Choking, Aspiration, and Suffocation Interventions



Education is a more active intervention that is designed to instruct the parent or caregiver how to separate the child from the choking or suffocation hazard. Educational intervention can include instruction on how to perform the Heimlich maneuver, and/or how to administer CPR to a child who has stopped breathing. Two studies are discussed below.

Review of education interventions:


Sunde et al, 1998

Study design and target population

Ecologic study design.

Intervention group: Employees of Oslo insurance company. Norwegian Child Safety Calendar and 2 day company child accident prevention campaign.

Comparison group: Norwegian Child Safety calendar mailed to all members of Norwegian Air Ambulance (NLA).


Mass mailing of wall calendar illustrating infant and child first aid and safety treatment-emphasis on CPR. Intervention group had option to borrow a baby manikin for practice. No official CPR instruction.


CPR skill test to determine how well lay persons could handle an infant choking followed by cardiac arrest.

6 min test by expert followed by 2 min feedback & instruction.


Intervention group mean test scores improved significantly from 27% precalendar (n=57) to 47% 1 week post calendar (n=125) p<0.001.

Scores 6 mos. later were lower but still significant.

No change in comparison group scores.

Study quality and conclusions

CPR educational material more effective if it is part of a larger campaign.

Practice with manikin improved scores.

Mass mailing of CPR or other first aid materials free of charge is ineffective.


Tertinger et al., 1984

Study design and target population

Before and after design

Families in rural southern Illinois receiving services from Project 12-Ways (multi-faceted intervention program for families referred for child abuse and/or neglect) and that had at least one child 4 years or younger. (n=6 families)


Home Accident Prevention Inventory (HAPI), an educational intervention aimed at reducing number of hazards that would place children at risk for injury in the home, largely through parent(s) eliminating hazard (i.e., childproofing the home).

Hazards included for this review are suffocation by ingested object and suffocation by mechanical means.


Baseline household hazard assessment, followed by second home check using HAPI (during which education-feedback was administered).


For all six families, 53 of 70 home visits (76%) revealed at least a 50% reduction in number of suffocation hazards present in home. However, no consistent downward trend is present in any of families’ data.

Unscheduled follow-up home visits, 2-3 weeks after HAPI score showed at least a 50% reduction in number of household hazards present between baseline and second home visit.

No information on change in reported child accidents during study (presumed to be none).

Study quality and conclusions

Very intensive, structured, and home-specific intervention. Widespread use of this educational intervention neither feasible nor recommended based on results.

Two of six families moved to new homes during study, rendering any trends in data specious.

Intervention was subsumed under larger program aimed at preventing child abuse. Charges of child neglect brought against these dysfunctional families were impetus of study enrollment; generalizability to other families likely to be low.

Summary of education interventions

The Tertinger study that assess an educational intervention of choking and suffocation is, unfortunately, extremely limited in its findings. While it did find that the highly-structured and personalized education offered to the parents was instrumental in removing at least half of the observed suffocation hazards in the home, there is no evidence that t he intervention has a lasting effect. Whether the results can be generalized to other, non-dysfunctional families, whether reducing the absolute number of suffocation risks is as good as removing the risk entirely is not known.

The Norwegian study by Sunde and colleagues illustrates an innovative educational approach in the general population. Educational information appears to be more effective when the information is distributed as part of a general safety campaign and opportunity for "hands on" practice is provided.

Recommendations on education programs

No recommendations can be made at this time on educational programs to reduce the risk of suffocation and choking.

Recommendations for future research

Clearly, more information is needed in the area of educational programs to reduce the risk of suffocation and choking. Studies that examine innovative educational programs that involve active participation and skill measurement should be designed and evaluated.