What a Pediatrician Says 'Most Parents Aren't Aware' of About Choking Hazards

Following the sad news that country singer Ned LeDoux‘s 2-year-old daughter Haven died in “a tragic choking accident” at home, many parents are wondering about their own children’s safety.

In a conversation with PEOPLE, pediatrician Dr. Jaime Friedman explains why she thinks it’s so important for parents to educate themselves on common (but often, overlooked) choking hazards for children — and to make sure to never take shortcuts when it comes to preparing their kids’ food.

“Parents are surprised when they come in for their child’s three-year check up and I still mention choking risks like grapes and popcorn. Most parents aren’t aware that we worry about choking up until age 4,” she said. “They seem pretty resistant to cutting grapes for their 3-year-olds.”

The reason they shouldn’t be: The AAP identified “mechanical airway obstruction” as the leading cause of unintentional death for children younger than 1, and the fourth deadliest for children ages 1 to 9 (surpassed by motor-vehicle deaths, drowning and fire/burns). And even parents who diligently cut grapes and hot dogs might still be surprised to find out that popcorn, peanut butter and cheese are all on the “danger list.”

So what does Dr. Friedman want parents to be aware of when it comes to choking hazards? First of all, the rule of thumb actually does apply to food items: Everything should be cut smaller than a thumb’s width before it’s served to children. “Anything that is the size of the airway (thumb size) that is solid or unforgiving is a choking risk,” she says.

And sticky foods, including peanut butter and marshmallows, are just as dangerous; for parents introducing peanut butter to an infant, “I always counsel on watering it down so that it doesn’t cause choking,” Dr. Friedman adds.

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As for the growing popularity of the “baby-led weaning” technique, in which parents skip purées in favor of starting children on finger foods (and relying on the child’s gag reflex while he or she learns how to eat the food), Dr. Friedman says, “If parents want to use more solid foods or a net to put solid foods in, they have to be aware of the risks and need to be sure that foods are soft and in small pieces. I would never suggest giving an infant a solid baby carrot to gnaw on, for example.”

For items like “chunks of meat, cheese and raw vegetables,” all of which the AAP identifies as a risk, Dr. Friedman suggests string cheese, meat cut into ½-inch pieces and vegetables cut lengthwise into long, thin strips, once the child has teeth and can appropriately chew the food.

Other surprising choking risks? Pen caps, marbles, magnets and buttons, as well as balloons, which Dr. Friedman says were a no-go in her house when her own children were small. “We didn’t really play with balloons and I don’t give them out in the office. I know dentists give them out so parents have to use caution, especially once they get in the car with a child who has a balloon,” she says.

For other non-food risks, “I recommend parents get on the floor and look in couch cushions for coins, batteries and small items that have dropped. I also [advise] against beaded jewelry like amber necklaces,” says Dr. Friedman.

Dr. Friedman recommends requiring proper training for anyone who might care for your child: “All caregivers should have at least one class on infant CPR and choking care. They should have children sit for meals and snacks — no running around.”

And if the worst-case scenario should happen? “Never perform a blind sweep in the mouth if they are choking, as they may push items further into the trachea,” she says. “If the child is not breathing, call 911 and start rescue breaths. If the child is drooling or can’t swallow, keep them calm; a child in distress can block their airway further. If there is any question about a swallowed or aspirated item, X-rays can be helpful, so have the child seen.”

What foods are the biggest choking hazards?
Hot dogs
Hard/sticky candy
Nuts
Meat
Grapes
Cookies/biscuits
Carrots
Apples
Popcorn
Peanut butter
Chunks of meat or cheese
Chunks of raw vegetables

What non-food items are the biggest choking risks?
Rubber balloons
Small toys
Pen caps
Small balls/foam balls
Marbles
Magnets
Disc batteries
Pieces of dog food
Buttons

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