Food or small objects can cause choking if they get caught in your throat and block your airway. This keeps oxygen from getting to your lungs and brain. If your brain goes without oxygen for more than four minutes, you could have brain damage or die.

Young children are at an especially high risk of choking. They can choke on foods like hot dogs, nuts and grapes, and on small objects like toy pieces and coins. Keep hazards out of their reach and supervise them when they eat.

When someone is choking, quick action can be lifesaving. Learn how to do back blows, the Heimlich maneuver (abdominal thrusts), and CPR.

Know how to help someone who is choking. Giving abdominal thrusts is a method of applying pressure to remove an obstruction, like a piece of food, from a person’s windpipe. Along with hands-only cardiopulmonary resuscitation (or CPR), knowing how to respond in a choking emergency is a basic life-saving skill that anyone can learn and teach to others.

If you suspect a person is choking and/or see someone giving the universal sign of choking—holding their neck with one or both hands—immediately take the following steps:

1. Ask the person if they are choking. DO NOT perform first aid if the person is coughing forcefully and is able to speak.
2. If they are unable to speak, perform abdominal thrusts:
   • Stand behind the person and wrap your arms around the person’s waist. For a child, you may have to kneel.
   • Make a fist with one hand. Place the thumb side of your fist just above the person’s navel, well below the breastbone.
   • Grasp the fist tightly with your other hand.
   • Make a quick, upward and inward thrust with your fist.
   • Check if the object was dislodged.
   • Continue thrusts until the object is dislodged or the person loses consciousness.
3. Call 911 if the person loses consciousness. Always call 911 in a life-threatening emergency.

Your baby is learning how to chew and swallow foods. This means your child may choke. By 12 months old, your child is getting better at eating and may even be feeding themselves. Even though your child can now eat most foods, some are still choking hazards. The way food is prepared may increase the risk for choking. For example, some foods that are served uncooked, whole, or in certain shapes or sizes can be choking hazards. Cutting up food into smaller pieces and mashing foods can help prevent choking.

Here are ways to help prevent your child from choking.

Foods and preparation

• Cook and prepare food to the right shape, size, and texture for your child’s development.
• Avoid small, sticky, or hard foods that are hard to chew and swallow.

Meals and snacktime

• Have your child sit up while eating (no lying down, crawling, or walking).
• Have your child sit in a high chair or other safe place.
• Avoid letting your child eat in the car or stroller.
• Keep mealtimes calm. Avoid distractions, disruptions, and rushing when eating.

Always

• Pay close attention to what your child puts in his or her mouth.
• Watch your child at all times while he or she is eating.

Be ready

• Talk to your child’s doctor or nurse to learn what to do if your child chokes.

Potential Choking Hazards for Young Children

Fruits/Vegetables

• Cooked or raw whole corn kernels
• Uncut cherry or grape tomatoes
• Pieces of hard raw vegetables or fruit, such as raw carrots or apples
• Whole pieces of canned fruit
• Uncut grapes, berries, cherries, or melon balls
• Uncooked dried vegetables or fruit, such as raisins

Proteins

• Whole or chopped nuts and seeds
• Chunks or spoonfuls of nut and seed butters, such as peanut butter
• Tough or large chunks of meat
• Hot dogs, meat sticks, or sausages
• Large chunks of cheese, especially string cheese
• Bones in meat or fish
• Whole beans

Grain Products

• Cookies or granola bars
• Potato or corn chips, pretzels, popcorn, or similar snack foods
• Crackers or breads with seeds, nut pieces, or whole grain kernels
• Whole grain kernels of cooked barley, wheat, or other grains
• Plain wheat germ

Sweetened Foods

• Round or hard candy, jelly beans, caramels, gum drops, or gummy candies
• Chewy fruit snacks
• Chewing gum
• Marshmallows

Choking

Choking is a life-threatening medical emergency the passage of air passage into the lungs is blocked by food or another object. This obstruction can be partial or complete. The disruption of normal breathing by choking hinders oxygen delivery to the body, resulting in asphyxia. Although oxygen stored in the blood and lungs can keep a person alive for several minutes after breathing stops, chocking is potentially fatal. It is a major cause of unintentional injury-related death.

Deaths from choking most often occur in the very young (< 1 year old) and in the elderly (> 75 years). The obstruction of the airway most commonly occurs at the pharynx or the trachea. Foods that can adapt their shape to that of the pharynx such as bananas, marshmallows, or gelatinous candies are particularly dangerous.

Choking is frequently caused by tumors, swelling of the airway tissues due to infections, and physical compression in strangulation. Complications

• Brain damage typically occurs if the body is deprived of air for three minutes.
• Death will usually occur if breathing is not restored in six to eight minutes.

Children younger than age three are especially at risk of choking because they explore the environment by putting objects in their mouth. Their airway is smaller in diameter than an adult's airway and their coughing may not be as effective as that of an adult in clearing an airway obstruction. In adults, choking is most often caused by food. Risk factors include:

• Medical conditions that affect the coordination of swallowing such as:
  • Strokes
  • Parkinson disease
  • Alzheimer disease
• Using alcohol or sedatives.
• Undergoing a procedure involving the oral cavity or pharynx.
• Wearing oral appliances.

The risk of chocking in children can be reduced by:

• Waiting until 6 months of age before introducing solid foods to infants.
• Supervision of children while eating or playing.
• Removal of hazardous objects from the reach of your children.
• Governmental safety regulation and inspection of children's toy products.

In adults with difficulty swallowing, selection of food items with appropriate particle size, texture and humidity can reduce the risk of chocking.

Choking can be treated with various basic techniques or advanced techniques.

Basic Treatment

For the conscious choking victim, most protocols recommend encouraging the victim to cough. If not effective, hard back slaps are attempted and if none of these procedures work, abdominal thrusts (Heimlich maneuver) or chest thrusts are applied. If the choking victim becomes un conscious, CPR is recommended.

Back Blows (or Slaps)

These are performed by leaning the choking victim forward, then delivering blows with the heel of the hand onto the victim's back, in between their shoulder blades. Back slaps must be performed with the head lower than the chest (patient bent over), otherwise the blow may drive the object deeper into the person's throat.

Abdominal Thrusts (Heimlich Maneuver)

Abdominal thrusts are usually recommended for their simplicity and effectiveness. They can be followed by chest thrusts, if abdominal thrusts are not effective. Abdominal thrusts are performed with the rescuer standing behind the person choking and exerting inward and upward pressure with their hands on the choking person's abdomen. The purpose of abdominal thrusts is to create pressure that will expel any object lodged in the airway upwards to relive the obstruction. The procedure is similar in chest thrusts, except that the pressure is applied around the chest. Chest trusts might be more effective on obese people.

For children less than 1 year old, the American Heart Association recommends performing cycles of 5 back blows (or slaps) followed by 5 chest compressions. Abdominal thrusts are not recommended because they can cause liver damage.

Advanced Treatment

There are many advanced medical treatments to relieve choking or airway obstruction. These include inspection of the airway with a laryngoscope or bronchoscope and removal of the object. Emergency cases in which the appropriate conditions to remove the object are not available may require cricothyrotomy (tracheostomy). It involves making an incision between the cricoid and the thyroid in the anterior aspect of the neck and inserting a tube into the trachea in order to bypass the upper airways. This procedure is only performed when the basic methods have failed and other options are not available.

Dysphagia is difficulty in swallowing. It can have various causes and involve different parts of the swallowing mechanism or anatomy. It frequently produces coughing, chocking or pulmonary aspiration (food or liquid going into the lungs) and subsequent aspiration pneumonia. Dysphagia can also lead to dehydration and weight loss.

Oropharyngeal dysphagia includes difficulty controlling the position of food in the mouth, difficulty initiating a swallow, nasal regurgitation and gurgly voice after swallowing. Patients identify the mouth or neck as the site of the problem. These problems are common among older individuals, patients who have had strokes, head and neck cancer and progressive neurologic diseases like Parkinson's disease, dementia or multiple sclerosis.

In esophageal dysphagia patients indicate an inability to swallow solid food, saying that it is held up before it reaches the stomach or is regurgitated. Various diseases in or adjacent to the esophagus can result in dysphagia and the treatment will depend on the cause. Achalasia is an exception to usual pattern of dysphagia in that patients report more difficulty swallowing fluids than solids. It is caused by a degeneration of neural tissue in the esophagus which results in peristaltic failure.

The diagnosis of dysphagia commonly requires specialized techniques due to the concealed nature of the swallowing mechanism. Endoscopic techniques involve the lowering of a camera into the mouth, pharynx and esophagus and allow for imaging of the structure in action. Videofluoroscopy can also be useful, providing live x-ray images of the neck structures while the patient swallows a radio-opaque fluid.

Many treatments are used in dysphagia because it is not a disease, but a symptom or condition associated with a wide variety of diseases. Treatments can include swallowing therapy, dietary changes, feeding tubes, certain medications, and surgery.