Reducing choke risks for children under 5

Whether your baby is starting on solids or your preschooler is finishing their fruit snack, there is a chance that they might bite off more than they can chew – or swallow.

Some foods are hard for young children to eat, and because littlies are still perfecting their munching skills and have small air and food passages, certain foods can pose a higher choking risk.

Under fives – and especially under threes – are at a greater risk of choking than older children, so it’s important to know which foods are more likely to cause choking and how you can make mealtimes safer. Here’s some food for thought from the Ministry of Health. 

Which foods are more likely to cause under fives to choke?

Anyone can choke on food (including rushed parents gulping down a sandwich), but when it comes to under fives, the experts say there are six food types that are more commonly associated with choking incidents:

1. Small hard foods that are hard to bite through and chew well enough to swallow safely. For example: Nuts, pumpkin/sunflower seeds, hard dried fruit, pieces of raw carrot, celery or apple, hard sharp pieces of crisp, corn chip or rice cracker and unpopped popcorn husks.
2. Small round or oval foods that can get stuck in a child’s throat. For example: Grapes, berries or cherry tomatoes, raisins/sultanas, fruit with stones/large seeds/pips, peas and lollies/sweets.
3. Foods with skins or leaves that can be hard to chew and can completely seal a child’s airway. For example: Chicken, sausages, saveloys, cheerios, frankfurters, stone fruits, apples, pears, tomatoes, lettuce/salad leaves, spinach and cabbage. 
4. Compressible foods that can squash into the shape of a child’s throat and get stuck. For example: Sausages, saveloys, cheerios, frankfurters, hot dogs, cooked meat pieces, marshmallows, popcorn and chewing/bubble gum.
5. Thick pastes that can mould to the shape of a child’s airway and get stuck. For example: Chocolate spreads and peanut butter.
6. Fibrous or stringy foods that can be hard to chew into easily-swallowed bits. For example: Celery, rhubarb and raw pineapple. 

How can you reduce the risk of your child choking?

Although the above foods pose a higher risk of choking, you don’t necessarily have to knock them off the menu. 

By changing the texture of the food (e.g. grating, cooking, finely chopping or mashing it), removing its risky parts (e.g. the skin or fibres) and avoiding small hard foods, you lower the risk of your child choking when they eat. 

When it comes to food preparation, the Ministry of Health recommends that you:

• Cook carrot, apple and celery pieces until they’re soft, or finely grate them.
• Chop grapes, berries and cherry tomatoes into quarters or smaller pieces.
• Soften raisins and sultanas by soaking them and cut them in half if they’re big.
• Remove stones from your child’s fruit.
• Cook and squash peas with a fork (raw peas are a choking risk for small children).
• Spread peanut butter thinly and evenly, so it doesn’t get stuck in your child’s throat. This applies to other thick pastes, like chocolate spread. 
• Finely chop lettuce and other salad leaves.
• Cook spinach and cabbage until it’s soft, then chop finely. 
• Peel the skin and strong fibres off celery and rhubarb before giving it to your child.
• Slice fibrous foods thinly across the grain. 
• Remove skins from foods before serving (e.g. peel skins off nectarines and chicken breast).
• Chop foods with skins and compressible foods (e.g. sausages) into pieces at least as small as your child’s little fingernail, then add them to mashed food.

As well as preparing foods carefully, it’s also important that you think about your child’s meal time behaviour and eating abilities, as well as your own first aid skills. 

As a parent, you should:

• Supervise your child while they’re eating or drinking.
• Serve foods that match their chewing and food-grinding abilities.
• Establish a routine where meal times are for eating, not for playing or running around. 
• Always make sure your child sits down while they eat.
• Minimise distractions so they can concentrate on biting, chewing and swallowing. 
• Make sure your child does not talk with their mouth full. 
• Learn choking first aid and cardiopulmonary resuscitation (CPR) in case your child does run into trouble when eating. There is practical first aid information in HealthEd’s Well Child Tamariki Ora My Health Book. 

What foods should young children avoid completely?

Small children have small air and food passages, they’re still learning how to move food around their mouths, their biting and chewing skills aren’t fully developed, and because their ‘cough mechanism’ isn’t as effective as it will be later on, they can’t always cough up things that get stuck in their throat. 

With this in mind, some foods are just too risky for under fives to eat, and the government recommends that you:

• Avoid giving whole nuts, large seeds or hard dried fruit to under fives
• Don’t give small round hard, chewy or sticky lollies or sweets to under threes
• Do not give marshmallows or popcorn to under threes
• Don’t give chewing gum or bubble gum to young children

If you’d like your child to eat peanuts, then you can give them thinly spread peanut butter instead of a handful of nuts.

What other choking risks should parents be aware of?

Of course, food isn’t the only thing that can get stuck in a young child’s throat. 

Things like deflated balloons, beads, coins, small toy parts and batteries can also pose a risk, so always buy toys designed for your child’s age and be vigilant about choking hazards around the house and elsewhere.  

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Further reading

The Ministry of Education is considering changes that would require early learning services to follow Ministry of Health guidelines when preparing and serving food to minimise choking risks.

To see what this would mean for services, click here. 

And to get feedback from the Early Childhood Council and others, click here. 

References

Ministry of Health: Foods that pose a higher choking risk for children under five years

Ministry of Health: Food-related choking in young children