Children choking at mealtimes can happen quickly and can be very scary. In fact, children between birth and four years of age are at the greatest risk of choking while eating, in part, because they may not chew food properly. Young children also have a small windpipe (or airway) about as wide as a drinking straw, making it more likely for food to be stuck.

How can you make eating safer for young children? Good practices include three key methods. First, know which foods are the most common causes of choking. Second, select and modify foods to the appropriate size, shape, and texture. Third, supervise children during mealtimes. Read on to learn ways to prevent choking in young children.

Brunette Hispanic Girl Shouting And Suffocate Because Painful Strangle. Health Problem. Asphyxiate And Suicide Concept.

Food That May Cause Choking

Food causes over 50% of choking episodes in young children. The following types of foods are most likely to be a choking risk for infants and young children.

Trail Mix With Popcorn And Pretzels

Firm, smooth, or slippery foods that slide down the throat before chewing
- Examples: hotdogs, nuts, whole pieces of fruits and vegetables (grapes, cherry tomatoes, mango)
Small, dry, or hard foods that are difficult to chew and easy to swallow whole
- Examples: popcorn, nuts and seeds, pretzels, small pieces of raw vegetables
Sticky or tough foods that do not break apart easily and are hard to remove from the airway
- Examples: large pieces of meat, chunks of peanut or nut butters, marshmallows, dried fruit

How to Modify Foods

Prepare foods to the right size, shape, and texture to lower the risk of choking.

Size

Cut foods into small pieces no larger than ½ inch (avoid foods that are as wide as or larger than a nickel).

Shape

Cut foods into short, thin slices or strips instead of round pieces.
Cut sphere-shaped foods such as grapes, cherries, or cherry tomatoes in half lengthwise and then cut them into smaller pieces.

Texture

Cook or steam food until soft enough to pierce easily with a fork.
Grate, mash, or puree foods.
Offer “squishable” foods that are soft and easy to chew.
- Examples: cooked cereal; whole blueberries that are squished or flattened; ground beef; soft, cooked vegetables
Remove seeds, pits, and tough skins/peels from fruits and vegetables.
Remove bones from fish, chicken, and meat.

The chart shows foods that pose a choking risk and ways to modify them so they are safe for young children to eat.

Food Item	Avoid	How to Modify
Cheese	Round pieces, chunks, or blocks String cheese cut into round pieces	Cut into thin slices or short strips Shred or grate
Fruit	Whole or raw fruit (grapes, cherries, mango, melon balls) Fruit with pits or seeds Large pieces of fruit with skin Whole pieces of canned fruit Raisins and other dried fruit	Remove tough skins or peels Cut into small, thin strips or slices Remove large seeds and pits Choose ripe berries, which are softer and can flatten slightly with a fork Remove membrane from oranges or cut up canned mandarin oranges Cut grapes or cherries lengthwise, then into smaller pieces no larger than ½ inch
Grains	Breads, cereals, or crackers with seeds, nuts, or whole grain kernels Popcorn Potato and corn chips Pretzels and pretzel chips	Cut bread, pita bread, or tortillas into thin strips Offer lightly toasted bread to decrease the “stickiness” Choose items without seeds, nuts, or whole grain kernels
Legumes	Raw beans or peas	Cook well and smash with a fork
Meat, Poultry, Fish	Dry, tough, stringy, or large chunks of meat, poultry, or fish Fish, meat, or poultry with bones Hot dogs, meat sticks, or sausages	Serve ground meat, poultry, or fish in pieces of no more than ½ inch Remove bones from poultry, meat, and fish Shred tough or dry meat
Nuts and Seeds	Peanuts, nuts, seeds	Finely grind peanuts, nuts, and seeds
Nut Butters	Large amounts of creamy nut butters Chunky nut butters	Spread a thin layer of creamy nut butters on toast or crackers
Vegetables	Whole, raw, round, or hard pieces (cherry or grape tomatoes, carrot rounds, baby carrots, green peas, string beans, celery, corn, whole beans) Large pieces of vegetables with skin	Remove tough skins or peels Cook or steam hard vegetables until soft, then slice lengthwise Cut raw vegetables like cucumbers into small, thin strips or slices Cut cherry and grape tomatoes into lengthwise quarters or halves
Other	Marshmallows, hard candy, gummy fruit snacks, ice cubes	Do Not Serve

Mealtime Behaviors

Children and adults should be attentive and focused during mealtimes to lower the risk of choking. Talk with children about proper mealtime behaviors before they sit down for a meal. Some tips to help prevent choking include:

Only provide food at a table or highchair.
Allow plenty of time for meals and snacks.
Encourage children to chew foods slowly and thoroughly before swallowing.
Teach children not to talk or laugh while chewing.
Have children sit upright at the table while eating.
Do not allow children to walk or run while eating.
Always stay in the room with the children.
Keep mealtimes calm and quiet.
Reduce distractions.
Model safe eating behaviors like eating small portions and taking only one bite at a time.
When serving infants, do not prop the bottle for the baby to feed themselves.

Small Child Choked On Food Eating In The Kitchen Indoors

Gagging vs. Choking

Gagging is often confused with choking. While it may be scary, children’s gag reflex is a natural defense against choking. If a child starts to cough or gag, give them time to work through it on their own. Do not try to remove the food with your fingers as you may push it farther back and cause it to get stuck in their throat.

Gagging involves a lot of coughing, but choking, in contrast, can cause high-pitched sounds or may even be silent. If you suspect a child is choking, take action immediately using skills learned in first aid or CPR training. Below are the different symptoms and signs of gagging and choking.

Gagging

May be loud with coughing or sputtering
Tongue thrusts forward
Eyes may water
Face may be red

Choking

Quiet or silent, cannot talk or cry
High-pitched noises, may gasp or wheeze
Ineffective cough
Bluish lips, nails, and skin

Communicate With Families

Talk with families about their child’s development as well as the foods and textures introduced at home. Use handouts from the Feeding Infants in the Child and Adult Care Food Program to help start a conversation. Examples of handouts include:

For Parents: Is Your Baby Ready for Solid Foods? (page 12)
For Parents: What Is Your Baby Eating? Let Us Know! (page 63)
For Parents: Varying Your Baby’s Veggies (page 88)

These handouts are available to download for free in English and Spanish.

Online Document Expertise Review Or Legal Text Content Research Censorship On Laptop Pc Vector, Digital File Analysis Concept, Article Inspect, Law Proof Information Searching, Essay Idea

Mealtime Discussion Prompts

During mealtime, reinforce what children know about choking by asking the questions below.

Do you know what choking is?
What types of foods may cause you to choke?
How should we behave at the table to make sure we do not choke when eating?

Young adult mother is enjoying a healthy meal with her two young children. Elementary age kids are eating healthy food from trays while sitting at table. Volunteers are serving meal to community in background.

Menu Ideas

The following menu ideas provide a variety of foods, colors, and textures that are appropriate for young children.

Breakfast

Cottage Cheese
(Meat Alternate)

Mandarin Oranges

1% Milk

Lunch/Supper

Mini Meatloaf Patties
(Meat)

Whole Grain Dinner Roll

Mashed Potatoes

Diced Avocado

1% Milk

Snack

Banana Bread Squares
(Grain)

Cinnamon Applesauce

Water

You can find the featured recipes from the Menu Ideas section in the resources below:

The Child Nutrition Recipe Box has USDA standardized recipes for child care centers and family child care homes.
The Child Nutrition Recipe Box: New CACFP Lunch/Supper Recipes has standardized recipes per age group (3–5 and 6–18 year-olds) and for servings of 6, 25, and 50.

References

Children’s Wisconsin, News Hub. (2018, February 5). Choking vs. gagging: What parents need to know when introducing solid foods to children. https://childrenswi.org/newshub/stories/choking-vs-gagging-what-parents-need-to-know-when-introducing-solid-foods-to-children

Institute of Child Nutrition. (n.d.). Banana bread squares – USDA recipe for child care centers. Child Nutrition Recipe Box. https://theicn.org/cnrb/recipes-for-centers-grains-breads/banana-bread-squares-usda-recipe-for-cacfp/

Institute of Child Nutrition. (n.d.). Child nutrition recipe box. https://theicn.org/cnrb/

Institute of Child Nutrition. (n.d.). Mini meatloaf patties for ages 3–5. Child Nutrition Recipe Box. https://theicn.org/cnrb/ages-3-5/age-3-5-6-servings/mini-meatloaf-patties-for-ages-3-5/

Institute of Child Nutrition. (n.d.). New CACFP lunch/supper recipes. Child Nutrition Recipe Box. https://theicn.org/cnrb/2022-cacfp-recipes/

U.S. Department of Agriculture, Food and Nutrition Service. (2019, April). Infant nutrition and feeding: A guide for use in the special supplemental nutrition program for women, infants, and children (WIC). https://wicworks.fns.usda.gov/sites/default/files/media/document/infant-feeding-guide.pdf

U.S. Department of Agriculture, Food and Nutrition Service. (2020, September). Reducing the risk of choking in young children at mealtimes. https://wicworks.fns.usda.gov/sites/default/files/media/document/English_ReducingRiskofChokinginYoungChildren.pdf

U.S. Department of Agriculture, Food and Nutrition Service. (2021, July). Feeding infants in the child and adult care food program. https://www.fns.usda.gov/tn/feeding-infants-child-and-adult-care-food-program