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Airway Obstruction

  • Most incidences of accidental child strangulation, suffocation and choking occur in the home. As a parent, extra care should be taken to childproof your house for young children, keeping in mind that the airways of young children are much smaller and easier to obstruct. Another preventive step to take is to learn cardiopulmonary resuscitation (CPR) and infant and child first-aid.

    Children's expert offers advice about toys and airway obstruction

    Children's offers the following comments and advice:

    • When you look at data about toys and safety, choking is number one way in which toys can kill children.
    • When selecting toys for your child, look at the toy itself and the small parts of the toy. For example, sometimes it might be the eye of a stuffed animal or a wheel off a truck that could
      cause your child to choke.
    • Magnets, which are in a lot of toys, can be dangerous. They're in building sets, doll clothes and all sorts of things. If your child swallows one, this may not be a big deal. But if your child swallows two, they can get stuck together inside and cause serious problems.

    Contact Us

    »
    If your child's airway is obstructed and this is a medical emergency, contact 9-1-1 immediately.
    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115
     617-355-6700
     fax: 617-730-0033

    »
    Learn preventative ways to avoid airway obstruction.
    Boston Children's Hospital
    300 Longwood Avenue
    BK 120
    Boston MA 02115
     617-919-3071
    +
    Boston Children's Hospital
    300 Longwood Ave
    BK 120
    Boston MA 02115
     617-919-3068

  • Foods and your child

    The American Academy of Pediatrics (AAP) recommends that children younger than 4 should not be fed any round, firm food unless they are cut into small, non-round pieces. Young children may not chew food properly before swallowing, increasing the risk of swallowing the food whole and choking. Food to avoid or cut into small pieces for children under age 4 include the following:

    • hot dogs
    • nuts
    • meat chunks
    • grapes
    • hard candy
    • popcorn
    • chunks of peanut butter
    • raisins
    • raw carrots

    Supervising your child's eating

    Always supervise your young children when they are eating. Sometimes, choking can occur when an older child feeds his/her younger sibling unsafe food. Also ensure that your young children should sit while eating, and never walk, play, or run with food in his or her mouth.

    Special note

    Hot dogs and grapes can be eaten by young children, so long as the skins are taken off and the food is cut into small, non-round pieces.

    Other choking hazards

    Nonfood items that are small, round, or conforming can be a choking hazard to your young child. You may want to purchase a small parts tester to help determine which items are choking hazards. Make sure your child plays with age-appropriate toys, keeping small items that are a choking hazard out of children's reach. Check under your furniture and between seat cushions for choking hazards. Examples include:

    • coins
    • small balls
    • balloons (inflated and deflated)
    • marbles
    • small game parts
    • small toy parts
    • safety pins
    • jewelry
    • buttons
    • pen caps
    • small button-like batteries (like for a watch)

    Strangulation and suffocation hazards

    Children can strangle themselves with consumer products that wrap around the neck, such as clothing drawstrings, ribbons, necklaces, pacifier strings, and window blind and drapery cords. A few tips to keep in mind to keep your child safe:

    • Tie up or cut all window blind and drapery cords, and remove hood and neck drawstrings from your children's outerwear.
    • Avoid hanging anything over the crib that has cords or ribbons longer than seven inches.
    • Do not allow your child to wear necklaces, purses, scarves, or clothing with drawstrings on playground equipment.
    • Avoid letting your child play on bean bag chairs that contain small foam pellets -- if the bean bag chair rips, your child can inhale and choke on the pellets.
    • Do not allow your young child to play with shooting toys. An arrow, dart, or pellet can be a choking hazard if shot into a child's mouth.
    • Make sure the spacing between bed guardrails, frames, and all spaces in the head- and foot-boards do not exceed 3.5 inches. Small passages through which a child's body, but not the head, fit can strangle a child, including spaces in bunk beds, cribs, playground equipment, baby strollers, carriages, and high chairs.

    More safety tips

    Infants can suffocate in soft bedding, or when a person rolls over onto them in an adult bed. Here are a few other tips to help prevent suffocation:

    • Plastic bags that cover the nose and mouth of infants are another common cause of suffocation. Remember to discard any plastic wrapping the toy came in -- plastic wrapping can suffocate a small child.
    • Children can also suffocate or otherwise injure themselves when they become trapped in household appliances, such as dryers, and toy chests.
    • Do not let children under age 6 sleep on the top bunk of bunk beds (they may strangle or suffocate themselves if they fall).

    Infants and sleeping

    The medical community recommends placing infants on their backs in their cribs to reduce the risk of sudden infant death syndrome (SIDS). Placing infants on their backs may also reduce the chance of choking, as infants may have a difficult time lifting their heads at first, if they are face down. The crib should adhere to national safety standards, with a firm, flat mattress. Avoid putting soft bedding, toys, and other soft products, pillows and comforters in the crib with your infant.

    Injury and death rates

    • Over 650 children ages 14 and under die in a given year from airway obstructions:
    • More than 470 children die from suffocation, strangulation, and entrapment (in household appliances and toy chests).
    • Almost 200 children died from choking (food and nonfood).
    • On average, 5,000 children, ages 14 and under, are treated in hospital emergency rooms for airway obstruction due to toys and toy parts annually. The majority of these children (75 percent) are ages 4 and under.

    Where and when

    • Most airway obstructions in children occur at home.
    • Suffocation is more common in the summer, while choking is more common in the winter.
    • Children most often choke on food items.
    • Balloons are the most common cause of toy-related choking death among children of all ages.
    • The majority of infant suffocation tends to occur where they sleep (60 percent).
    • Strangulation by window blind or drapery cords most often occurs when the cord hangs near the floor or crib. The majority of children who strangle by window covering cords are ages 3 or under.
    • More than half of drawstring strangulations (i.e., on the hood or neck of a jacket) occur when they become entangled on playground slides.
    • Since 1990, at least 57 children have died because they became entrapped in bunk beds.

    Who

    • The age group that is most at risk for all forms of airway obstruction is ages 4 and under.
    • Boys, low-income, and Caucasian children are at increased risk for airway obstruction.
    • Children who sleep in adult beds are at increased risk for airway obstruction.
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Doctors Who Treat "Airway Obstruction"

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