Toddlers and choking

Air enters the lungs via the trachea (windpipe). Choking is caused when a foreign object, like a hard lump of food, goes into the trachea instead of the oesophagus (food pipe). If the object is at the entrance to the trachea (epiglottis), a good cough will, more than likely, expel it. If the object has made its way past the epiglottis, coughing may prevent the object from descending further down the trachea. Sometimes, an inhaled object may cut off the airway completely. Toddlers are at risk from choking on food and small items, such as buttons or beads. Parents can take many precautions to reduce the risk of their child choking. The most important thing to remember is never to pat or slap your choking child on the back if they are managing to cough. Your actions may dislodge the object and allow it to be inhaled deeper into the airway.

Symptoms

If the object is sitting at the epiglottis, coughing will expel it. However, breathing may be impaired if the object is lodged further down the trachea. This is a medical emergency. Symptoms include:

• Panic
• Inability to cough
• Stridulous (high pitched, noisy) breathing
• Breathing difficulties
• No breathing at all
• The skin around the mouth turns blue because of low oxygen levels (cyanosis)
• Unconsciousness.

First aid

If your child is choking and has trouble breathing, first aid suggestions include:

• Encourage your child to cough.
• Put your child in a position where their head hangs down, perhaps over your knee.
• Slap firmly four times between the shoulder blades.
• Check to see if the object has fallen out and if your child can breathe properly again.
• If not, repeat the procedure and call an ambulance.
• If your child loses consciousness, place them on the floor on their side and repeatedly compress and release their ribcage with your hands, using sharp, fast actions. This may force the remaining air in their lungs to expel the object.
• If your child is still not breathing, perform mouth-to-mouth resuscitation until the ambulance officers arrive and take over.

Toddlers and eating

The molars (back teeth) are used for grinding and mashing foods. Children don't start getting their molars until they are somewhere between 12 and 18 months of age, and it may take a further two years or more until all the molars are through and the child is fully proficient at chewing. This means they are vulnerable to choking on hard foods, such as raw carrot, chunks of apple, lollies, popcorn or peanuts. Suggestions to prevent choking include:

• Hard foods should be cooked, mashed, grated or avoided altogether.
• Cut meat into small, manageable pieces for your child, and remove tough skins from sausages and frankfurters.
• Cut food lengthwise to make it narrower.
• Supervise your child while they are eating.
• Explain to your child the importance of eating food quietly and while sitting down.
• Don't try to feed them if they are laughing or crying.

Sitting down at mealtimes

A child is more likely to choke on food if they are eating while running around. Suggestions for getting your child to sit down at mealtimes include:

• Accept that changes in behaviour take time and effort. Be patient and calm.
• Discuss your plan of action with your partner and other carers, so that your approaches are consistent.
• Be a good role model. Don't let your child see you walking around the house while eating.
• Establish a predictable mealtime routine to help your child remember they are required to sit down. They should sit down at an appropriate table and not be distracted - for example, by television.
• Involve your child in family discussions at mealtimes, so they are less inclined to leave the table.
• Don't fight over the 'sitting down' issue at mealtime.
• Talk about it with your child in a calm and reasonable way.
• Tell your child that their meal is over when they leave the table. Take away their plate, but offer them a healthy snack later if they are hungry.
• Be consistent. Insist that snacks are also eaten while sitting down.
• Compliment your child whenever they show the desired behaviour.

Prevention strategies - toys and small objects

Parents should be aware of potential choking hazards. Suggestions include:

• Treat any object smaller than a ping-pong ball (such as coins, buttons, marbles and beads) as a possible choking threat. Keep these small objects out of your child's reach.
• Polystyrene beads, found in beanbags and some stuffed toys, are easily inhaled.
• If you spot a potential choking hazard, deal with it immediately.
• Only buy toys from reputable manufacturers. Toys should comply with the Australian Standard AS1647.
• Warning labels on toys, such as 'Not suitable for children under three years', means that small parts may present a choking hazard. The label doesn't refer to skill level.
• Check toys regularly for signs of wear and tear. For instance, beaded stuffing inside a toy may present a choking hazard.
• Keep balloons away from small children. A bitten balloon may burst and send fragments down the child's throat.
• Older children in the household should be warned not to leave potentially dangerous items near young children.
• Peanuts are a well-known hazard.

First aid courses

Emergency medical treatment for young children isn't always the same as for adults, which is why all parents should ideally take a course in paediatric (child) first aid.

Where to get help

• Your doctor
• Maternal and child health nurse
• Parentline Tel. 132 289
• Tweddle Child and Family Health Service Tel. (03) 9689 1577
• St John's Ambulance Australia (Victoria) - for first aid course information Tel. 1300 360 455
• Maternal and Child Health Line, Victoria (24 hours) Tel. 132 229
• In an emergency, Tel. 000 for an ambulance.

Things to remember

• Choking is caused by a foreign object, such as a hard lump of food, going into the trachea instead of the oesophagus.
• Toddlers are at risk from choking on food and small items, such as buttons or beads.
• Hard foods, such as raw carrot and apple, should be cooked, mashed or grated.
• Supervise your child at all times when they are eating.
• Keep small items, such as coins, buttons and beads, out of reach of small children.

You might also be interested in:

• Child safety - at home.
  
• Child safety - reducing injuries.
  
• Toddlers and dummies.
  
• Toddlers and fussy eating.
  
• Toddlers and mealtime manners.
  

Want to know more?

Go to More information for support groups, related links and references.

This page has been produced in consultation with and approved by:

(Logo links to further information)

Tweddle Child and family Health Services

Fact sheet currently being reviewed.
Last reviewed: January 2011

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.

If you would like to link to this fact sheet on your website, simply copy the code below and add it to your page:

<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Toddlers_and_choking?open">Toddlers and choking - Better Health Channel</a><br/>
Choking is caused by an object going into the trachea (windpipe) instead of the oesophagus (food pipe). Toddlers can choke on food and small items, such as buttons or beads. Parents can take many precautions to reduce the risk. Learn first aid techniques to help your child in an emergency.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

For the latest updates and more information, visit www.betterhealth.vic.gov.au

Copyight © 1999/2012  State of Victoria. Reproduced from the Better Health Channel (www.betterhealth.vic.gov.au) at no cost with permission of the Victorian Minister for Health. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission.