Choking Hazards for Infants and How to Prevent Infant Suffocation

Statistics from the Center for Disease Control and Prevention (CDC) show that the leading cause of injury death for infants under 1 year old is suffocation, accounting for three-quarters of all infant injury deaths — thousands every year. Many of these senseless deaths could have been avoided by taking appropriate cautionary measures.

Below are objects in and outside the home, with which parents need to use precautions, to avoid choking hazards.

Sleeping Environment

Most suffocation deaths occur in the sleeping environment, which includes beds and cribs.

Child experts generally recommend that an infant never sleep in the company of adults, other children, or pets. Choose a crib that has been certified by the Juvenile Products Manufacturers Association (JPMA). A JPMA label should be on the box. The safest sleep position for infants is on their back.

The American Academy of Pediatrics (AAP) recommends against babies sleeping on their sides and against use of infant sleep positioners (ISPs), pillows, comforters, and other soft bedding. To keep your baby warm, use a sleep sack (fitted blanket). Make sure that the crib has no missing, loose or broken pieces. Check the spacing between crib slats to ensure that the baby’s head or body cannot slip through.

Choking: Food

Choking on food is very common, especially for infants, who are not able to determine proper bite size. Infants should be under constant supervision when eating and be in an upright, sitting position. The child should be free from outside distractions and other stress while eating.

Foods like grapes, raw vegetables, hard candy, nuts, seeds and popcorn present a risk of choking for infants and small children. These foods should be crushed or broken apart before feeding.

Pasty foods like peanut butter should be spread thinly on wafers or bread for ease of swallowing.

Choking: Household Items

One of the most important aspects of “baby-proofing” your home is being vigilant to remove any items around the house that a baby could choke on, if swallowed. Employ the “toilet paper tube” test to determine if an item is unsafe. If the object can fit completely into the tube, it poses a risk of lodging in an infant’s throat and blocking air passages. Examples of this are: beads, buttons, jewelry, tacks, batteries, coins, toy parts, marbles, safety pins, batteries. These items should be stored in a safe, secure location.

Plastic bags of any kind and balloons present an even greater risk and should be disposed of quickly.

Choking: Toys

Insure that all toys accessible to infants meet the guidelines of the U.S. Consumer Product Safety Commission. Watch for recalled toys on the CPSC’s website.

First Aid in the Event of a Choking Accident

There are techniques you can learn, to try to dislodge an item that gets trapped in an infant’s throat. If baby is coughing, let him try to cough up item. But if he’s having difficulty with crying or coughing, he may be choking. If another person is present, call 911 and begin tending to infant simultaneously. If you’re alone, try techniques below first; if unsuccessful at removing obstacle after one minute, call 911 then and immediately resume below techniques.

The techniques used to dislodge an object involve giving alternating series of gentle blows to the back first, then several gentle chest compressions.

For the back blows, hold baby at a downward angle (baby’s head is lower than his torso) on your lap, with baby’s head facing the floor. Use one forearm to support baby, placing your thumb and fingers to either side of baby’s jaw, to support the head. Give baby firm, gentle hits with the heel of your palm, between baby’s shoulder blades. After administering several back blows, turn baby over and press on the chest about one and a half inches down, between the nipples, using 2 or 3 of your fingertips, while holding baby at a downward angle and cradling nape of neck with your palm.

Alternate sets of back blows and chest compressions until object is spat out, or until baby starts crying or coughing with force, or starts breathing normally.

If baby falls unconscious, CPR will be necessary. Giving CPR to a choking baby is similar to giving CPR to an adult, but there are differences. The pulse check, head positioning, compression hand position and depth of compressions are different for infants. Every parent should attend an accredited infant CPR course to understand their options in case of an emergency.

There are other sources of suffocation which do not respond to CPR, as there is nothing to cough up. The two main ones are strangulation and allergic reactions.


Extension cords and appliance cords are potential choking hazards. Make sure that they are out of reach of infants and properly wound up when not in use.

Do not place cribs near window blinds that have cords. If an infant is entangled with cord or twine, try to calm the infant first, as further struggle may entangle him more. Try to unwind the cord from around the neck, and if that is not possible, use scissors to cut the cord.

Allergic Reactions:

Allergies to foods, inhalants, household chemicals and other substances can produce a swollen throat in the infant, blocking air passage. This condition is called anaphylaxis.

Watch for foods like dairy, wheat products with gluten, shellfish, nuts, and soy. These foods have been linked to reactions. Inhalants like pollen and cat dander can have a similar effect, as can chemicals in cleaning products. Medicines such as antibiotics can also produce reactions, though they’re rare. Bee stings can cause reactions, as well.

In the event of an allergic reaction, baby may present rash and swelling of the skin, lips or tongue, as well as wheezing or experience difficulty breathing.

If you suspect the baby is having a reaction, call 911 immediately. While you wait for medics to arrive, try to keep baby calm. It may help to place infant on his side, holding head or resting it on a pillow, while you raise his chin, thus helping to open airways. If baby’s breathing or heart stop, immediately start performing CPR.

By Eirian Hallinan