Parents, It's Time For Us To Get Real About Choking

by Cynthia Pepper
Aynur_sib / iStock

“How can I give my child a cracker when he might choke on a block the same size?!”

“How can she possibly chew fruit with no teeth?

“She gagged on a cracker, so she’s not ready!”

“It’s dangerous…”

I know many of you are nervous to give your little ones foods that easily fit in their tiny hands. After all, you spend most of your day diligently stalking them to make sure they don’t put small objects in their mouths for fear of them choking.

This is scary and confusing. I get it! I know because you tell me. As a feeding therapist and a friend to many new parents, I have listened to these fears. I also see it in your eyes when I suggest trying a piece of fruit or a cracker for the first time. I hold your hand and reassure you as we watch your cherub explore the new solid. We watch your baby scale his first of many new mountains and stumble and get back up. Without question, it is terrifying.

However, there is a difference between scary and dangerous.

I know I can’t possibly understand what it’s like to give a child of my own something so potentially dangerous. That’s true, but I can tell you that I have watched someone I love choke. My mother choked on a cookie while we were walking in a mall when I was 12. It was terrifying. I started screaming and a good Samaritan gave my mom the Heimlich to expel the piece of white chocolate macadamia lodged in her trachea.

Why are you telling me this horrible story while telling me not to worry about choking?!

First, to tell you that I understand why you are scared, the fear of choking is real and visceral. I get it.

Second, to make a plug for taking a first-aid and CPR course so you know what to do if something does happen to your child or anyone else around you. (Thank you to that good Samaritan at Garden State Plaza in 1995, whoever you are!)

Third, to point out that choking can happen at any time and at any age, but certain circumstances make it more likely. I know you are concerned about giving your 1-year-old a cracker, but I am much more worried right now about your 3-year-old walking around with a bowl of grapes or running while eating fruit snacks.

If you want to implement one rule that will help reduce your child’s risk of choking, try my favorite rule: You sit while you eat. Your toddler can eat snacks or run around but not at the same time. Your preschooler can try eating a carrot like a rabbit but not while hopping around like one. They can sit on your lap, a couch, a park bench, or the ground. They just need to be sitting.

I know that children don’t like rules, particularly ones that we adults don’t follow ourselves. You could try to implement the sit-and-eat rule as a household (and it could become the latest fad diet since it actually reduces snacking!). However, it’s probably not very realistic in our harried lives. As an adult, you don’t have to sit while you eat because you’ve already learned to eat. Your children, however, are still learning.

Eating takes a lot of cognitive effort and attention before it becomes automatic. Your child needs to focus their attention on the act of eating and all the oral motor skills and sensory integration it requires. Like with any other complex motor activity, mastery requires experience. And this brings me to my last point, the Herculean task of eating takes practice.

Practice with different textures and sizes of foods to help your child learn how to control their tongue and more safely navigate food around their mouth. Puréed baby food does not give them this practice. If your child does not encounter solid foods until they are 16 months, they are not going to magically know how to control these foods in their mouth simply because they are chronologically older. They only develop these skills through practice, and improved skills mean safer eating and lower risk of choking.

Practice won’t always be pretty. When a child learns to ride a bike, they often fall off several times. It’s likely you will watch your child spit, sputter, gag and maybe vomit. However, gagging is not choking. Gagging can look frightening, but it is amazingly protective.

Eating safely means that a child learns how to get food out as much as they learn to chew and swallow safely. The gag reflex on an infant is much closer to the front of the tongue than ours is, and it is only through mouthing objects and foods (again, experience) that the gag reflex migrates farther back on the tongue and ultimately to the back of the throat.

So if you offer your child a new food and they start gagging, sit on your hands for a moment and let them practice getting it out before rushing in to help. Put on your best flight attendant face (the one that masks your fear) and then celebrate them trying a new food. Your child will most likely react to your concern more than their gag reflex, so try your best to stay positive even if you are flailing on the inside. There is a lot of research that confirms just how reactive a child is to your emotions (check out Joseph Campos’s work to learn more). In fact, your child may not try a new food simply because your facial expression is saying “Beware!”

Parents, I know how little support there is for you in this endeavor. I do not mean to belittle you or to make light of the task of feeding. This is new, anxiety-provoking territory for you, and I have the utmost respect for how hard you work and how much you love your child.

I wish I could be there for each of you to hold your hand through this, but do not be afraid to ask for help. Ask a family member, a friend, or a neighbor to be there next to you while you give your infant a new food. You will feel better knowing you are not alone. Also, don’t be afraid to ask other parents about their feeding experiences or to talk to the teachers at your child’s daycare. Reach out to a feeding therapist, like myself, if you need more information. It takes a village!