Choking in children: a guide teaches parents and caregivers how to act safely.

Around 2,000 children died from choking in Brazil between 2009 and 2019, according to the Brazilian Society of Pediatrics (SBP). More than half of these accidents occurred in children under 4 years old, and almost 95% before the age of 7. Helping a choking child is one of the most tense moments for any parent or caregiver—the fear of doing the wrong thing and worsening the situation is enormous, and often the instinctive reaction may not be the most appropriate.

Confusion between choking on liquids or solids, or between partial and complete obstruction, can lead to inappropriate maneuvers and worsen the situation, increasing the risk of complications and death. With this in mind, the Brazilian Society of Pediatrics (SBP) recently published a Practical Guide for parents and caregivers, with didactic and detailed guidelines, aimed at the general public, on how to act in each situation.

The document explains the difference between choking on liquids, such as breast milk, juices, or saliva, and choking on solids or semi-solids, such as food and small objects. “Choking is one of the leading causes of accidental death in childhood. This guide represents a milestone in accident prevention because, for the first time, the Brazilian Society of Pediatrics (SBP) has compiled standardized national guidelines on how to act in these cases,” says pediatrician Quíssila Neiva Batista, from the Einstein Hospital Israelita in Goiânia. “Initiatives like this are fundamental, since many choking incidents can be prevented with information and preparation.”

In the United States, the American Heart Association (AHA) updated its guidelines for choking response in 2025. However, these guidelines focus only on cases of obstruction by a foreign body, that is, solids and semi-solids.

"There are practically no formal first aid recommendations outside of a hospital setting for choking caused by liquids, precisely because they rarely lead to total obstruction of the upper airways and, therefore, do not impact the statistics of deaths by asphyxiation," observes pediatrician Valéria Bezerra, coordinator of the Basic Life Support Course at the Brazilian Society of Pediatrics (SBP).

Different types of choking

Choking on liquids is usually related to normal airway protection reflexes, especially in young babies who are still developing their swallowing skills. In these cases, there is generally no complete airway obstruction, and the child should be positioned sitting or semi-sitting. "We noticed that many people were trying to apply airway obstruction maneuvers for foreign objects in cases of choking on liquids, which can be harmful to the child," says Bezerra.

According to the SBP (Brazilian Society of Pediatrics) document, if the child's own coughing or vomiting resolves the episode, no intervention is necessary. However, if any persistent respiratory distress occurs, the child should be taken to an emergency room. In critical situations, when breathing is interrupted, the recommendation is to gently stimulate the back and, if necessary, initiate resuscitation maneuvers.

In cases of choking on solids or semi-solids, the priority is to identify whether the obstruction is complete. According to a pediatrician at Einstein Goiânia, airway obstruction by a foreign body (OVACE) is especially critical in children under 3 years old, a period in which oral exploration and chewing are not yet fully developed. Among the most dangerous foods are whole grapes, sausages, nuts, large pieces of meat, popcorn, and hard candies. Latex balloons are the leading cause of non-food-related death in children under 6 years old.

Warning signs of airway obstruction include inability to speak or cough, noisy breathing, paleness, or gestures of clutching the neck. In children under 1 year old, airway clearance involves five back blows alternating with five chest compressions, performed carefully. For older children, the Heimlich maneuver should be performed until breathing resumes.

Parents and caregivers should know the correct procedures and act quickly, as early identification and appropriate intervention save lives. Blind sweeps in the mouth, application of excessive force, or delay in calling the Mobile Emergency Care Service (SAMU) at 192 are common mistakes that can worsen the situation.

“Clinically, it can be difficult for parents and caregivers to recognize the exact degree of obstruction during choking. Therefore, the recommendation is to carefully observe the warning signs, which help to differentiate between partial and complete obstruction, and from there, define the appropriate course of action,” advises pediatrician Ana Carolina Viegas, specializing in Family Health and Pediatric Intensive Care, from Rio de Janeiro.

In cases of partial obstruction, when the child is still able to cough or speak, the Brazilian Society of Pediatrics (SBP) advises avoiding aggressive maneuvers. Simply encourage coughing and observe carefully. Even if the choking episode seems resolved, take the child to the emergency room for medical evaluation. The professional may request imaging tests, such as a chest x-ray, to check for the presence of residual foreign bodies or possible injuries, since choking maneuvers can cause minor trauma.

How to avoid accidents

Prevention is the most effective strategy against choking in children. “Supervising mealtimes is very important. Solid foods, for example, should only be offered from 6 months of age, gradually, in very small pieces, always observing the baby's response,” advises the pediatrician from the Brazilian Society of Pediatrics (SBP).

Other simple precautions are also essential, including teaching the child to chew slowly and not talk while eating. It is important to avoid contact with hazardous items, such as toys with small parts, balloons, or coins. This guidance should extend to caregivers and family members, ensuring that everyone knows how to differentiate between choking on liquids and obstructions caused by solids.

Source: Einstein Agency

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