Reducing Choking Risks in Early Childhood

Mealtimes with young children can be fun, messy and sometimes stressful. Our registered dietitians wanted to support early childhood educators, parents and caregivers who are feeding young children. They teamed up with pediatric feeding experts to create a free visual guide. It shows how to make foods safer and reduce choking risk. This guide is referenced throughout this article and may be helpful to download as you read.

Young children are at higher risk of choking

Although choking can happen at any age, young children are at a higher risk for several reasons.

• Their teeth are still developing.
• They are learning to coordinate chewing and swallowing.
• Their smaller airways can easily be blocked by food.
• They may become distracted while eating since they are naturally curious.

The good news is that you can make foods safer for young children. This can help give you peace of mind during mealtimes.

Three ways to keep mealtimes safer

#1 Avoid foods most likely to cause choking.

Choking can happen with any food, but some are considered high risk. This is due to their shape, size and texture. 

Certain foods can not be modified to them make safe. They should not be served to children under the age of 5.

• Whole or pieces of nuts and seeds
• Popcorn
• Marshmallows
• Ice cubes
• Hard candy and cough drops
• Gummy and sticky candy
• Chewing gum
• Fruit leather
• Hard roasted chickpeas and corn nuts
• Foods on toothpicks or skewers
• Tortilla chips and hard pretzels

#2 Modify high risk foods to make them safer.

Certain foods are more likely to cause choking, especially if served in their whole or unmodified forms.

Examples of common choking hazards:

• Hard foods (carrots, apples)
• Tube-shaped foods (hot dogs, string cheese)
• Small, round foods (grapes, cherry tomatoes)
• Chewy foods (meat, dried fruit)
• Foods with bones (chicken, salmon)
• Stringy foods (celery, lettuce)
• Sticky foods (peanut butter)
• Doughy foods (soft bread, muffins)

Refer to the Guide: Reduce the risk of choking for a detailed list of food examples and how to make them safer for young children.

#3 Create a safer mealtime environment.

It is also very important to consider how you serve food, in addition to what foods you are serving. Create a safe eating environment by following these guidelines:

• Supervise children closely while they eat.
• Have them sit upright with feet supported.
• Encourage children to eat slowly, take small bites and chew well.
• Turn off screens and put away toys to keep mealtimes focused and distraction-free.
• Avoid feeding children in a moving car, stroller or wagon.
• Take a First Aid and CPR course so you know what to do in an emergency.

Every child develops at their own pace. Some may be ready for certain foods earlier than others. Talk to a healthcare professional about what’s safe for the child if you have questions or concerns.

Serving food to young children doesn’t have to be overwhelming. Learning about choking hazards and using this expert-backed guidance tool can help you feel confident and prepared.

Download your copy of the guide.

References

This article and resource were informed by a comprehensive review of over 75 international sources, along with input from pediatric experts. A curated selection of key references and practical resources is provided below.

• Chapin, M. M., Rochette, L. M., Annest, J. L., Haileyesus, T., Conner, K. A., & Smith, G. A. (2013). Nonfatal choking on food among children 14 years or younger in the United States, 2001–2009. Pediatrics, 132(2), 275–281. https://doi.org/10.1542/peds.2013-0260
• Committee on Injury, Violence, and Poison Prevention, American Academy of Pediatrics. (2010). Policy statement: Prevention of choking among children. Pediatrics, 125(3), 601–607. https://doi.org/10.1542/peds.2009-2862
• Feeding Littles. (2024). Choking hazards to avoid or modify for kids [PDF Handout provided by author].
• Gergès, C., & Edger, M. (2018, October). Prévention de l’étouffement chez le nourrisson et le jeune enfant [PDF Handout provided by author]. Nutritionnistes en pédiatrie.
• Health Canada, Canadian Paediatric Society, Dietitians of Canada, & Breastfeeding Committee for Canada. (2014). Nutrition for healthy term infants: Recommendations from six to 24 months.
• Kennedy, E., (n.d.). Choking prevention and when food modifications are no longer needed. My Little Eater Inc.
• Lumsden, A. J., & Cooper, J. G. (2017). The choking hazard of grapes: A plea for awareness. Archives of Disease in Childhood, 102, 473–474. https://doi.org/10.1136/archdischild-2016-311750
• Ministry of Health. (2020). Reducing food-related choking for babies and young children at early learning services. Wellington, New Zealand: Ministry of Health.
• New York State Department of Health. (2022, February). Choking prevention for children.
• (2023, November 15). Choking: Tips to prevent choking in children. Parachute Canada.
• Parent Health Education Resource Working Group. (2024). Loving care: 1 to 3 years. Nova Scotia Health; reprinted by Province of New Brunswick.
• S. Department of Agriculture, Food and Nutrition Service. (2020, September). Reducing the risk of choking in young children at mealtimes [Tip sheet].
• Justine Veilleux, Sandrine Bellavance, Mahukpe Naricsse Ulrich Singbo & Patrick Daigneault (2024) Foreign body aspiration in children: A review of prevention guidelines by analyzing choking episodes in Eastern Québec from 2006 to 2020, Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 8:5, 222-228, https://doi.org/10.1080/24745332.2024.2389883