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Meet the Expert

Gary Smith, MD, DrPH

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Choking Hazard Foods Need Warning Labels

Experts Say Labels, Better Education Needed On Foods That Choke Children

(COLUMBUS, Ohio) - A new policy statement from the American Academy of Pediatrics calls for consistent use of warning labels on foods that put children at high risk for choking, a leading cause of death in children. The policy statement appears online and is scheduled for publication in the March issue of the journal Pediatrics.

Lead policy statement author Dr. Gary Smith, who directs the Center for Injury and Policy at Nationwide Children’s Hospital, says that many foods that are thought to be kid-friendly are actually dangerous. Foods like grapes, popcorn and nuts can get lodged in a toddler’s throat or lungs. Statistically, the all-American hot dog causes more choking deaths than any other food, Smith says.

“If you were to design the perfect plug for a child’s airway, you couldn’t do much better than a hot dog tip,” says Dr. Smith. “This will wedge itself in so tightly and completely block the airway that within minutes, because of a lack of oxygen, the child will die.”

Because of the high risk that foods like hot dogs present to young children, Dr. Smith says food manufacturers must do their part to warn parents of their potential danger.

“Food manufacturers should put warning labels on certain high-risk foods,” Dr. Smith says. “In addition, when possible, they should redesign foods to give them different shapes and sizes to minimize the choking risk.”

In the meantime, Smith, who is also with Ohio State University, offers these tips for parents:

-Cut hot dogs lengthwise and cut grapes into quarters. This changes the dangerous round shape that can block a young adult’s throat.
-Avoid giving toddlers other high-risk foods like hard candy, nuts, seeds and raw carrots.
-Never let small children run, play or lie down while eating.

These tips and more are key parts of every meal and snack that Katherine Zuehlke of Westerville, Ohio prepares for her two-year-old daughter Tiffany. For Tiffany, it was a candy-coated peanut that got caught in her throat and made Katherine catch her breath.

“We flipped her over and we started to pat her back pretty heavily over the sink,” Katherine says. “Between the patting and herself, she got it up. She was really scared, her eyes were watering, we were all really scared.”

Katherine now cuts all of Tiffany’s food into small pieces.

If a child is choking but can still breathe, Dr. Smith recommends that parents let them try to cough the food out on their own. If the child isn’t making any noise or is turning blue, Dr. Smith encourages parents to call 911 and perform the Heimlich maneuver on kids over age one.  For babies younger than 12 months, Smith recommends doing back blows and chest thrusts to get the airway clear.

For more information and to download broadcast-ready video, audio and still photos, please visit

* Policy Statement – Prevention of Choking Among Children, Pediatrics, Volume 125, Number 3, March 2010




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