Choking on food – Essential advice to ensure safe mealtimes

Written By:
Edwina Revel
Subject:
Food safety

Feel confident about food safety in your setting with this advice on gagging and choking on food from Edwina Revel at Early Start Nutrition…

Tragically, a child dies in the UK every month from choking. Each day around 40 under-fives are rushed to hospital after choking or swallowing something dangerous.

It can happen quickly and it can happen to anyone. It is reported that choking on food is the most likely cause, but small objects such as toys can be risky for young children too.

We know that many early years staff and families worry about children choking on food, particularly when introducing new textures and finger foods.

Parents are sometimes unsure if their little one is gagging or choking. Let’s look at the steps you can take in your setting to support children at mealtimes and consider the information you can share with families.

Ensure a safe setting

The EYFS Statutory Framework requires early years providers to take all necessary steps to keep children safe and well. They state that your setting must be confident that those responsible for preparing and handling food are competent to do so. You can take the following steps to meet these requirements.

Ensure children have adequate supervision at mealtimes. Staffing arrangements must meet the needs of all children to ensure their safety.
Infants and young children should be seated safely in a highchair, or appropriately sized low chair while eating. The NHS advise using a five-point harness to secure babies in a highchair.
In group provision, all staff involved in preparing and handling food must receive training in food hygiene.
Staff should be familiar with paediatric first aid advice including how to assist a child who is choking.

Gagging

Gagging is completely normal and can happen often during weaning. Children’s gag reflexes are much more sensitive than adults, as they are further forward on their tongue.

Gagging is a safety mechanism to reduce the risk of choking because it helps to bring the food back to the front of the mouth. Babies grow, learn and develop at different rates so some babies will naturally gag more than others.

During the initial stages of weaning, babies need to be supported to learn to bite, chew and move food around in their mouth. Encourage babies to move on to thicker, lumpier textures and finger foods so they become more confident to bite, chew and swallow.

As baby grows, the gag reflex moves further back in the mouth and becomes less sensitive and as they get older, they will gag less.

How do you know a baby is gagging on food?

Gagging is usually loud with coughing and/or spluttering. You may notice that their eyes water and their face may go red. They may bring the food forward in their mouth and make a retching movement and may even vomit.

What should you do if a baby gags when eating?

Staff and parents often wonder if they should intervene when a child is gagging. If a baby does cough or gag when eating, it’s important to stay calm and reassure them.

Often they will carry on eating. But if they become upset don’t force them to carry on. You can simply try again at the next mealtime. Afterwards, give them a smile, some reassurance and a sip of water, if needed. Remember to always stay with babies and children while they’re eating.

Choking

It’s reassuring to know that choking is very uncommon. For babies and young children, food can be a choking hazard, especially if they don’t chew their food well or try to swallow it whole. Choking can happen with any foods. However firm foods, food containing bones and small round foods present a higher risk.

How do you know if a baby or toddler is choking?

Choking is when an object has either partially blocked or completely blocked the airway. You’re likely to notice the child is having difficulty breathing, speaking or coughing with a red puffy face.

They may also show signs of distress and may point to their throat or grasp their neck. If a child is quiet and blue they need your help.

What should you do if a child is choking?

Follow the guidance from your paediatric first aid course, depending on the age of the child. For further information, read guidance from the NHS and St John’s Ambulance.

Reducing the risks

There’s lots we can do to reduce the risk of choking at mealtimes. Firstly, it’s important to stay with babies and toddlers while they’re eating or drinking. Support children to stay in a sitting position to allow them to swallow the food safely or spit it out, if required.

It’s best to avoid distractions at mealtimes to support little ones to focus on the texture of the food and to co-ordinate putting it to their mouth to bite or chew and swallow safely.

Preparing food to avoid choking

It is also important to think about how foods are prepared. Choking can be a cause of injury in young children, mainly because their small airways are more easily obstructed. Follow these tips to reduce the risk of choking:

Avoid offering chunks of food, such as pieces of sausage, chunks of fruit and vegetables or cubes of cheese
Cut foods into narrow batons to make them safer and more manageable. It’s important to consider the size, shape and texture of the foods that you offer to babies and young children to help keep them safe and reduce the risk of choking
Start by softening hard fruits and vegetables (such as carrot and apple) by steaming or simmering them until soft. As children become more confident eaters, you can gradually increase the firmness of the foods you offer
Peel the skin of fruits, vegetables and sausages to make them easier to chew
Always remove hard pips and stones from fruit
Chop dried fruits, such as raisins, dates and apricots, and only include as part of a meal
Cut round foods, such as cherry tomatoes and grapes, into quarters
Avoid offering hard foods, such as whole or broken nuts and hard sweets. Instead, crush or flake nuts and peanuts and add to dishes, such as wheat bisks
Avoid offering sticky foods, such as marshmallows and raw jelly cubes
Be careful of foods such as popcorn. It’s best to wait to offer these to children until they’re a little older and more competent eaters
Remove bones from meat and fish
Foods, such as cereal or rusks, should never be added to a baby’s bottle as this can cause choking