The airway is the passage that connects the nose and mouth with the lungs. Choking occurs when the airway becomes partially or completely blocked by a foreign object (e.g., a piece of food or a small toy), by swelling in the mouth or throat, or by fluids, such as vomit or blood. If the airway is blocked by the person’s tongue or by swelling, this is called an anatomical obstruction. If it is blocked by a physical object, this is called a mechanical obstruction. Children younger than 5 years old have a particularly high risk of choking because their airways are about the size of their little fingers, but a person of any age can choke.
Anatomy and Physiology
The respiratory system consists of the airway and the lungs. When breathing in, air moves from the outside world into the lungs through the airway. The respiratory system constantly supplies the body with the oxygen it needs and removes carbon dioxide. The process is largely involuntary and is controlled by the brain.
Partial choking happens when the airway is partially blocked. Coughing is the body’s way of clearing the airway, and so it may indicate partial airway obstruction. A person who is coughing is still able to breathe. Since forceful coughing usually eliminates the obstruction, encourage the person to keep coughing. Stand by and monitor the person in case further help becomes necessary. Note that the care for complete choking will be ineffective for partial choking because it depends on creating pressure behind the blockage (which is impossible unless the blockage is complete). If the person is or becomes too weak to cough, his or her condition will quickly deteriorate into complete choking. If a choking person is unable to cough forcefully for any reason, call EMS/9-1-1 immediately and monitor the person’s condition closely.
Complete choking happens when the airway is completely blocked. When a person is experiencing complete choking, he or she is unable to breathe and is in a life-threatening situation. Immediate first aid (and possibly medical intervention) is required to remove whatever is blocking the airway.
Any medical condition that affects a person’s ability to chew and/or swallow increases his or her risk of choking. So can dental problems or poorly fitting dentures that affect a person’s ability to chew food properly.
Common causes of choking include the following.
- Trying to swallow large pieces of food
- Eating while talking, laughing, walking, or running
- Eating too quickly
- Nuts and seeds
- Hot dogs and sausages
- Chunks of meat or cheese
- Chunks of fruit (e.g., apples)
- Small fruits (e.g., whole grapes and cherries)
- Hard raw vegetables (e.g., carrots and celery)
- Peanut butter
- Hard, gooey, or sticky candy (e.g., peppermints, marshmallows, and gummy bears)
- Foods that break easily into small pieces (e.g., teething biscuits and cookies)
HOUSEHOLD OBJECTS AND TOYS
- Plastic bags, broken or uninflated balloons (the thin material can block the airway)
- Small “button” batteries (e.g., those found inside watches, car key fobs, and hearing aids)
- Small rocks, beads, or decorative stones
- Pen and marker caps
- Pills and vitamins
- Items from the garbage or recycling (e.g., corners of milk bags and pull tabs from cans)
- Toys meant for older children, which may be small or have small parts
The following may reduce the risk of choking in adults
- Chewing food well before swallowing
- Eating slowly and calmly
- Avoiding talking, laughing, walking, and other kinds of physical activity while chewing
The following may reduce the risk of choking in children and babies
- When babies start eating solid food, begin with purées as opposed to solid pieces.
- Always supervise children and babies when they are eating.
- Teach children to eat calmly, chew properly, and not to speak with a mouthful of food.
- Encourage children to sit while eating.
- Make sure that babies and young children cannot reach objects small enough for them to swallow.
- Remember that children can choke on soft plastic (e.g., the cut-off corners of milk bags) and rubber (e.g., burst balloons) as well as hard objects, so keep these items out of reach.