Choking and Suffocation

Children younger than 4 years of age are at a greater risk of suffering a serious injury or death caused by airway obstruction. In fact, airway obstruction is the leading cause of unintentional injury-related death among children younger than 1 year of age. Choking, suffocation and strangulation are unintentional injuries that most often occur in the home. Parents should follow age-appropriate safety recommendations to keep children safe at every age. 

Choking — safety recommendations


Young children may not chew food properly before swallowing, increasing the risk of choking. According to the American Academy of Pediatrics (AAP), children younger than 4 years old should not be fed any round, firm food unless the food is cut into small, non-round pieces. The following safety recommendations can help prevent choking in young children:

  • Always supervise your child while he/she is eating
  • Have your child sit down while eating
  • Cut food into small, non-round pieces
  • Avoid round and/or hard food, such as: hot dogs, nuts, meat chunks, grapes, cheese cubes, hard candy, popcorn, chunks of peanut butter, raisins and raw carrots

Non-food objects

Small, round or similar objects can be choking hazards and should be kept away from young children. You may want to purchase a small parts tester to help determine which items are small enough to cause choking hazards. You can also use a toilet paper roll, keeping in mind that it is wider than the official tester.

Examples of objects that can obstruct the airway include:

  • Coins
  • Small balls
  • Balloons (inflated and deflated)
  • Marbles
  • Small game and toy parts
  • Safety pins
  • Jewelry
  • Buttons
  • Pen caps
  • Coin lithium button batteries*

*Special note to parents and caregivers

Coin-sized lithium button batteries are potential hazards to young children. When swallowed, these batteries can get stuck in the throat, resulting in serious burns and possible death. There are many everyday electronic devices that contain coin-sized lithium button batteries, including singing greeting cards, key fobs, thermometers and calculators. Parents should keep all products containing lithium batteries out of children’s reach. If your child swallows a lithium button battery seek emergency care immediately.

Learn more about the dangers of button batteries »

Suffocation — safety recommendations

The following safety recommendations can help prevent suffocation in young children:

  • Place infants on their backs during sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS) and accidental suffocation.
  • Infants should sleep in their own crib, on a firm, flat mattress with a fitted sheet. Infants should not sleep on soft surfaces, such as chairs, couches or regular mattresses.
  • Use a crib that adheres to all federal safety standards.**
  • Do not put pillows, loose blankets, comforters, soft toys, bumpers and other soft items in the crib.
  • Never allow your children to play with plastic bags.
  • Never allow children to play in small, unventilated spaces.

**Special note to parents and caregivers

As of June 2011, the CPSC requires that all cribs manufactured and sold in the U.S. meet new standards. The new standards include improved slats, mattress supports and hardware and prohibit the traditional drop-side rail cribs.

The American Academy of Pediatrics does not recommend the use of bumper pads and similar products because of their potential to cause suffocation, entrapment and strangulation of young infants.

Strangulation — safety recommendations

The following safety recommendations can help prevent strangulation in young children:

  • Remove drawstrings from outerwear, such as jackets and sweatshirts, for young children. Drawstrings can catch or become entangled with objects, such as a car door, school bus doors or playground slides.
  • Do not allow infants and young children to wear scarves, necklaces, ribbons or other strings around their necks.
  • Tie up or cut all window blind and drapery cords.
  • Make sure the spaces between guardrails and bed frames, and between the headboard/footboard and mattress, are less than 3.5 inches.

Injuries are the leading cause of death and disability to children in the United States. The Injury Prevention Program at Children's Hospital of Philadelphia is dedicated to preventing injuries in children. Our multi-faceted program educates families about safety and offers safety devices to increase safety practices.

There are many safety products available to help “child-proof” your home. Visit the Safety Center to buy child safety products at low prices and to get free injury prevention information.