Preventing Infant Choking: from Bottles to Solids

Choking is a common cause of injury and death in children, but it doesn't have to be.   Parents and caregivers can prevent situations that may cause choking in infants by ensuring that:

1.  bottle fed babies are monitored and using proper flow on the nipple 
2. only developmentally appropriate foods are offered 
3. small items that can fit in the mouth are never in baby's reach


Bottle Feeding
Whether from the breast or bottle, it's important to continually keep an eye on baby to be sure s/he's feeding well and comfortably.  When baby is bottle feeding however, we need to be sure the correct size nipple is being used.  There are many brands of bottles but the nipples on each bottle are typically standard with a flow rate of 1, 2, 3 or 4.  

Level 1 indicates the smallest hole in the nipple, making it the slowest and most appropriate for newborns and very young babies. Level's 2, 3 and 4 are used as baby gets older. There is no specific date when bottle levels should be increased; this is one of those things baby will show you as they become more efficient at each level.

The other crucial thing to remember when bottle feeding is not to prop the bottle up to feed baby; don't use a rolled up towel or other device to feed baby. When a bottle is propped it can slip, or continue to drip or pour fluid into baby's mouth causing fluid to pool in the back of he mouth and throat. Not only can this quickly lead to choking but it can also lead to tooth decay, ear infections and decreased bonding.

​Starting Solids
When baby begins eating solid foods, purees and smooth foods should be the only things offered.  As more foods and textures are introduced, it's important not to offer foods considered high risk. Even when solid-food feeding is established, babies' airways may become constricted when they take in foods that are too big, not easy to chew or easily swallowed.

The following foods are not recommended for children age 4 and under (AAP):

• Hot dogs
• Nuts and seeds
• Chunks of meat, cheese or raw veggies
• Whole grapes 
• Hard candies or sticky candy (like a Starburst or a gummy vitamin)
• Popcorn
• Chunks of peanut butter
• Gum 

Everyday
No matter your baby's age, these items should always be kept out of baby's reach (from the AAP). It can be challenging especially when there are toddlers and older children around but these are all choking hazards:
​

• Coins
• Buttons
• Toys with small parts or that can fit entirely in a child’s mouth. Be on the look out for Legos, puzzle pieces and other toys that older kids might use being left within baby's reach.
• Small balls, marbles
• Balloons
• Small hair bows, barrettes, rubber bands
• Pen or marker caps
• Small button-type batteries, such as a watch battery
• Refrigerator magnets
• Pieces of dog food

Like most things in newborn and infant care, prevention and knowledge are the key to health and safety. To learn what to do if baby is actually choking, visit and print this .pdf.

---