Food Safety in Children: What Every Parent Needs to Know to Prevent Choking Accidents

Every five days in the U.S. alone, a child dies from choking on food. In addition, over 10,000 children come to U.S. emergency rooms every year for food choking episodes. Most of these kids are under four years old, although it can happen to older kids as well.

Because of their immature swallowing control, lack of a complete set of molars (which usually fully develop at age six), rare ability to sit still while eating, and poor coordination protecting their breathing passages, young children are the group most frequently affected by food choking. It is one of the leading causes of accidental injuries in the home for this age group, and it is the fourth leading cause of accidental death in kids under age 14 years.  

The toddler years are a time when a child gains more independence from parents and caregivers. Since toddlers are playful, adventurous, and rarely like to sit still, safe eating is usually not on their minds.  But it should be on ours. Unfortunately, we as parents and caregivers do not have access to established guidelines regarding food safety in children.  While we can go into any toy store and check the labels for safety, ‘small-parts’, and appropriateness based on the ‘age’ label, we can get a bit lost in the grocery store, where virtually no such labels exist.

The Child Safety Protection Act of 1994 mandated that the Consumer Product Safety Commission place choking hazard labels on all toys intended for children under age six years if they contain small parts, and on all balloons and marbles intended for children of any age. Unfortunately, there is no similar mandate in place for food choking risks. While the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) give specific guidelines and recommendations regarding which foods to avoid for young children, there are no legislative guidelines in place.

The FDA investigates foods that pose an unusual choking hazard, and will periodically issue a recall or special labeling; however, this occurs infrequently and does not include common food items given to children.

Since we don't have the labels on foods yet, here is a list of foods that the AAP (with some additions) considers to be choking hazards for children under three years old:

1. Hot Dogs (unless cut lengthwise, and then in half-circle or quarter-circle shapes) (These are one of the few foods that may occasionally have choking risk labeling.)
2. Any nuts
3. Seeds (especially those with shells, such as sunflower or pumpkin seeds)
4. Whole grapes (these may be peeled, a la Roman times, and then cut into quarters)
5. Popcorn
6. Raw vegetables
7. Chewing gum
8. Hard candy/taffy/caramel
9. Lollipops, especially the spherical kind

We’ve all fed our kids some of the items from the list above. It's not worth the risk. As an airway doctor, I've treated kids who have choked on all of these items. Even older kids (and adults, for that matter) can choke on food.

If your child chokes on a foreign object, whether it’s food or a toy or an object from the ground, first assess whether or not he’s crying or coughing. These are signs that your child’s airway is NOT completely blocked.  Let him try to clear the object on his own.  If he has choked, and is not able to make any sound, the object is blocking his airway. 

First attempt the Heimlich maneuver.  To perform this, stand behind your child, wrap your arms around his upper belly area, grasp your hands together, and give five quick thrusts in an inward/upward direction.  If your child is under one year, place him on your lap with his belly on your knee, and give five back blows.  If he begins coughing or crying, the object may be partially or completely dislodged.  Do not continue the maneuver, but see if he can clear the object on his own.  If he continues to be unable to make a sound, and is not breathing, begin CPR. If you are with someone, have him or her call 911.  If you are alone, perform CPR for two minutes, and then call 911 and resume CPR after the phone call. 

If you have ANY questions about food safety, check with your doctor. If they don't know, err on the side of caution.  Public awareness of food safety is in its own infancy. Hopefully, in time, it will become as second nature and sunscreen and car seats.