Children's Development

Choking hazards: When to introduce certain foods to children

Choking hazards: When to introduce certain foods to children

By: Nikhila Raol, MD, MPH

When my youngest son was one-year-old, my father-in-law unknowingly handed him a whole pecan to eat while I was in the kitchen. Hearing commotion, I turned about to see my sister doing a finger sweep and my son still choking. Being a pediatric otolaryngologist (a doctor who specializes in working with tiny ears, noses and throats), sticking fingers and instruments in the head and neck was my expertise. So I ran over, stuck my finger in his mouth and swept out the pecan. While I would not recommend anyone go through this traumatic experience, it did make me realize that as caregivers, a little education on when it’s safe to eat certain foods would be really helpful! And in hindsight, my finger sweep posed risk of shoving the pecan further down his throat. Please don’t do what I did, but instead see the choking guide below for the American Academy of Pediatrics recommended steps. My own scary experience as a mom is exactly why I want to share some information with you today - here we go!

Kids under 4 years of age are at the highest risk of choking due to lack of appropriate molars to break down hard foods combined with a lack of a mastery of chewing.  Here is a list of high risk foods/types of food that I avoided giving my own children until they were at least 4-years-old (not accounting for the pecan incident!!)

  1. Nuts and seeds: As you know from eating these yourselves, you have to do a lot of grinding and chewing to get these to a safe consistency to swallow. I can’t tell you the number of times I have removed these from kids’ airways. But wait, you think to yourself, didn’t we just hear that we should introduce nuts early to prevent allergy? We, as pediatric otolaryngologists, are absolutely on board with early introduction of food to prevent allergy, but want to ensure we are being safe. Stick to feeding these foods to your younger kids in a nut/seed butter form to allow for early exposure while avoiding the choking hazard.
  1. Nut butter: And on the topic of nut butter, just be sure you aren’t giving gobs of it to your kids. It is quite sticky and sometimes hard to get down (see Barney’s peanut butter and jelly song—it can really get stuck anywhere in your mouth and throat - link below!!). 
  1. Hot dogs: These are actually one of the scariest food choking hazards. That’s because when kids choke on these, they are typically a size that can get stuck right at the entrance to the voice box and completely obstruct the airway. One way to reduce this risk is to cut the hot dogs lengthwise and into small pieces (≤1/2 inch).
  1. Hard/gooey/sticky candy: These candies are often the size of the opening to the airway and can (like hotdogs) also completely obstruct the entrance. Combine that with the stickiness and need for lots of chewing - it makes the list of foods that are choking hazards.
  1. Chewing gum: In addition to the fact that a lot of toddlers do not understand the concept of chewing and not swallowing what they chew, the ability of gum to mold to the airway makes it a high risk food!
  1. Whole grapes: While grapes are good for your kids, the best way to serve them is quartered and without the skin for toddlers.
  1. Chunks of meat and cheese:  Cut into no more than a half-inch pieces to make sure that if your toddler swallows them whole, they will go down easily and not get stuck in their throat.
  1. Raw vegetables: We absolutely encourage early veggie consumption, but stay away from the raw forms early on. The safest way to serve these is either pureed or in a squishy form. If you can compress it into a sort of a puree between your fingers, you are good to go!
  1. Popcorn: This is another food that is risky because it’s  difficult to chew it well. Additionally, the pericarp, which is attached to the white popped part of the popcorn, can independently go into the airway and cause issues!

A few other foods to beware of are raisins, apple chunks and marshmallows. Some important tips to decrease the risk of choking are to make sure your toddler is seated upright when eating (don’t let them walk around and eat) and avoid feeding them in a car or moving vehicle. 

Being a parent can be tough, especially when kids are curious and are putting everything in their mouths. As a doctor who specializes in children’s airways and a mom of 3 young kids, choking is something that is pretty much always on my mind. I hope these tips can make your choices a little easier when deciding on what to feed your little ones.

About the author: 

Ahimsa Expert: Nikhila Raol, MD, MPH

Nikhila Raol is a pediatric otolaryngologist in Atlanta, GA, but she'll always be a Texan at heart. She specializes in disorders of the airway, including feeding difficulties, voice problems, and obstructive sleep apnea. When she's not taking care of kids in the hospital, you'll probably find her with her husband and three kids playing or watching sports, reading, dancing, and figuring out how to help solve our world's problems.



Barney’s Peanut Butter and Jelly song!

Responding to a Choking Emergency: American Academy of Pedicatrics


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