Choking Hazards for Babies

The opinions, advice, suggestions, and information presented in this article are for informational purposes only and are not a substitute for professional advice from or consultation with a pediatric medical or health professional, nutritionist, or expert in feeding and eating. Never disregard professional medical advice or delay in seeking it because of something you have read or seen here.

These pages have been created with typically developing infants and children in mind. If your baby/child has underlying medical or developmental differences, including but not limited to: prematurity, developmental delay, hypotonia, airway differences, chromosomal abnormalities, craniofacial anomalies, gastrointestinal differences, cardiopulmonary disease, or neurological differences, discuss your child's feeding plan with their primary medical provider when considering starting finger food. Close consultation with a feeding and swallowing specialist can provide safe guidance for your child's feeding journey.

If your child is having a health emergency, please call 911 or your emergency medical resource provider immediately.

A choking hazard is any object that could be caught in a child’s throat, blocking their airway and making it difficult or impossible to breathe.

If you think your child is choking, begin choking first aid and call 911 or emergency services immediately. Do not wait. Brain damage or death can occur within 4 minutes of oxygen deprivation.

For visual representations of the differences between gagging and choking see gagging vs. choking and check out our Infant Rescue guide.

Minimizing the Risk of Choking

We can talk all day about which foods are choking hazards and how to best prepare them to minimize the risk, but the reality is any food can cause choking, at any age, even when cut and prepared in the most developmentally appropriate and safe manner. This is why setting up a safe eating environment and understanding how babies swallow is key.

Swallowing is a complex reflex with multiple lines of defense built in to prevent choking. These actions happen reflexively, meaning we don’t have to think about them or do anything special to make them happen. There are three important lines of defense that we have with every single swallow.

1. Your vocal cords, which are like the front door to the airway, slide closed to keep food out

2. The breathing tube itself is pulled upward and forward to move it out of the way

3. The epiglottis, a tiny flap of cartilage, closes like another door over the larynx. The larynx is a space before the vocal cords. If the vocal cords are like the front door to the airway, you can think of the larynx like a front porch—so items can’t even get close to the front door (vocal cords) because the epiglottis closes off access to the porch.

And just like any good system, we have back up already built in, such as a strong cough response to push things back out in the event that something slips past all those doors. For more on this, check out our Gagging and Choking page.

Here are additional tips to minimize choking risk:

1. Never place food in baby’s mouth with your fingers; set baby self feed when introducing finger food.

2. Never put your fingers in baby’s mouth.

3. Never let baby eat while moving. This includes crawling, walking, climbing, or any other movement.

4. Refrain from offering food in the stroller or carseat.

5. Ensure baby is in a completely upright, supportive seat and never feed baby in reclined chairs or carseats. See our high chair page for tips on modifying high chairs to make them safe for eating as well as how to feed baby if you don’t have a high chair.

6. Remove small non-food related objects from the table at all meals: condiment packets, bottle caps, and small toys can create a high risk situation while eating.

7. When baby is sick (cough, congestion, etc.) exercise caution and, if offering a meal, default to the least challenging food presentations.

8. Stay calm when baby is gagging and give their body a chance to work the food out independently.

9. Modify foods that are firm, round, and/or slippery so that they are no longer hard, no longer round, and no longer slippery. Cut round foods lengthwise in half, cook firm/hard foods until soft, and roll slippery foods in crushed cereal, finely ground nuts, or even leftover infant cereal to give the foods a bit more texture.

Top Choking Hazards

Foods that are small, firm, round, slippery, and challenging to chew, or which become small, firm, round, and challenging to chew as you bite into them pose an elevated choking risk. While a baby can choke on any food or liquid—even milk—it’s important to avoid or modify foods that are common choking hazards or carry an exceptionally high risk of true choking.

Other factors also contribute to an increased risk of choking, including :

The list below includes foods identified as choking hazards by the U.S. CDC and the American Academy of Pediatrics. Additionally, the list also includes foods identified in the literature as high-risk foods in research and medical literature, as well as others that are higher-risk foods based on their structural properties. It is also important to note that children can choke on non-food objects.

Whether preparing food for a 6-month-old or a 4-year-old, the foods below present the highest risk. (An asterisk denotes foods that are not appropriate for babies in any form.)

Understanding Choking Risk

Contrary to popular belief, choking on food is not a leading cause of death among children under 5 years. When examining the underlying cause of death among children in the United States using the CDC WONDER Database, unintentional injuries (or accidents) is one of the leading causes of death among infants and younger children (1-4 years of age), accounting for 1,210 and 1,252 deaths per year respectively. Accidental suffocation in bed, drowning in a pool or fresh body of water, choking on food, and choking on non-food objects are some examples of accidents.

After examining the underlying cause of accidental death among infants, it is clear that choking is not a leading cause of death. Accidental suffocation in bed accounts for 70% (about 844 cases) of accidental injuries among infants each year. Comparatively, choking on food accounts for 0.8% of deaths from accidents each year (10 cases per year), and choking on non-food objects accounts for 2.0% of deaths from accidents each year (24 cases per year). Sudden Infant Death Syndrome, which is not coded under accidents, accounts for 1,510 deaths yearly.

When examining the data among children 1 through 4 years of age, similar patterns emerge. Accidents account for 1,252 deaths per year. Of these deaths, 2.8% (35 cases per year) are attributed to choking on food and 2.1% (27 cases per year) are attributed to choking on non-food objects. Accidental death from drowning in a pool or fresh body of water accounts for 26% of accidental deaths (322 cases per year).

It is safe to conclude that choking on food is not a common cause of death among young children; however, the prevalence of non-fatal choking events, while extremely difficult to calculate, is much higher among children, and it is imperative to be cautious when introducing high-risk choking foods.

Modifying Foods to Lower Choking Risk

While there are foods on the above list that are not appropriate for babies in any form, there are many nutritious foods you can modify to make safer for babies. For example:

For detailed information on age-appropriate food shapes and sizes, check out our page on safe food sizes and shapes and be sure to look up foods in our First Foods® database.

Keep in mind that modifying these foods does not remove all risk of feeding a baby or child of any age. These modifications reduce the risks but there is no way to eliminate all risk when it comes to eating solid foods.

What do I do when food gets stuck to the roof of baby’s mouth?

Many foods that are commonly introduced early are mushy and sticky, like avocado and banana. Baby is still learning how to move food around in the mouth, how to use their tongue in a coordinated way to move food to the side for chewing instead of the center of the tongue for sucking, so it's common for food to end up stuck to the roof of the mouth. This can be very uncomfortable for baby, and many times, will lead to intense gagging that may cause baby to vomit, which will clear the food from the palate. Unfortunately, it is quite challenging for a young baby to clear this on their own without gagging and/or throwing up.

Food getting stuck to the roof of baby’s mouth can be especially common and problematic for babies with a high arched palate. They can get stuck in this phase (of food getting stuck and then intense gagging and vomiting) for much longer than other babies because the pallet provides a perfect little nook for food to get trapped in. If this is the case for your baby or you feel like this happens frequently, or you’ve been working on this for a while with no progress, it is worth talking with your doctor and seeking out a feeding therapy evaluation.

What to do:

Start by offering your baby the wrong end of a silicone spoon to bite and suck. A silicone infant spoon that baby holds and munches on can help baby generate more saliva, which will start to slowly break down the item, or it might help dislodge the food either by physically moving it or by helping your baby generate enough suck pressure against the spoon handle to move the food. They may end up sucking the food back and swallowing it.

If the spoon doesn’t work, offer a very small sip of water. This would be a tiny sip to help add a little bit more liquid inside the mouth which could help reduce the stickiness of the bite and loosen it from the pallet. Try to avoid a large cup of water which would just wash the item into the throat—as now the baby would have to manage both the bite as well as a mouth full of liquid.

If neither of those strategies work, this may be an instance where you have to help dislodge the food. While we generally do not advise putting a finger into babies mouth because this can increase the risk that that food will be pushed back in the babies airway this is one instance where you might not have another choice.  First and foremost, keep yourself calm and confident looking. This may feel scary to baby and if you look terrified you are confirming that something is really wrong. Try to keep a soothing demeanor which can help baby trust that you know what you’re doing and that everything is okay. Kneel next to baby so they are looking down. Try to coax baby to open their mouth so you have a clear idea of where the food is in baby’s mouth, or if there are other pieces in there besides what is stuck to the palate. Starting on the side where the upper and lower lip come together, place one finger in baby's mouth and run your finger along their cheek. Then sweep your finger up and across the palate and to the front to dislodge the sticky food. The motion of the finger should be forward and out.

In the future, slightly mash these stickier food items for a while as baby is building their chewing skills. Consider serving these stickier foods on an infant spoon or a food teether such as a mango pit, a pineapple core, or a sparerib so that baby has something firm they can bite and suck against right from the start,  which will trigger their chewing reflex and their tongue lateralization reflex. Those resistive foods act as teethers and can help to map the mouth making it more likely over time that baby will know how to move the food around within their mouth and less likely that your baby will lose track of food into their pallet.

When can I stop modifying foods?

It depends on the child's skill and practice with challenging foods but the best way to reduce risk with high-risk foods as your child gets older is to build the skills of learning how to eat that food safely. How to take small bites, manage the food in the mouth, spit it out if necessary, and so forth. For a detailed instructions on this, see our guide Teaching Children How to Safely Eat High-Risk Foods.

The opinions, advice, suggestions and information presented in this article are for informational purposes only and are not a substitute for professional advice from or consultation with a pediatric medical or health professional, nutritionist, or expert in feeding and eating. Never disregard professional medical advice or delay in seeking it because of something you have read or seen here.