Health Alert: The Risks of Choking (August, 2014)

The Division of Developmental Disabilities has prepared this advisory to share important information regarding choking risks; foods commonly identified as contributing factors in choking; and emergency response to choking.

Choking: (a blockage of the upper airway) is a serious risk factor for individuals with intellectual/developmental disabilities.


Factors that Increase the Risk of Choking

Individuals with intellectual/developmental disabilities may have a number of factors that increase the risk of choking, including but not limited to:

  • Neurological and muscular disorders such as cerebral palsy and seizure disorders
  • Dysphagia (difficulty swallowing)
  • Side effects from medications
  • Gastroesphogeal reflux disease (GERD)
  • Difficulty swallowing
  • Few or no teeth
  • Dentures
    • Can make it difficult to sense whether food is fully chewed before it is swallowed
    • If dentures fit poorly or hurt, individuals might not bother to chew their food or may not wear them and be unable to chew their food
  • Placing too much food or medication in one's mouth
  • Not chewing food well enough prior to swallowing
  • Putting too large a portion in one's mouth
  • Eating or drinking too fast
  • Inattention to eating
    • Talking, laughing, walking, running or playing
    • Distracted by other persons or activities
  • Poor posture while eating
  • Swallowing non-edible objects (Pica)
  • Food stealing - resulting in obtaining non-prescribed/inappropriate diet, eating quickly, etc.
  • Incorrect diet texture - liquids or food items not prepared in accordance with prescribed diet
  • Eating something with two or more diet textures, especially anything with a thin liquid and a solid component such as cereal and milk

Common Foods Identified as "High Risk" for Choking

  • Hotdogs served whole
  • Chicken on the bone
  • Grapes
  • Peanut butter
  • Peanut butter sandwiches on soft bread
  • Thick chewy bread, e.g. white bread, bagels, pizza, etc.
  • Marshmallows
  • Dry, crumbly foods such as cornbread or rice served without butter, jelly, sauce, etc.
  • Dry meats such as ground beef served without sauce, gravy
  • Whole, raw vegetables served in large bite-sized pieces
  • Whole hard fruits like apples or pears
  • Candy with large nuts
  • Hard nuts

Awareness is the First Step of Prevention

Because of the risk factors associated with choking, it is critical that care givers ensure adequate supervision of persons served, and are trained and familiar with individuals':

  • Prescribed diets
  • Meal time or Pica precautions
  • History of previous choking incidents or difficulty swallowing
  • Properly assisted eating techniques
  • Positioning during and after meal time
  • Required supervision during meals
  1. Emergency Response to Choking

    1. Immediately call 911.  If another person is present instruct them to call 911.
    2. Follow your agency's training for responding to a choking victim. 
    3. If trained, immediately provide repeated abdominal thrusts, known to some as the Heimlich maneuver, until the object causing the choking is dislodged and the individual can cough forcefully, speak or breathe, or until the individual becomes unconscious. 
    4. If the individual is unconscious, remove any visible obstructions from the mouth and begin administering CPR.  Check periodically to see if the obstruction becomes dislodged.

Indicators of PARTIAL Airway Obstruction

  • Able to speak, cry, and respond to you 
  • Breathing is noisy, labored, or gasping.  Some air will come from the mouth 
  • Coughing, or making "crowing" noises 
  • Very agitated or anxious 
  • Skin goes paler, blue color
    1. Emergency Response to Partial Obstruction of Airway

      1. Reassure the individual. 
      2. Encourage the individual to cough. 
      3. Avoid giving the individual anything to eat or drink. 
      4. Keep monitoring the situation. 
      5. Call an ambulance if the obstruction is not relieved, or you can hear wheezing or noisy breathing. 
      6. If the obstruction is cleared, always have medical/nursing personnel determine if there is a need for additional clinical follow up.

Important Safety Tips

  • Some people may feel embarrassment when they choke and move away from others. This places them at increased risk because they are less likely to be near people who can help. When food is served, be alert for those who leave without warning and check on them to ensure they are not in need of assistance.
  • It is recommended that agencies use regular drills or mock emergencies in order to ensure that staff are trained to recognize and respond quickly and appropriately to a choking incident.

This advisory is not intended as a sole area for information and advice.  It is only to serve as information for a basic understanding of the subject included.