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Kids Health Info

Safety: Choking, suffocation and strangulation prevention

  • Young children are naturally curious and are always exploring their environment. From as early as two months of age, babies start putting things in their mouths. Touching, feeling and mouthing any small item within reach is how babies and young children learn about their surrounding environment.

    Babies and toddlers have small airways that are easily blocked. In addition, their reflexes are not well developed and their bodies are not very strong, so they may have difficulties getting themselves out of trouble.

    If your child is choking or having trouble breathing, call an ambulance immediately.

    Common hazards around the home

    There are a number of items in and around the home that present a choking, suffocation or strangulation risk to infants and young children.

    Food

    Certain foods can be dangerous for young children because they are easily inhaled and block the breathing tubes. These include nuts, raw carrots and other hard vegetables, pieces of apple, popcorn, corn chips, lollies and grapes. Children under the age of three years may not have their full set of teeth and can't chew properly, so any food that is small and firm is a choking hazard.

    • Ensure young children sit quietly while eating or drinking.
    • Never force young children to eat, as this may cause them to choke.
    • Never give whole nuts to children under five years of age (smooth nut butters are OK, if your child is not allergic to them).
    • Carrots, apples and other hard fruit and vegetables should be cooked, mashed, peeled or grated.
    • Grapes should be cut into half lengthways, then into half again.
    • Meat should be minced or cut into small pieces and served without bones.
    • Hold your baby while they drink from a bottle – do not leave them alone with a bottle propped up.

    Small objects

    Any small object can choke children under three years. Make sure that young children cannot reach or play with:

    • needles, pins or safety pins.
    • coins, small magnets and small batteries – make sure that any toys containing batteries have the battery compartment lid screwed on tightly.
    • buttons, beads, marbles, the tops of ballpoint pens and polystyrene beads (found in stuffed toys and bean bags), which are all easily inhaled.

    Toys and play equipment

    Choose age-appropriate toys that are well made, as less sturdy toys can break easily into small parts. Avoid toys that have small parts, especially if they can be removed.

    • Don't allow your baby or young child to have access to toys smaller than a D-sized battery (e.g. marbles, small building blocks or small bouncy balls).
    • When outdoors, make sure that young children are always supervised on rope swings, as these can present a strangulation hazard.
    • Do not attach cords, string or ribbons to dummies and make sure hanging mobiles are out of reach.
    • Do not allow young children to play with balloons unsupervised as popped or uninflated balloons can be inhaled into the lungs. Long strings on balloons are also dangerous.

    Curtain and blind cords

    Young children can get caught in dangling curtain cords, which can strangle them. Where possible, use curtains with rods instead of cords.

    • If you do have cords, attach them to the wall with a plastic safety device. These are available at hardware stores or blind and curtain retailers.
    • The length of any cord should not be longer than 30cm and must be out of reach of curious toddlers.
    • Keep cots away from blind and curtain cords.

    Plastics

    Plastic bags, dry cleaning bags and plastic wrap are especially dangerous for young children. A child can easily suffocate if these items are pulled over their head.

    • Always tie a knot in dry cleaning and plastic bags before throwing them out.
    • Plastic bags should be stored out of reach.
    • Plastic covers on mattresses should always be removed and discarded before use. They are not a substitute for waterproof mattress protectors.

    Pillows and mattresses

    Choose a firm, close-fitting mattress.

    • Pillows and cot bumper pads should not be used for children under two years of age.
    • Do not put infants and young children to sleep on soft surfaces, such as beanbags or waterbeds.
    • Babies should not be put to sleep on sofas or in adult beds.

    Prams

    Do not leave a sleeping baby unsupervised in a pram. Babies can become trapped and suffocate.

    Clothing

    Be aware that cords and drawstrings on clothing such as parkas and hooded windcheaters can catch on play equipment.

    • When choosing clothing, avoid ties, ribbons or crocheted jackets that may pull tight.
    • Always remove a baby's bib before putting them down to sleep.
    • Avoid necklaces and other jewellery that can get caught.

    Disused refrigerators and toy boxes

    By law, doors of fridges and freezers must be removed before disposal in a tip (or on the nature strip outside the house awaiting collection). Make sure that this is done at home if the fridge is no longer in use.

    • Children love playing hiding games, and boxes or trunks are an appealing hiding place. Make sure that a heavy lid or a lid that catches cannot trap a child inside. It is safest to remove the lid.
    • Ensure toy boxes have ventilation holes.

    Choking first aid

    It is recommended anyone caring for children should do a first aid course and learn infant and child cardiopulmonary resuscitation (CPR) in the case of an emergency.

    If a child is choking and still breathing

    In many cases, coughing will help dislodge the object.

    • Encourage the child to cough. Infants and young children may cough instinctively.
    • Stay calm and reassure the child.
    • Continue to monitor for breathing until they recover.

    If a child is choking and not breathing

    If coughing doesn’t help dislodge the object, or the child stops breathing at any time, call an ambulance. Follow the first aid steps outlined below.

    • Infants (less than one year old) should be placed face down, across your knees and held with their head lower than their chest.
    • Older children can sit and lean forwards if they are able; otherwise lie them on the floor on their side (recovery position).

    Once the child is positioned appropriately:

    1. Give five sharp back blows with the heel of your hand between the shoulder blades. In between each back blow, check to see if the object has been dislodged and if the child is breathing.
    2. If the back blows are unsuccessful, turn the infant onto their back. If an older child is lying down, also turn them onto their back.
    3. Give five chest thrusts using two fingers (infant) or the heel of your hand (child), keeping your hand in contact with the chest at all times. For a chest thrust, position your hand or fingers over the same area you would use for CPR compressions (the lower half of the sternum or 'breast bone').
    4. After each chest thrust, check to see if the object has been dislodged.
    5. If the blockage has not cleared, continue to alternate between five back blows and five chest thrusts (steps 1 to 4 above) until the ambulance arrives.

    If at any time the child becomes unconscious, call an ambulance and start CPR.

    Do not use the Heimlich manoeuvre (forceful squeezing of the abdomen) at any time, as this can cause serious damage to internal organs.

    Key points to remember

    • Don't give young children whole nuts or grapes, or hard fruit and vegetables, and supervise your child while they are eating.
    • Choose well-made toys with no small parts, and keep small objects like coins and marbles out of reach.
    • If your child is choking or having trouble breathing, call an ambulance immediately. 
    • Plastics, curtain cords, pillows and mattresses, clothing and prams all pose strangulation or suffocation risks.

    For more information

    Common questions our doctors are asked

    Are amber teething necklaces safe for my baby?

    Necklaces are not recommended for babies and young children. Even though most amber necklaces have knots in the cord between the beads, there is still a risk that one of the beads breaks off and your baby inhales it. There is also the risk that children can be strangled by the necklace if it is worn during sleep or if it catches on furniture or play equipment. If it is important for you that your baby wears an amber necklace, then supervise your child carefully whenever the necklace is worn and always remove it before sleep.

    How will I know if a toy is safe for my young child?

    Avoid buying cheap toys from variety stores because they may not be made to acceptable safety standards. Also be careful when buying second hand toys, because they may be old and worn and likely to break. Also, they probably won't have the packaging, which gives important safety information. Always follow the recommendations on toy packaging about the age for which the toy is suitable. Toys that state they are 'Not suitable for children under three' pose a choking risk – this is a safety message and doesn't relate to the child's intelligence or ability to work the toy.


    Developed by The Royal Children's Hospital Safety Centre. We acknowledge the input of RCH consumers and carers. We acknowledge the input of RCH consumers and carers.

    Reviewed July 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


Disclaimer

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.