By Vanessa Rasmussen, © 2004, All rights reserved.

Choking happens when an object gets stuck in the trachea (windpipe) and breathing becomes very difficult or impossible. A small object blocking one of the major airways usually causes choking in children. This may be a small toy that they have put in their mouth and inadvertently swallowed, or it may be a small piece of food that hasn't been properly chewed. Choking commonly occurs in children because their windpipe is very small. Putting things in their mouths is one of the ways that babies and small children explore the world. Anything that fits in their mouths can be a danger. Choking is usually caused by food, toys, and other small objects such as beads or buttons that can easily lodge in a child's small airway.

Following are some suggestions to prevent choking in children:

  • Give very small children bite size pieces they can swallow easily. Do not give small, hard pieces such as nuts, hard candy, raw peas, etc to children under four.
  • Encourage children to sit when eating and to chew thoroughly. They must not talk or laugh while they are eating.
  • 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.
  • Check toys frequently for loose or broken parts.
  • Keep balloons away from small children under the age of eight. A bitten balloon may burst and send fragments down the child's throat. A child who is blowing up or chewing on a balloon can choke by inhaling it. Inflated balloons pose a risk because they can pop without warning and be inhaled.

Choking often begins with small coughs or gasps as the child tries to draw in breath around the obstruction or clear it out. This may be followed by struggling sound or croaky whispers as the child tries to tell you that he or she cannot breathe. The child may get restless and dribble and their eyes may get teary. They may flush red and then turn blue. Some children, particularly babies, can be astonishingly quiet as they choke. Some children might even lose consciousness if their air passage is not cleared.

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

  • Encourage your child to cough. If he/she is able to cough and speak as well, do not panic as there are chances that the child will recover on his/her own.
  • Don't slap the back of your child or reach into his/her mouth with your fingers while he/she's coughing; it could push the object farther down the windpipe.
  • Give 5 back slaps: with a baby lying along your arm, head low and chin supported, or an older child leaning forwards.
  • In older children you can perform the Heimlich Maneuver, but this can not be done in infants under one year of age.
  • If the child loses consciousness, place him/her 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 the child is not breathing in spite of your actions, perform mouth-to-mouth resuscitation until the ambulance arrives.
  • Even if the child seems fine after a choking incident that requires intervention, take him/her to the doctor to make sure that the blockage has been completely removed and that there is no lasting damage.

Copyright 2001, 2004. All rights reserved. Any reproduction of this article in whole or in part without written or verbal permission is strictly prohibited. For information about reprinting this article, contact the copyright owner: Vanessa Rasmussen, Ph.D, Starting a Day Care Center,