Choking in Babies: How to Help & Prevent Choking

Written Dr. Seran Kim, board-certified Emergency Physician

Choking is a terrifying prospect for parents. Unfortunately, this is not an uncommon occurrence. Every year, over 12,000 children are evaluated in the Emergency Department for choking-related episodes. And 1 child dies approximately every 5 days due to choking in the United States. But the good news is that choking is largely preventable.

Choking happens suddenly and can have devastating consequences. It occurs when a baby cannot breathe due to a foreign body blocking their trachea (airway). This then impairs oxygenation and ventilation. When a baby does not get enough air, permanent brain damage can occur in as little as four minutes.

How to prevent choking in babies

Choking rates are highest for babies younger than 1 year. The best way to ensure your baby does not have a choking episode is by avoiding choking hazards. Small objects, such as food and candy, are the most common choking hazards. However, certain feeding behaviors (such as eating while distracted) and everyday household items and toys can also cause choking.

To prevent choking in an infant, follow these steps:

• Appropriately time the introduction of solid foods. Babies need effective motor skills to be able to swallow their food. Introducing your baby to solid foods too early can lead to infant choking. Wait until your baby is at least 4 months old to introduce pureed solid foods.
• Avoid high-risk foods. Do not give babies (or young children) hot dogs or sausages, large chunks of meat, cheese (especially string cheese), grapes or cherries, raw vegetables or fruit chunks—unless they are cut up into small pieces. Also avoid giving babies hard foods, such as seeds (including sunflower), nuts (especially peanuts), pretzels, popcorn and hard candy, which can’t be changed to make them safe options. Don’t forget that breads or crackers with seeds or nuts, dried fruit (especially raisins) and whole kernels of cooked rice can also pose as choking hazards. Other high-risk foods include peanut butter, marshmallows, gummy bears and chewing gum.
• Supervise mealtime. As your baby gets older, be sure that they avoid playing, walking or running while eating. Remind your child to chew and swallow food before talking. Encourage your child to take small bites, and avoid putting large amounts of food into their mouth.
• Carefully evaluate toys. The United States Consumer Product Safety Commission continually evaluates and monitors infant and child toys for safety. Be sure to check their website for recalls or safety notices. As a reminder, do not allow your baby or toddler to play with latex balloons or vinyl gloves, which are extremely dangerous choking hazards when deflated or broken into pieces. Also avoid encounters with small balls, marbles or toys that contain small parts or are meant for older children. Always double-check for age guidelines when purchasing toys and regularly examine toys to make sure they are in good condition.
• Keep hazardous objects out of reach. Common household items that are seemingly innocuous can be great choking hazards. These include coins, button batteries, dice, screws, jewelry (such as earrings), holiday decorations (such as ornaments, tinsel and lights), crayons, erasers and pen caps.

What are the signs that a baby is choking?

There are many danger signs that can alert you that your baby is choking. These include:

• Gagging
• Difficult, noisy breathing
• Inability to cry or make much sound
• Bluish skin or lip color (note: skin color changes can be harder to see in babies with darker skin, so be sure to rely on the other signs as well)
• Weak, ineffective coughing
• Soft, squeaky, or high-pitched sounds while inhaling
• Loss of consciousness (unresponsiveness), if blockage is not cleared

What to do if your baby is choking:

If your baby exhibits any of these, administer first aid immediately. When properly performed, choking first aid is proven to save lives. The American Red Cross recommends the “five-and-five” approach, which consists of alternating blocks of back blows and chest thrusts.

Do NOT perform these procedures if your baby is actively coughing or has a strong cry, as these actions can help push the object out of the airway. Note that these procedures are different from the Heimlich maneuver, which is reserved for children over 1 year of age, and adults.

It is always recommended to learn the proper techniques by taking a formal infant CPR/First Aid class. There are many options on how and where to take this, including in-person, as well as virtually (here’s one from the American Red Cross).

Although these guidelines do not supplant a certified course, here are the steps for delivering choking first aid:

1. Give 5 back blows.

• Place your baby tummy down across your forearm. Point the head downward, lower than the body. Cradle the chin with your fingers.
• Give 5 quick, forceful blows on your baby’s back, with the heel of your other hand.

2. Give 5 chest thrusts.

• If the object does not come out after 5 back blows, turn your baby around face up, supporting the head.
• Use 2 fingers in the middle of the breastbone, just below the nipples, and give 5 quick chest thrusts, compressing about 1/3 to 1/2 the depth of the chest.

3. Alternate between 5 blows and 5 thrusts.

• Continue the 5 back blows, followed by 5 chest thrusts cycle, until the object is dislodged.
• If you see the object, you can attempt to remove it with a finger sweep, but do NOT attempt if you cannot see it, as you could push it further down.
• Always check in with your doctor, even if the choking incident has resolved, and your baby seems fine.

If your baby loses consciousness, stops breathing or turns blue:

• Shout for help.
• Perform Infant CPR for 1 minute.
• Then call 911.

An infant’s trachea is less than the diameter of a straw. So it is easy to see how any baby can easily choke on a seemingly harmless object or piece of food. Remember, the best key is prevention. But in case of emergency, periodically review the choking first aid algorithm. You could save a life!

Disclaimer: The medical information provided does not substitute for medical advice and is for educational purposes only.

Factually reviewed by Dr. Seran Kim, board-certified Emergency Physician, on June 7, 2021.