Choking, Aspiration, and Suffocation

Scope of the Problem

In the United States, deaths due to mechanical suffocation and asphyxiation by foreign bodies are estimated at 4,700 annually. Among children less than 1 year of age, they account for almost 40 percent of unintentional injury deaths.¹ The number of childhood deaths from choking on food is estimated to be 75 per year, with the highest incidence among children less than 2 years old.² Fatal choking in young children typically involves not only round food products such as candies, nuts, grapes, and hot dogs, but also non-food products such as undersized pacifiers, small toys, and latex balloons. Additionally, children are at risk of asphyxiation from such elements as plastic bags, old refrigerators, and grain silos.

The elderly are also at high risk for asphyxiation through food and non-food items, usually as a result of underchewed food, use of sedative drugs, or diseases affecting coordination or mental function. About 2,500 annual deaths to people aged 65 or older attributed to choking on food or nonfood material.¹

For the purposes of this review, ‘suffocation’ is often defined as death due to oxygen deprivation from mechanical causes (e.g., plastic bags, refrigerator entrapment, or fallen earth), ‘strangulation’ as suffocation from mechanical pressure on the trachea (e.g., drapery cords, clothing drawstrings), and ‘asphyxiation’ as suffocation due to inhalation of food or foreign bodies.

The prevention strategies considered for this review are primarily for children under 5 years of age, and include:

• Legislation/regulation
• Toy size/small parts regulations
• Crib choking/strangulation prevention through product modification and/or regulation

• Education
• Education about foods for young children
• Training in the Heimlich maneuver
• Education about choking hazards for young children
• Education about balloon hazards
• Education about plastic bags
• Drapery cords
• Grain silos

• Product modification
• Cribs
• Toys
• Drawstrings on clothes
• Refrigerators with magnetic locks rather than latches

From this list of potential interventions, the following areas were examined for their effectiveness in preventing choking:

Prevention Interventions

• Legislation
• Education
• Product modification