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What is airway obstruction?

If your child is struggling to breathe, turning blue, or has a battery stuck in their ear, nose or throat, seek emergency medical care right away.

Airway obstruction, also known as foreign body airway obstruction, happens when a small item gets stuck in a child’s throat or upper airway and makes it hard for the child to breathe. Because of its small size, a child’s airway can get blocked when a piece of food or a small, round object like a coin or marble gets lodged in their throat. Other common household items like drapery cords or plastic bags can strangle or suffocate a child.

On average, 5,000 children, ages 14 and under, are treated in hospital emergency rooms each year for airway obstruction. The majority of these children are ages 4 and under.

More than 650 children die in a given year from choking, strangulation, suffocation or getting trapped in a household appliance or toy chest.

How to reduce the risk of airway obstruction

Cut food into small pieces

The American Academy of Pediatrics (AAP) recommends that children younger than 4 should not be fed any round, firm food unless the food is cut into small, non-round pieces. Young children may not chew food properly, swallow food whole and start choking. Foods to avoid or cut into small pieces for children under age 4 include:

  • hot dogs whole or sliced into circles
  • meat chunks
  • whole grapes
  • popcorn
  • peanuts and other whole nuts
  • pumpkin seeds and other seeds
  • raisins
  • raw carrots

Children younger than 4 should not be given hard candy or chewing gum.

Young children can eat hot dogs and grapes, as long as the skins are taken off and the food is cut into small, non-round pieces.

Supervise your child's eating

Always keep your eye on young children while they are eating. Sometimes, choking can occur when an older child feeds a younger sibling unsafe food. Ensure that your young children sit upright while eating, and never allow them to walk, play or run with food in their mouths.

Keep choking hazards out of reach

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 reach. Check under your furniture and between seat cushions for choking hazards such as:

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

Remove strangulation and suffocation hazards

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

  • Tie up or cut all window blind and drapery cords, and remove any hood and neck drawstrings from your children's outerwear.
  • Do not allow your child to wear necklaces, purses, scarves, or clothing with drawstrings on playground equipment.
  • Do not allow your child to play on beanbag 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. This includes spaces in bunk beds, cribs, playground equipment, baby strollers, carriages and high chairs.
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Remove suffocation hazards

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:

  • Discard plastic bags and plastic wrapping that could cover the nose and mouth and suffocate a small child.
  • Remove the doors of unused household appliances and lids from toy chests so that children can not become trapped and suffocate inside.
  • Do not let children under age 6 sleep on the top bunk of a bunk bed as they could strangle or suffocate themselves if they fall.

Place sleeping infants on their backs

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. Infants may have a difficult time lifting their heads 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.

How we care for airway obstruction

Boston Children’s Hospital has one of the largest pediatric otolaryngology (ear, nose and throat) teams in the country. Our Department of Otolaryngology and Communication Enhancement cares for over 60,000 infants, children, adolescents and young adults each year in Boston and at five satellite locations in Waltham, Peabody, Weymouth and Lexington and North Dartmouth.

Airway Obstruction | Symptoms & Causes

What are the symptoms of airway obstruction?

A child with an obstructed airway may exhibit the following symptoms:

  • choking or gagging
  • sudden violent coughing
  • vomiting
  • noisy breathing or wheezing
  • struggling to breathe
  • turning blue

What causes airway obstruction?

Blocked airways

A child’s risk of choking on food is highest before they have a full set of teeth or when the muscles involved in swallowing have not yet fully formed. Whole nuts, seeds, raw carrots cut into circles, grapes and hot dogs are particularly hazardous for young children.

Small children often put foreign objects in their mouths as they explore the world. If a child inhales an object like a coin, button or small toy, it can become lodged in the throat or esophagus. These passages are much smaller in children than in full-grown adults. Of all toys, balloons are the most common cause of choking death among children of all ages.

Strangulation

Window blind cords, drawstrings, scarves, necklaces, long ribbons and other cords can get wrapped around a child’s neck and cut off the flow of oxygen. In 2011, the U.S. Consumer Protection Safety Commission designated drawstrings on children’s clothing as hazardous and now most children’s outerwear has Velcro or snaps instead.

Suffocation

The majority of infant suffocation tends to occur when babies are asleep. Sleeping toddlers can suffocate on soft bedding, loose blankets, crib bumper pads, or in adult-size beds or furniture. Beanbag chairs, bunk beds, balloons, and toy chests with lids also pose suffocation hazards for young children.

Airway Obstruction | Diagnosis & Treatments

How is airway obstruction diagnosed?

A health care provider may order an x-ray or perform a bronchoscopy to determine if a child’s airway is blocked and the location of the blockage.

How is airway obstruction treated?

Treatment for a blocked airway depends on the size of the object and where it is lodged in the airway.

  • The child may cough the item up or pass it through the gastrointestinal tract
  • An emergency medical responder or other health care provider may be able to dislodge the item with thrusts to the child's back, chest, or abdomen.
  • Surgery may be necessary to remove an item that has gotten stuck or is causing internal damage to the child's airways or stomach.

Parents should seek emergency medical care for their child right away if their child is struggling to breathe, turns blue or has swallowed a magnet or battery.

Airway Obstruction | Programs & Services