All About Choking

Choking happens when something – food or another item – is caught in the back of the throat. If the object (or food) blocks the top of the trachea a person may be unable to breathe. This is an emergency. It is also possible that food or other things can get stuck in the esophagus; while painful, this does not cause a person to stop breathing. This article will cover causes, prevention and the treatment of choking.

Certain medical conditions or circumstances can make a person more likely to choke. Risk factors include (but are not limited to):

• children under the age of 5
• the elderly
• people with neurological illnesses
• people with diseases that cause muscular degeneration, such as multiple sclerosis
• disorders of the esophagus such as a narrowed esophagus due to chronic acid reflux (GERD)
• people with anatomical genetic abnormalities that affect the swallowing process (cleft lip for example)
• people with injuries that affect the swallowing process

Additionally, certain activities or habits can also increase your risk of choking:

• eating too quickly
• not sitting down while eating
• not chewing food properly
• eating while lying down

Children under the age of 5 have an increased risk for choking. Both cognitive development and anatomic differences in children cause an increased risk in this age group. Small children lack the ability to differentiate what objects may get stuck in their throats. This is often during their oral phase of development when they put everything into their mouths.

As your child gets older, they still remain at risk due to their smaller airway. The risk, however, decreases because cognitively, they become more aware of which items are safe to put in their mouth. While completely child-proofing your home is near impossible, keeping certain objects away from small children can go a long way toward preventing choking.

• latex balloons – leading cause of death in children under the age of 6
• balls
• marbles
• coins (18% of choking-related ED visits for children 1 to 4 years old.)
• disc batteries (also called button batteries and are especially dangerous because when swallowed there is a possibility they will leak toxic alkaline contents into the digestive tract.)
• small toys - some say that if an object can fit inside a roll of toilet paper your child can choke on it.
• caps (pen or marker caps especially)
• safety pins

• hot dogs – most common fatal food-related hazard
• hard candy – (19% of choking-related emergency room visits)
• grapes
• nuts
• raw carrots
• apples
• marshmallows
• popcorn
• peanut butter

Approximately 60% of non-fatal choking hazards are caused by food items. Foods that are choking hazards are foods that can be compressed to fit the size of the airway. In addition to the foods listed above,​ you should not give a small child, elderly person or any individual who has difficulty swallowing, foods that are difficult to chew or are a size or shape that will easily become compressed in the airway.

Supervision is also one of the single most important factors to help prevent choking. One hundred percent supervision is usually not possible but should be implemented as much as possible when children under 5, elderly persons or a person with a history of swallowing difficulties is eating. Keeping small objects out of reach and purchasing appropriate age level toys can also help prevent non-food related choking. Also, not allowing children to run and play while eating food or candy can help prevent choking on food.

Some other good prevention tips include:

• eating food only at the table
• cooking vegetables until they are soft
• cutting hotdogs and other food items into pieces that are less than 1/2 inch and avoid cutting into round shapes
• encouraging adequate chewing – this might not be mastered until your child is 4 years old
• limiting distractions while eating
• having a drink available while eating – avoid swallowing food and liquid at the same time
• some individuals with swallowing problems (dysphagia) should only drink thickened liquids

If someone is choking, you should determine whether or not they can talk. If they can talk, cough or make other noises that indicate air passage, let them clear their airway on their own. Intervention at this point may cause further lodging of the object to occur.

If an individual has something caught in the esophagus they will still be able to speak and breathe but it may be painful, especially when swallowing. They may also drool. You should seek medical attention so the object can either be retrieved or pushed into the stomach/intestines using a scope (EGD).

If the person choking is not able to speak or make other noises, they will not be able to breathe either. An indication that a person is not breathing is cyanosis. This is an emergency. You should start abdominal thrusts, also known as the Heimlich maneuver. If the person at any point becomes unresponsive (unconscious), you should begin CPR. If you are not alone, have someone else call 9-1-1. If you are alone call 911 immediately and (if possible) stay on the line while performing CPR.

Prevention is key when it comes to choking. Educating yourself on common causes of choking can help prevent complications from occurring and keep your loved ones safe.