What Causes Choking? Top Hazards, Prevention Tips, First Aid

Choking, also known as foreign body airway obstruction (FBAO), is a significant health concern. Although it is a preventable injury, it claims many lives worldwide each year. 

This article will provide an in-depth exploration of the causes of choking across different age groups, including infants, children, adults, and the elderly. We will also detail the types and signs of choking to enhance your understanding and help you better prevent this life-threatening incident.

Research shows that in the UK, choking claims around 250 lives annually, while in the USA, the figure reaches approximately 5,200. It is notably the leading cause of accidental death in Japan. 

The issue receives significant attention due to its prevalence not only among infants and children but also its rising occurrence in the elderly. In the United States, data from 2000 to 2013 highlights that choking was the third leading cause of accidental death in adults over the age of 65.

Understanding Choking: How Foreign Objects Block Airflow

Choking occurs when foreign objects or secretions block the airways, preventing air from entering the lungs for ventilation, thereby affecting normal breathing. In severe cases, choking can lead to death within minutes.

When people swallow, the epiglottis covers the trachea to prevent food from entering the airway, while a sphincter at the opening of the esophagus helps control the entry of food and liquids into the esophagus, preventing reflux.

Choking can occur when people talk or laugh while eating, causing the epiglottis to open and food to slip into the trachea. Incoordination or underdevelopment of swallowing functions (as in infants and young children) can also lead to food or foreign objects slipping into the airway.

Choking on foreign objects typically occurs in the right main bronchus. The trachea branches into the left and right bronchi; the right bronchus is wider and more vertical, whereas the left bronchus is narrower and more angled.

Therefore, when a foreign object accidentally slips into the airway, due to gravity and anatomical structure, larger or heavier objects are more likely to enter the right bronchus, while smaller objects may enter the left bronchus or remain in the main trachea.

Common Causes of Choking in Infants and Babies

• Physiological Development Features: Narrow airways, underdeveloped chewing and swallowing abilities.

• Inappropriate Food: Feeding infants foods unsuitable for their age, such as hard, round, smooth, or sticky foods like candy, which can easily get stuck in the airway.

• Poor Feeding Habits: For infants and babies, improper feeding positions, feeding too quickly, or allowing infants to eat while playing.

Note: To ensure safer feeding practices, always hold your infant in an upright position instead of lying flat or on their side. This position helps prevent milk or food from flowing back into the throat and airway.

• Poor Home Care: Inadequate parental supervision at home.

Common Choking Hazards in Infants and Babies

• Non-Food Items: Small toys or toy parts.
• Food Items: Milk, soft candies, jellies, sticky foods, etc.

Common Causes of Choking in Children

• Age Characteristics: Children like to explore their surroundings, are active, and often distracted. They may put small items like toy parts, coins, or food fragments into their mouths while playing, which can accidentally be inhaled into the airway.

• Physiological Development Features: Narrow airways, immature teeth, underdeveloped chewing and swallowing abilities, high levels of activity, and lack of concentration.

• Inappropriate Food: Foods such as hard, round, smooth, or sticky foods like nuts, grapes, and candies, can easily get lodged in the airway.

• Bad Eating Habits: Young children are often distracted while eating, running, crying, or roughhousing, which increases the risk of foreign objects entering the airway.

• Poor Home Care: Inadequate parental supervision and guidance.

Common Choking Hazards in Children:

• Non-Food Items: Coins, marbles, pen caps, button batteries, latex balloons, shells, small toys or toy parts.
• Food Items: Candies (especially hard candies), jellies, hot dogs (most common), seeds, nuts, grapes, peanuts, beans, glutinous rice balls, rice cakes, chewing gum.

Common Causes of Choking in Adults

• Carelessness While Eating: Adults are prone to choking if they eat too hastily, especially if they do not chew large pieces of food thoroughly, and if they talk or laugh while eating, which can cause food to slip into the airway.

• Excessive Alcohol Consumption: High blood alcohol levels can cause the muscles in the throat to relax, impairing swallowing and allowing food to enter the airway.

• Comatose Patients: Patients in a coma may experience airway blockage due to the tongue falling back and reflux of stomach contents and blood into the throat.

• Mentally Ill Patients: Mentally ill patients may swallow foreign objects uncontrollably during meals, leading to airway obstruction and choking.

Common Choking Hazards in Adults:

• Non-Food Items: Buttons, small ornaments.
• Food Items: Large chunks of meat, fish balls, vegetable stems, candies, preserved plums, pills, seeds or pits, beans, etc.

Common Causes of Choking in the Elderly

• Age-Related Characteristics: Chronic diseases such as dementia, Parkinson's, and pneumonia can make chewing and swallowing difficult.

• Medication Side Effects: Some prescription medications commonly used by the elderly, such as anticholinergics, anti-anxiety drugs, and sedatives, may impair the swallowing reflex and cough function.

• Bedridden Position: When elderly people are bedridden, the position in which they are fed may not be conducive to swallowing, increasing the risk of foreign body airway obstruction.

• Negligence: Family members or caregivers may inadvertently forget to remove items like dentures, leading to inhalation of dentures or dental devices into the airway.

Common Choking Hazards in the Elderly:

• Non-Food Items: Dentures or dental devices, buttons, small accessories, etc.
• Food Items: Glutinous rice balls, sticky rice dumplings, dumplings, steamed buns, chicken, jelly, candies, beans, peanuts, etc.
• Other: Pills, phlegm scabs, vomit, etc.

Understanding Choking: Types and Symptoms

Choking is typically classified into two primary categories based on the nature and severity of the airway obstruction: Partial Choking and Complete Choking. Below, we detail each type along with their respective symptoms and signs.

What is Partial Choking (Mild Choking)? 

Partial choking occurs when an airway obstruction is not complete, allowing some air to pass through to the lungs. This situation means that although the airway is partially blocked, the person can still breathe to some extent, albeit with difficulty.

Symptoms and Signs of Partial Choking:

• Coughing: An effective and strong cough is a good sign, indicating that the person can still breathe and is trying to clear the obstruction themselves.

• Wheezing or Gurgling Sounds: These sounds may occur as air squeezes past the blockage.

• Difficulty Breathing: The individual may show signs of struggle while breathing, but is not completely unable to breathe.

• Ability to Speak or Make Noise: They might be able to speak, cry, or make vocal sounds, though these could be weak or strained.

What is Complete Choking (Severe Choking)? 

Complete choking is a severe and life-threatening condition where the airway is totally blocked, preventing any air from entering the lungs. In this situation, the person cannot breathe at all, which requires immediate action to remove the obstruction.

Symptoms and Signs of Complete Choking:

• Inability to Speak or Breathe: The person cannot talk, cry, or make any noise; they may attempt to speak or make sounds but are unable to produce any.

• Silent Coughing or No Coughing: Unlike partial choking, there may be no sound from coughing or the person might not be able to cough at all.

• Cyanosis: The skin, lips, and nails may turn blue or gray due to lack of oxygen, a condition known as cyanosis.

• Panicking or Anxious Behavior: The individual might exhibit signs of panic such as frantic gestures or grabbing at the throat.

• Loss of Consciousness: If the airway is not cleared, the lack of oxygen may cause the person to become unresponsive or lose consciousness.

How to Prevent Choking? 

Preventing choking, especially in children and vulnerable adults, is crucial since it can happen suddenly and be life-threatening. Here are practical strategies to reduce the risk of choking:

For Everyone

• Chew Food Thoroughly: Teach and encourage everyone, especially children, to chew their food slowly and thoroughly before swallowing.

• Eat While Seated: Avoid eating while walking, running, lying down, or playing. Sitting down while eating reduces the risk of choking.

• Avoid Talking While Eating: Keep talking and laughing during meals to a minimum as these can increase the risk of inhaling food.

• Proper Food Preparation: Cut food into small, manageable pieces, especially for children. Remove pits and seeds from fruit, and avoid cooking foods to a hard consistency.

• Stay Focused During Meals: Pay attention while eating, and do not eat in a hurried or distracted manner.

For Infants and Children

• Supervise Meal Times: Always supervise young children while they’re eating. Do not leave them alone with food.

• Appropriate Food Selection: Avoid giving children under 4 years of age hard, small, or slippery foods such as nuts, seeds, hard candy, whole grapes, raw carrots, popcorn, and chunks of meat or cheese.

• Safe Toys: Ensure all toys are age-appropriate and check for small parts that could become a choking hazard. Regularly inspect toys for damage.

• Keep Hazardous Objects Out of Reach: Store small objects out of reach of children.

• Teach Safe Eating Habits: Educate older children about the dangers of putting non-food items in their mouths.

• Use Appropriate Utensils: Encourage the use of child-sized, soft-tipped utensils to make eating safer and easier.

For the Elderly

• Modify Diet as Needed: For those with difficulty swallowing (dysphagia), modify the texture of foods to softer consistencies that are easier to swallow, and consider thickening liquids.

• Mealtime Assistance: Provide assistance during meals if necessary, and be particularly vigilant if the individual has shown signs of swallowing difficulties.

• Regular Dental Checks: Ensure dentures fit properly and that any dental issues that could impair chewing or swallowing are addressed.

Get Prepared to Avoid Choking

• First Aid Knowledge: Learn basic first aid and CPR techniques, including how to perform the Heimlich maneuver or abdominal thrusts on different age groups.

• Be prepared with a lifesaving anti-choking device. Better safe than sorry.

What to Do if Someone Is Choking?

If the choking victim is conscious and able to breathe, encourage them to take slow breaths and then cough forcefully to try to expel the foreign object themselves.

If the patient shows signs of severe air exchange insufficiency, cannot breathe, or coughs without sound, identify and confirm complete choking and immediately take first aid while calling for help and dialing 911.

• For Adults:

Apply back blows and the Heimlich maneuver. If the choking person becomes unconscious, you should also apply cardiopulmonary resuscitation (CPR) techniques.

• For Children:

Apply back blows and the Heimlich maneuver. If the child becomes unconscious, proceed with CPR techniques.

• For Infants:

Apply back blows and chest thrusts. If the infant becomes unconscious, proceed with CPR techniques.

• For Pregnant Women:

Avoid the Heimlich maneuver as traditional abdominal thrusts may harm the fetus. Instead, perform chest thrusts. Place your hands at the base of the breastbone and give quick, firm thrusts to help dislodge the object.

• For Yourself:

If you are alone and choking, you can perform a self-Heimlich maneuver. Make a fist and position it just above your navel. Hold this fist with your other hand. Then, bend over a solid surface such as a countertop or the back of a chair. Press your fist inward and upward sharply into your abdomen

In situations where the traditional Heimlich maneuver is risky or ineffective, using a professional anti-choking device can be a safer alternative. This choking suction device creates a vacuum at the mouth and attempts to pull the object upward, dislodging it from the throat. It is a lifesaver for choking first aid.

Conclusion

Choking is a life-threatening emergency and a significant cause of death, especially among children and the elderly. 

When choking occurs, it is crucial to take prompt first aid actions, such as the Heimlich maneuver or using a professional choking rescue device.