Preventing Choking in Infants and Toddlers

AllisonMS, RDN, CDN

Reading time: 6 minutes

What to know about choking hazards for infants and toddlers

  • Know which foods are choking hazards

  • Understand the important difference between choking and gagging

  • Learn strategies to help prevent choking

As your baby learns to eat solids foods, it can be normal to feel nervous about your little one choking. But knowing which foods to watch out for can help you prevent choking.

Choking occurs when a foreign object (think food or another small object) becomes lodged in the throat or windpipe, blocking off airflow.1 In general, choking hazards include foods that are round, hard, and about the same size as a child’s airway.  

Which foods are choking hazards?

  • Hot dogs and sausages

  • Hard, gooey, or sticky candy like marshmallows and caramels

  • Nuts and seeds

  • Raw apples

  • Whole grapes

  • Small foods with pits like cherries and olives

  • Raw carrots and celery

  • Popcorn

  • Chunks or thick layers of nut butters, including peanut, almond, sunflower, and cashew

  • Chunks of cheese

  • Chewing gum

  • Raisins

  • Large pieces of soft bread2,3

Use this list as a guide, but ultimately your own judgment will come into play. Avoid foods that have similar consistency, texture, shape, or size to those listed above or are seemingly difficult for your baby to handle. Remember, choking can occur with any type of food so always supervise your baby while they are eating.

Read more: Introducing Solids: First Foods & Textures

Learning to chew and swallow: No teeth necessary!

Every baby learns to handle solid foods at their own pace. With practice and time, your baby’s mouth and tongue muscles will begin to develop the correct movements and coordination for chewing and swallowing.4,5

But don’t worry if your child does not have many (or any!) teeth. The number of pearly whites does not affect the risk of choking, nor your baby’s ability to eat soft solid foods. In fact, your baby can "gum" most soft foods into a mash before swallowing them.5

Make sure any food you feed your baby can be easily smushed between your fingers, or is able to be dissolved by saliva, to help ensure it is safe for baby to eat.6,7

Wait to advance textures (purees to lumpy purees/ mashes to soft solids) until your baby is showing appropriate signs of developmental readiness.

Learn more here: Introducing Solids: First Foods & Textures

Choking versus gagging

It is very common for babies to gag as they are first learning to eat and manipulate solid foods.7 Being able to distinguish between gagging and choking will make mealtimes safer for your baby and more relaxed and enjoyable for you.

What is gagging?

The gag reflex causes the throat to close, while pushing the tongue to the front of the mouth. It’s an important safety mechanism that actually helps prevent choking. Gagging also helps babies learn how to safely manage food in their mouth.8 We all have this reflex with us our whole lives.11

Interestingly, at six months of age, the gag reflex is much closer to the front end of the tongue, making baby gag much more often while learning to eat.8 This reflex moves farther back as baby gets older.8

Gagging is a very normal part of learning to eat solid foods!

What does gagging look and sound like?
  • Your baby’s eye may water

  • Food may be pushed forward or out of baby’s mouth

  • Baby may make retching noises, or may even vomit8

What is choking?

Choking is when the airway becomes blocked and baby can no longer breathe.1 Often baby may start coughing to try to clear the airway. Soft foods are many times easily coughed out, but harder foods or objects may get stuck.

If your little one is able to speak, cry, or breathe – they are not choking and may be able to cough the object out.9

What does choking look and sound like?
  • Your baby may gasp or make a struggling or gurgling sound

  • May have bluish skin color

  • Baby is not able to cry or make sounds12

Knowing first aid, such as the Heimlich maneuver and CPR, may be important should your child ever begin to choke. For more information, please chat with your child’s health care provider. You can also find resources at American Red Cross and American Academy of Pediatrics.

Tips to help prevent choking

Supervise seated meal and snack times

Keeping an eye on your little one will allow you to be ready to help if needed. This is especially important since choking may be silent.

Eating should only happen at a table or in a highchair while sitting up (and with good support for infants). Eating while walking or running may cause choking, as may eating while lying down.5

While tempting, the American Academy of Pediatrics does not recommend allowing children to eat in the car. Should your little one choke, it will be very difficult to help them as quickly as they may need it.5

Teach and demonstrate good, safe eating habits

Keep your baby’s meal and snack times relaxed and unrushed. Role model and teach chewing thoroughly and eating slowly.2,3

Speaking and laughing with food in your mouth increases the risk of choking. Teach your little one the importance of chewing with your mouth closed and waiting to speak until after swallowing.10

Discourage your little one from putting too much in their mouth at a time.

Prepare and cook foods in the right texture and size for your child

Advance from purees to mashes to soft solids only as your little one shows they are ready. Make sure any food you prepare for your infant is soft enough for them to mash with their gums.7

For soft solids, cut into small pieces for baby to grasp and self-feed.

Avoid round shaped foods: Cut round foods length-wise and then into smaller pieces.6

Educate any caregivers on the strategies for avoiding choking

Make sure caregivers are familiar with the choking hazards and risks along with the appropriate plan of action in the event of an emergency.

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For more on this topic, check out the following articles:

Introducing Solids: Purees vs. Baby Led Weaning

Introducing solids: First foods and textures

Introducing solids: Signs of readiness

Introducing Major Food Allergens to your Infant

Learning to Love Healthy Foods