Avoiding Choking Hazards During the Holidays

The holidays are supposed to be the most wonderful time of the year, but this festive season can also offer a multitude of choking hazards for children. To help parents be proactive and ward off potential perils, Stanford Medicine Children’s Health pediatrician Joelle McConlogue, MD, offers some expert tips for dealing with choking threats around the holidays and throughout the year. She also discusses choking hazards in a HealthTalks podcast.

According to the California Department of Public Health, choking is one of the primary causes of accidental injury and death in children. During the holidays, we often have a massive flood of gifts, new foods, holiday décor, and visits to and from family and friends. Although festive, these changes in our environment can increase a young child’s chance of encountering a choking hazard.

“The new toys and the increased number of small items in the house are a big hazard. There’s also different food around the house during the holidays: lots of nuts, small or hard candies, which can create a big risk for choking as well,” Dr. McConlogue said. “And then there’s the decorations. Ornaments hanging on a Christmas tree or a decoration that has a small piece that isn’t normally part of someone’s home décor can all be potential hazards.”

Kids under 4 years old and children with developmental delays are particularly at risk, Dr. McConlogue explained. Between their tendency to mouth everything in sight and their lack of molars, it can be a lot easier for a little kid to choke on a stray nut at Grandma’s or a small LEGO piece from big brother’s new holiday gift.

“We’re most worried about choking in younger kids,” she said. “First of all, they like to put things in their mouths. Developmentally, everything goes in the mouth; that’s how they’re exploring, so that puts them at risk. And their airways are smaller compared with adults. So, small pieces can occlude, or get stuck in the airway, which can cause them to choke.”

Keep holiday décor safe

The first step, according to Dr. McConlogue, is to check your environment. “Do a sweep of the house and just look around. Ask yourself, ‘What small items do I have that I may not have noticed?,’ especially as you’re decorating around the home and putting holiday things out. Check the Christmas tree and look at what’s on those low-hanging branches. Are there small ornaments or items with little pieces that can be undone or pulled apart? Maybe put those a little bit higher.”

Getting down to a child’s level and seeing what they see can also be a good way to find hidden dangers. Ornament hooks, tiny light bulbs, beads, or anything with small pieces can all be potential hazards and should be removed or placed out of reach. “If you have nicer ornaments that may have small parts, put them on the upper part of your tree, or put them up on your mantel. Save the lower areas for big, clunky wooden decorations or soft toys,” she advised.

Reduce hazardous holiday foods

Popular holiday foods like popcorn, nuts, marshmallows, and candy canes (and all hard candies in general) present a higher risk for choking, especially for infants and toddlers. Even older kids can use a little extra supervision around holiday snacks. While it may be fun to see how many marshmallows you can stuff in your mouth at once, it can be very dangerous for youngsters.

“Many kinds of holiday foods can be conducive to choking. I always recommend to my families that when kids are eating at any age, they should be sitting down. They shouldn’t be walking around, they shouldn’t be wandering; encourage them to chew and swallow,” Dr. McConlogue said. “And then just be careful of some behaviors—for example, throwing popcorn in your mouth, or stuffing in big sticky things like marshmallows.”

Stay vigilant when visiting family and friends

There’s nothing like enjoying time with loved ones during the holidays. However, families with young children need to be especially watchful when going to holiday parties or visiting with family and friends, Dr. McConlogue said. “Parents need to be mindful and watching when they’re in other people’s homes. Perhaps there is a bowl of nuts on a low table, or a dropped a candy that a kid could pick up. There can be a lot of distractions, so it’s important to keep an eye on young kids who may be at risk for choking.”

Keep holiday gifts age-appropriate

Dr. McConlogue recommends sticking to toys that are appropriate for your child’s age level. Toys should be labeled with an age range to help parents figure out which toys are right for their child. For families with several children, help keep little ones safe by putting toys with small parts out of reach.

“When shopping for infants or toddlers, really look at the toys that you’re buying, and make sure that they’ve got big parts,” she said. “If you have older kids in the household, the older kids need to put their toys with small parts up high, or they need to be played with in a different area.” Cleaning up and making sure no pieces are left on the ground is also important when little kids are around.

Dr. McConlogue warns families that batteries not only are a choking hazard but also can be very dangerous when swallowed, so parents need to be extremely careful. “I would really encourage parents to check that the battery cover is screwed on, not something that the kids can pop off and easily open.”

What to do if your child chokes

If a child is choking, you need to call 911 and get emergency services right away, Dr. McConlogue stressed. She also recommends that parents take a CPR first aid course to be prepared for emergencies. Fast action is critical in a respiratory-distress situation.

“I would first look and see if you can see anything in the mouth. If there’s something there that you can easily sweep in and pick up, then parents just use a one-finger sweep into the mouth and pull it out,” she said. “If you can’t do that, in a young baby, then turn them over and do some gently but firm back blows with the child’s head facing downward for gravity to help. If it’s an older child, then they’ll probably need to do the Heimlich maneuver.”

Being watchful and prepared can help your family keep the holidays safe and joyful for the entire family.

“People just need to be reminded to keep their guard up, especially in new places and as we put up those different decorations,” Dr. McConlogue shared. “Just pause for a minute and check things to make sure that they’re all safe. We want to keep the holidays joyful, so use the decorations safely and have fun.”  

Read more advice from Dr. McConlogue >

Learn more about how to protect your child from choking >