Editing Choking (section)

== Prevention ==
The time to react to choking is quite brief, and choking can be lethal in the worst cases. For these reasons, it is convenient to prevent it,<ref>{{Cite web |last=Arizona Department of Economic Security. |title=Choking Prevention. |url=https://des.az.gov/sites/default/files/sifs_chokingprevention_5.pdf |access-date=2023-12-14 |archive-date=2017-10-31 |archive-url=https://web.archive.org/web/20171031170757/https://des.az.gov/sites/default/files/sifs_chokingprevention_5.pdf |url-status=bot: unknown }}</ref> so that it does not happen.

=== General prevention ===
[[File:02021 0547 (3) Breakfast, Vienna sausages.jpg|thumb|[[Sausage]]s are a particularly dangerous food for choking, and may require being cut into small pieces.]]Choking usually happens by swallowing mouthfuls that are too large or too abundant, and have been badly chewed. To reduce this risk, food is split into pieces of a moderate size, and chewed thoroughly before swallowing. Whenever a food can be chewed, it must be chewed, no matter whatever it is, even if it is very soft or gelatinous (such as creams, jellies and soft desserts).

The most dangerous foods for choking are the dry ones, the doughy ones, and the elongated ones. It is useful to have some liquid near, so it can be drunk and help to finish swallowing (before choking has happened and is already complete).

To swallow correctly, it is recommended that the neck be in a normal position, with the head looking forward, and being sitting down or standing up (not lying down or too reclined).

Distractions and being absent-minded increase the risk of choking, as when one laughs or does an activity at the same time. For this reason, eating while under the effects of sleep (not completely awake) also increases the possibilities of choking. The danger also increases in the case of being under the influence of alcohol, drugs or some medications that affect to perception or reaction capabilities. Eating in mouthfuls require some care.

It is convenient to place [[#Anti-choking devices|anti-choking devices]] in public sites, events, risk areas and homes, to solve the cases of swallowing that can happen there.

=== Prevention for babies and children ===
All young children require care in eating, and they must learn to chew their food completely to avoid choking.  Feeding them while they are running, playing, laughing, etc. increases the risk of choking. Caregivers must supervise children while eating or playing.<ref name=":03">{{Cite news |title=Choking Prevention for Babies |language=en |work=Safe Kids Worldwide |url=https://www.safekids.org/safetytips/field_age/babies-0%E2%80%9312-months/field_risks/choking-and-strangulation?gclid=Cj0KCQiAgs7RBRDoARIsANOo-HjfEJgbAdX6WkGugweSYUtf_bfEh0tmWp7JHl7_xCdsCrzsGF1O9moaAsXOEALw_wcB |access-date=2017-12-15}}</ref>

Pediatricians and dentists can provide information on various age groups to parents and caregivers about which food and toys are appropriate to prevent choking.<ref name=":0" /> 
[[File:Garbage bag Basel Bebbisagg.JPG|thumb|Little children can choke on any type of plastic bag or plastic balloon, as the bags for diapers]]
It is recommended waiting until 6 months of age before introducing solid foods to infants (according to the American Academy of Pediatricians).<ref>{{Cite web |title=Infant Food and Feeding |url=https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/Pages/Infant-Food-and-Feeding.aspx |access-date=2017-12-15 |website=www.aap.org |language=en-US}}</ref> Caregivers should avoid giving children younger than 5 years-old foods that pose a high risk of choking, such as hot dog pieces, bananas, cheese sticks, cheese chunks, hard candy, nuts, grapes, marshmallows, or popcorn.<ref name=":03" /> Later, when they are accustomed to these foods, it is recommended to serve them split into small pieces. Some foods as hot dogs, bananas, or grapes are usually split lengthwise, sliced, or both (being the cut into slices the main part for safety in many long-shaped foods).<ref name=":0" />

Children readily put small objects into their mouths (deflated balloons, marbles, small pieces, buttons, coins, button batteries, etc.), which can lead to choking. A complicated obstruction for babies is choking on deflated balloons (including preservatives) or plastic bags. This also includes the nappy sacks, used for wrapping the dirty diapers, which are sometimes dangerously placed near the babies.<ref>{{Cite web |title=Campaign Against Nappy Sacks |url=https://rospa.com/Campaigns-Fundraising/Current/Nappy-Sacks |website=Royal Society for the Prevention of Accidents}}</ref> To prevent children from swallowing things, precautions should be taken in the environment to keep dangerous objects out of their reach. Small children must be supervised closely and taught to avoid putting things into their mouths. Toys and games may indicate on their packages the ages for which they are safe. In the US, children's toy and product manufacturers are required by law to apply appropriate warning labels to their packaging,<ref name=":0" /> but toys that are resold may not have them.<ref name=":0" /> Caregivers can try to prevent choking by considering the features of a toy (such as size, shape, consistency and small parts) before giving it to a child.<ref name=":0" /> Children's products that are found to pose a choking risk can be taken off the market.<ref name=":0" />

Parents, teachers, and other caregivers for children are advised to be trained in choking first aid and [[Cardiopulmonary resuscitation#Compressions with rescue breaths|cardiopulmonary resuscitation]] (CPR).

==== Anticipatory guidance from pediatricians ====
[[File:SmallPartsTestFixtureCPSCgov.jpg|thumb|Small Parts Test Fixture (SPTF): used to determine whether toys and other products pose a choking hazard to children under 3 years old]]

As a part of well-visits, pediatricians provide education to parents and their children regarding their development. Included in these visits is anticipatory guidance, which provides advice to parents and children as primary prevention of disease and illness including choking. For example, for a child that is 7–9 months old, children start to develop a pincer grasp allowing them to reach for objects.<ref>{{Cite journal |last=McIntire |first=S. C. |date=2003-02-19 |title=Rudolph's Pediatrics |url=http://dx.doi.org/10.1001/jama.289.7.922-a |journal=JAMA: The Journal of the American Medical Association |volume=289 |issue=7 |pages=922 |doi=10.1001/jama.289.7.922-a |issn=0098-7484}}</ref> The ability to place these objects in their mouths significantly increases choking risk.

Example anticipatory guidance for children 7–9 months old:<ref>{{Cite book |url=https://publications.aap.org//ExternalLoginResponse.ashx?elpId=3&redirecturlback=http://publications.aap.org/aapbooks/book/478/Bright-Futures-Guidelines-for-Health-Supervision?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000 |access-date=2022-09-12 |year=2017 |doi=10.1542/9781610020237|isbn=978-1-61002-023-7 |s2cid=79224169 |editor-last1=Hagan |editor-last2=Shaw |editor-last3=Duncan |editor-first1=Joseph F |editor-first2=Judith S |editor-first3=Paula M |title=Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents |publisher=American Academy of Pediatrics |edition=4th }}</ref>

* Infants should avoid moving when feeding like riding in a car or stroller. Infants should be sitting upright and remain still. 
* Infants should be supervised when feeding including children younger than 3 years old 
* Infants will try to feed themselves. Avoid foods such as grapes, popcorn, carrots, nuts, and hard candies. Difficult to swallow foods like peanut butter and marshmallows should be given with caution.
* Specifically, toys like marbles, balls, balloons should not be given including children younger than 3 years old.<ref name=":10">{{Cite journal |last=Committee on Injury, Violence, and Poison Prevention |date=March 2010 |title=Prevention of choking among children |journal=Pediatrics |volume=125 |issue=3 |pages=601–607 |doi=10.1542/peds.2009-2862 |issn=1098-4275 |pmid=20176668|doi-access=free }}</ref>

====Regulations for children in the United States====

Several laws and commissions are aimed at preventing choking hazards in children. Formed in 1972, alongside the passing of the Consumer Products Safety Act, the U.S. Consumer Product Safety Commission (CPSC) regulates consumer projects that may pose "unreasonable risk" of injury to its users.<ref>{{Cite web |title=About Us |url=https://www.cpsc.gov/About-CPSC |access-date=2022-09-12 |website=U.S. Consumer Product Safety Commission |language=en}}</ref> The Consumer Products Safety Act allowed the CPSC to ban or place warnings on objects that could harm consumers. A Small Parts Test Fixture (SPTF) is a cylinder measuring 2.25 inches long by 1.25 inches wide determines whether a choking hazarding warning will be placed on the product.<ref>{{Cite web |title=Small Parts for Toys and Children's Products Business Guidance |url=https://www.cpsc.gov/Business--Manufacturing/Business-Education/Business-Guidance/Small-Parts-for-Toys-and-Childrens-Products |access-date=2022-09-12 |website=U.S. Consumer Product Safety Commission |language=en}}</ref> Furthermore, in 2008, the Consumer Product Safety Improvement requires any advertisements or websites regarding sale of a product to display choking hazard warnings.<ref>{{Cite journal |last=Dowd |first=M. Denise |date=2019-09-01 |title=Choking in Children: What to Do and How to Prevent |url=https://pubmed.ncbi.nlm.nih.gov/31505005 |journal=Pediatric Annals |volume=48 |issue=9 |pages=e338–e340 |doi=10.3928/19382359-20190819-01 |issn=1938-2359 |pmid=31505005|s2cid=202555712 }}</ref>  

According to a 1991 study, warning labels are an effective preventive measure against choking accidents. Items that contain many parts may include pieces that are considered choking hazards. Labels on children's toys may state recommended age ranges, and other items may carry a warning to parents to keep them out of the reach of children. Warning labels are clearly placed and written, usually including an obvious image.<ref>{{Cite journal |last=Langlois |first=Jean A. |date=1991-06-05 |title=The Impact of Specific Toy Warning Labels |url=http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.1991.03460210094036 |journal=JAMA: The Journal of the American Medical Association |language=en |volume=265 |issue=21 |pages=2848–2850 |doi=10.1001/jama.1991.03460210094036 |issn=0098-7484 |pmid=2033742}}</ref>

While products are protected, there are currently no Food and Drug Administration (FDA) regulations regarding food choking hazards.<ref name=":10" />[[File:Vegetable mash.jpg|thumb|People in groups with high risk of choking may require mashed food|253x253px]]

=== Prevention for other groups at risk ===
Some population groups have a higher risk of choking, such as the elderly, persons with disabilities (physically or mentally), people under the effects of alcohol or drugs, people who have taken medications that reduce the ability to salivate or react, patients with difficulties in swallowing ([[dysphagia]]), suicidal individuals, people with epilepsy, and people on the autism spectrum. They may require more assistance to feed themselves, and it may be necessary to supervise them while they eat.

As the ability to eat is deteriorating, some problematic foods (such as hot dogs, sausages, bananas, or grapes) can be split into slices and, additionally, lengthwise (being the cut into slices the main part for safety in many long-shaped foods). People who are unable to chew properly should not be served hard food. In cases where a person is unable to safely eat, food can be given by feeding syringes.

People who have taken any medication that reduces saliva should not eat solid food until their salivation is restored.