Airway obstruction injury is the leading cause of unintentional injury-related death among infants under age 1. These injuries occur when children are unable to breathe normally because food or objects block their internal airways (choking), materials block or cover their external airways (suffocation) or items become wrapped around their necks and interfere with breathing (strangulation). Children, especially those under age 3, are particularly vulnerable to airway obstruction death and injury due to their small upper airways, their relative inexperience with chewing and their natural tendency to put objects in their mouths. Additionally, infants' inability to lift their heads or extricate themselves from tight places puts them at greater risk.

AIRWAY OBSTRUCTION DEATHS AND INJURIES

• Each year, approximately 890 children ages 14 and under die from airway obstruction injuries.
• Children sustain approximately 17,200 suffocation injuries each year.
• In 2006, there were more than 14,000 emergency room visits for choking-related episodes.
• In 2004, 963 children ages 14 and under died from an unintentional strangulation injury; 88 percent of these deaths occurred to children under 4 years of age.
• Choking accounts for 45 percent of all toy-related fatalities.
• Each year, cribs and playpens are responsible for half of all nursery product-related deaths among children ages 5 and under.
• Cribs, often older or used cribs, are responsible for 26 strangulation and suffocation deaths each year.

WHERE AND HOW AIRWAY OBSTRUCTION DEATHS AND INJURIES OCCUR

• The majority of childhood suffocation, choking and strangulation incidents occur in the home.
• Sixty percent of infants suffocate in the sleeping environment as a result of pillows/cushions blocking their airway while sleeping.
• The majority of childhood choking injuries are associated with food items, including hot dogs, candies, nuts, grapes, carrots and popcorn.
• Non-food choking hazards tend to be round in nature, such as coins, small balls, and/or objects that conform, like balloons.
• Common items that strangle children include clothing drawstrings, ribbons, necklaces, pacifier strings, and window blind and drapery cords.
• Openings that permit the passage of a child's body but are too small for his or her head, can lead to entrapment and strangulation. Hazards include bunk beds, cribs, playground equipment, baby strollers, carriages, and high chairs.

WHO IS AT RISK

• Children ages 4 and under, especially under age 1, are at greatest risk for all forms of airway obstruction injury. Children 4 years and under are 15 times more likely to experience a suffocation death than children between 5-14 years of age.
• Male and non-white children, as well as children from low-income families, are at increased risk from suffocation, choking and strangulation.
• Black children are twice as likely as white children to die from suffocation.
• Children placed in adult beds are at increased risk for airway obstruction injury. Since 1990, at least 296 children under 2 years of age have died in adult beds as a result of entrapment in the bed structure. In addition, 209 children in this age group died in adult beds from smothering as a result of being overlain by another person.

AIRWAY OBSTRUCTION PREVENTION LAWS AND REGULATIONS

• The Child Safety Protection Act bans any toy intended for use by children under age 3 that may pose a choking, aspiration or ingestion hazard and requires choking hazard warning labels on packaging for these items when intended for use by children ages 3 to 6.
• The U.S. Consumer Product Safety Commission (CPSC) has issued voluntary guidelines for drawstrings on children's clothing to prevent strangulation in the neck and waist drawstrings of upper outerwear garments, such as jackets and sweatshirts.
• In 1992, the CPSC voted to ban infant cushions, in order to prevent infants from suffocating while sleeping on infant cushions. Banned cushions have all the following features: 1) a flexible fabric covering; 2) is loosely filled with a granular material such as plastic foam beads or pellets; 3) is easily flattened; 4) is capable of conforming to the body or face of an infant; and 5) is intended or promoted for use by children under age one.

HEALTH CARE COSTS AND SAVINGS

• The total annual cost of airway obstruction injury among children aged 14 years and under exceeds $1.5 billion in the United States.
• Children aged 4 years and under account for more than 60 percent of these costs.

SUFFOCATION PREVENTION TIPS

Prevent possible suffocation and reduce the risk of sudden infant death syndrome (SIDS). Since most infant suffocation occurs in the sleeping environment, babies should sleep only in properly equipped cribs.

• Lay your baby to sleep on his or her back, facing up.
• Babies should never sleep on couches, chairs, regular beds or other soft surfaces and should never share a bed with a sibling or parent(s).
• The safest place for your baby to sleep is in a safety-approved crib with a firm mattress and a well-fitting sheet with a JPMA (Juvenile Products Manufacturers Association) label indicating that it meets national safety standards.
• Remove pillows, comforters, stuffed toys and other soft products from the crib.
• Use a crib that meets all current national safety standards. Corner posts should be 1/16 inch or shorter and they should be the same height as the end panels. The distance between crib slats should be 2 3/8 inches or less and the crib shouldn't have sharp or jagged edges.
• Make sure the directions are thoroughly read when assembling, using and caring for cribs and other furniture.
• Be sure to inspect the baby's crib regularly to make sure there are no loose, broken or improperly installed screws, brackets or other hardware.
• Check with the U.S. Consumer Product Safety Commission (CPSC) to make sure that the crib has not been recalled.
• Make sure the baby's crib has a firm, tight-fitting mattress (no more than two fingers of space between crib and mattress) and that is free of all plastic wrappings.
• Use tight-fitting bottom sheets that are made for crib mattresses. Never use adult sheets as a substitution.
• Use a sleep sack or swaddle to keep the baby warm, or tuck him/her in a light blanket that goes no higher than the baby's chest. Do not use adult-sized blankets.

Make sure toys and other items children play with don't pose suffocation hazards.

• Make sure toy chests have no lids or have safety hinges. Don't allow children access to household appliances where they could become trapped, such as refrigerators or dryers.

CHOKING PREVENTION TIPS

To avoid choking, always supervise young children while they are eating, and keep small objects that are potential choking hazards out of their reach.

• Don't let children under age 3 to eat small, round or hard foods, including small pieces of hot dogs, hard candy, nuts, grapes and popcorn. Other hazardous food items include raw vegetables, jellybeans, raw unpeeled fruit slices, dried fruits, grapes or chunks of meat.
• Cut foods into small pieces and give infants soft foods that they don't need to chew.
• Don't let your child eat or suck on anything like candy while lying down or playing.
• Have children sit in a high chair or at a table while they eat.
• Get on the floor on your hands and knees, so that you are at your child's eye level. Look for and remove small items such as jewelry, coins, buttons, pins, nails and stones. Be sure to keep all plastic bags out of reach.

Make sure toys and other items children play with do not pose choking hazards.

• Make sure that children play with safe and age-appropriate toys, as indicated by choking hazard safety labels. Toys that are labeled for children 3 years and older should be kept away from children under age 3. These toys may have small parts and could cause choking if placed in the mouth.
• Regularly check toys for damage that may have created sharp edges or loose small parts. Damaged or dangerous toys should be repaired or thrown away immediately.
• Consider buying a small parts tester to determine whether toys and objects in your home may present a choking hazard to young children. If you don't have a small parts tester, you can use an empty toilet paper roll, which is slightly larger in diameter than a small parts tester. Don't let young children play with anything that can fit into any of these cylinders.
• Don't let children under age 8 blow up balloons. Use Mylar balloons instead of latex balloons. If you must use latex balloons, store them out of reach of children, and deflate and discard balloons and balloon pieces after use.
• Sign up to receive product recalls with the Consumer Product Safety Commission at www.cpsc.gov.

Learn CPR for infants and children and the Heimlich maneuver for choking.

STRANGULATION PREVENTION TIPS

Keep cords and strings out of your child's reach.

• Cut window blind and drapery cords short and tie them out of reach. Young children find window blind or curtain cords interesting and are attracted to them.
• If possible, consider using cordless window products in your home if you have young children or they visit your home frequently.
• Check all Roman Blinds and roll up shades in your home - kids have been strangled while playing with dangling cords. If looped pull cords, exposed inner cords, or exposed lifting loops are found, replace the blinds or shades with products that don’t have exposed pull cords or inner cords.

Remove cords and drawstrings from your child's clothing and accessories.

• Never let children wear necklaces, purses, scarves, helmets or clothing with drawstrings while on playgrounds. These cords can get caught in playground equipment or on crib parts and strangle your child.
• Never use strings or ribbon to tie a pacifier or toy to your baby or around your baby's neck.
• Never use a necklace or bib with ties on your baby.
• Take off your baby's bib before bedtime or nap time.
• Remove loose ribbons or strings on toys and stuffed animals.

Maintain a safe sleeping environment for children.

• Openings that permit the passage of a child's body but are too small for his or her head, can lead to entrapment and strangulation. Hazards include bunk beds, cribs, playground equipment, baby strollers, carriages, and high chairs.
• Never hang anything on or above a crib with strings or ribbon.
• Never place the crib, bed, high chair or playpen near windows, draperies, blinds, or wall mounted decorative accessories with cords.
• Crib slats or spindles should be spaced no more than 2 3/8" apart, and none should be loose or missing.
• Never use a crib with corner posts over 1/16 of an inch above the end panels (unless they're over 16" high for a canopy). Babies can strangle if their clothes become caught on corner posts. These should be unscrewed or sawed off, and the remaining end panel should be sanded smooth.
• Remove cutout areas on the headboard or footboard so your baby's head can't get trapped.
• If your child has a bunk bed, check the guard rails on the top bunk. Make sure that all spaces between the guardrail and bed frame, and all spaces in the head and footboards, are less than 3.5 inches so your child's body can't slide through.

Learn CPR for infants and children.

Research more facts about unintentional childhood injury.