen caps, and the like—make it too risky for the floor.