High choking risk foods for children under 5 years

Children can choke on food at any age, but those under five are at higher risk – and especially children under three.

The shapes and textures of some foods means they’re more likely to cause choking. The kinds of foods more commonly associated with choking incidents are described below, along with ways of reducing the risks.

Remember to:

  • Always supervise children during meal and snack times - develop the routine that your child sits at the table accompanied by a parent/guardian. This will present opportunities for talk time with your child and catching up with their adventures!
  • Make sure children sit whilst eating - children should not run around and play while eating.
Small hard foods are difficult for children to bite through and break down enough to swallow safely – pieces can become stuck in children’s airways.

Examples include:

  • nuts
  • large seeds (eg, pumpkin and sunflower seeds)
  • hard dried fruit

Reduce the risk:

  • avoid giving whole nuts, large seeds or hard dried fruit to children under the age of five
  • use thinly spread smooth nut butter instead of whole or chopped nuts
  • pieces of raw carrot, celery or apple
  • carrot, apple and celery can either be cooked until soft or finely grated
Small round or oval foods can lodge in children’s airways. 

Examples include:

  • grapes
  • berries and cherry tomatoes

Reduce the risk:

  • cut grapes in half length ways and then cut into quarters - this is very important.
  • berries and cherry tomatoes can be quartered or chopped smaller
  • raisins and sultanas
  • soak raisins and sultanas to soften, and cut in half if large
  • fruit with stones and large seeds or pips (eg, watermelon, small stone fruits)
  • remove stones from fruits
  • peas
  • peas can be squashed with a fork
  • lollies/sweets
  • young children can not chew small round hard, chewy or sticky lollies/sweets. (The HSE-CSP advise not to give these food items to children under 5 years of age - in line with advice from the American Academy of Pediatriacs)
Foods with skins or leaves are difficult to chew and can completely seal children’s airways.

Examples include:

  • chicken (with skin), sausages, saveloys, frankfurters, etc

Reduce the risk:

  • remove or peel skins before serving
  • chop up (to at least as small as the child’s small fingernail) and add to mashed food
  • stone fruits (eg, plums, peaches, nectarines)
  • remove stones from fruit
  • peel fruit
  • chop up
  • apples and pears
  • tomatoes
  • remove or peel skins before serving (the HSE CSP advises grating before serving to young children)
  • chop up (to at least as small as the child’s small fingernail)
  • lettuce and other raw salad leaves
  • finely chop salad leaves
  • spinach and cabbage
  • cook spinach and cabbage until soft and chop finely
Compressible foods can squash into the shape of a child’s throat and get stuck there

Examples include:

  • sausages, saveloys, frankfurters, hot dogs, etc

Reduce the risk:

  • remove skins before serving
  • Cut in half length ways and cut up (to at least as small as the child’s small fingernail) and add to mashed food
  • pieces of cooked meat
  • Remove skins before serving
  • cook meat until very tender, chop finely and add to mashed food
  • marshmallows
  • popcorn
  • marshmallows and popcorn should not be given to young children (The HSE-CSP advise not to give these food items to children under 5 years of age - in line with advice from the American Academy of Pediatriacs)
  • chewing or bubble gum  
  • don’t give young children chewing or bubble gum.  (The HSE-CSP advise not to give these food items to children under 5 years of age - in line with advice from the American Academy of Pediatriacs)
Thick pastes can form to the shape of a child’s airway and stick to its side.  

Examples include:

  • chocolate spreads
  • nut butter.

Reduce the risk:

  • use thick pastes sparingly and spread evenly onto bread
Fibrous or stringy foods can be hard for children to break up into smaller pieces.  

Examples include:

  • celery
  • rhubarb
  • raw pineapple

Reduce the risk:

  • peel the skin/strong fibres off celery and rhubarb
  • slice these foods thinly across the grain of fibres

Source: All information in the table above is from the Ministry of Health, New Zealand – www.health.govt.nz (last accessed on 16.10.2015) unless otherwise stated.

Most unintentional injuries (often called accidents) can be prevented:

Remember the key message where child safety is concerned -
Watch your child at all times, as children do not understand danger