Choking prevention and when food modifications are no longer needed

Featured image for article: "Choking prevention and when food modifications are no longer needed". Pictured is a baby eating a baby carrot.
It’s one of the top fears that parents have when they start solids with their baby – choking. I hear this all the time, and I completely agree – I was terrified too! And this fear doesn’t end once they’re comfortably eating solids, in fact, most top choking hazards remain high risk foods until your child is 4 years old. That’s a long time to be either avoiding foods, or modifying them, depending on the recommendations. So how do you know when it really is safe to offer these foods in their unmodified form? What’s so magical about the age of 4? Let’s talk about it! (And if you prefer to listen, I covered this on the podcast too, download that episode here.)

Choking Hazards and Recommendations

Most foods considered choking hazards include small, round or cylindrical shaped foods that are harder or can conform to the shape of your child’s airway (ie. hot dog rounds, whole grapes, carrot slices, whole peanuts, large seeds, and hard candy). Food that globs up, like fresh un-toasted bread, or globs of peanut butter are also known choking hazards just because they’re really hard to maneuver in the mouth. For a full list of the top choking hazards and how to modify them, take a look at my download in this in-depth blog post on the topic.

Technically, it’s recommended to modify these foods or avoid them completely up until age 4.

But really though? Do you need to be quartering their blueberries until they’re 4?

Or I bet you’re asking…do I have to actually wait until they’re 4 to give them their very first apple slice or before they can ever try a raw carrot?

Here’s the thing…these recommendations are blanket recommendations because regulatory bodies that set these guidelines can’t possibly know how well every child chews, and what experiences they’ve had with eating. So they’re set at this age to be extra safe. It’s assumed that by the time they’re 4 years old, they’ll have experienced eating enough foods, and different types of foods, that it won’t be such a struggle for them, or as difficult for them to eat them safely and therefore it’s not going to be as high of a risk. Before that, especially under age 2 or 3, toddlers and babies can lack the ability to consistently and effectively chew food into manageable pieces. Their swallowing mechanism can still underdeveloped, especially those younger babies, and they lack the experience to prevent or stop a potential choking episode on their own – without adult monitoring especially.

Also keep in mind that even for a child that’s over 4 years of age, they can still choke on certain things. It doesn’t mean that adults can’t choke on them as well, or that once they’ve hit 4 years of age they can’t choke on them. I mean, my son choked on a hot dog at age 5! I thought I was in the clear at this point… and yet it still happened. So the guidelines are just that…guidelines. Now, this didn’t mean that I went back to quartering and dicing hotdogs or sausage for him (even though it was the most terrifying experience of my life)…rather I just needed to remember that he still needed close watching, and that I needed to encourage him to chew his food really well, despite him having the general skills to effectively manage these foods. So it really still is something that you have to assess on an individual basis, and that you have to teach your child. They have to be taught to eat slowly, to take bites, etc.

When is it recommended to stop modifying or avoiding choking hazards?

When kids seem to grasp the need to thoroughly chew their foods, this is when you can start letting go of the full modifications to every single choking hazard, even though they still will still benefit from the odd reminder from their parents to “slow down” and “chew well”. Usually, the age at which this starts to happen is a sliding sale, but somewhere around 18 months to 2 years of age, is where CERTAIN foods can be offered without the same modifications, while other foods you may still need to wait until 3 or 4 years of age to offer at all. Of course, this timeframe should also be extended if your child isn’t a great chewer, has sensory issues, or if they haven’t had as much experience with textured foods because they were introduced to more advanced textures later on, say over 1 year of age.

It’s sort of like saying…at what age is it safe to allow your child to climb the monkey bars at the playground? It so depends on your child, your comfort level, what they’ve already done before, and what level of risk you want to take. It’s a balancing act between wanting them to experience life and gain independence, and also being safe. So you’ve got to weigh this out and really, this is an individual parenting decision.

That’s why the most important thing I can coach you on…is to educate your child on how to eat them safely! It’s not like these foods magically won’t be higher choking risk foods, just because they turn 4. They will always be higher choking risk foods, but we have to teach them how to handle it. Once they know, we can trust them to do more and more.

So to recap, when you feel your child has mature eating skills (moves food around in their mouth well, chews food before swallowing, etc.), then you can start to consider offering some of the foods that were considered choking hazards under 12 months, in a cautious way, and in gradually less modified forms. But there is no one set age to do this across the board, for every child. Always offer them in a safe and supervised setting.

How to gradually decrease modifications

Depending on the choking hazard, and your child’s eating skills, you may choose to gradually decrease the modifications that you’re doing to the food, instead of going straight to the whole form to see how they handle things and help you make informed decisions. Let’s go over some examples of how you may do this to ensure that you’re able to assess where your child is at with their skills, what they’re ready for, and can confidently move them to progressively more challenging forms of these foods.

Whole Grapes:

With whole grapes, you can start by halving them lengthwise, as opposed to quartering them which is the recommended modification. This is a good place to start with before progressing to whole grapes. When you do finally get to whole grapes, maybe you only offer them when you can watch them closely and sit with them, vs. when they’re at daycare, or with a friend, or when you can’t sit at the table with them and give them your undivided attention. You can show them how to take bites out of large grapes, either by placing it right over their molars and teaching them to take bites out of that, or by showing them how to take small bites with their front teeth, and then move it to the side of their mouth, over their molars, and chew it that way. As you show them how to do this, be sure you’re making really exaggerated motions with your mouth, this helps them see exactly how they should do it. And, make this fun so they want to follow along. Say “CHOMP CHOMP CHOMP!” and make sure they learn to crush it really, really well before swallowing.

Whole Blueberries:

With blueberries, offer large ones first, and teach them to take bites out of it in the same way as grapes. Encourage them to chomp down on halved blueberries. Again, if you’re not with them and you’re worried someone won’t be watching them, or you know you need someone to coach them through chewing it well, then maybe you offer quartered blueberries during those times, and halved or whole when you’re available to monitor them.

Bell Peppers:

With peppers, you can offer them strips and have them “chomp like a dinosaur” over their molar areas. Make really loud crunches and laugh and make it a silly thing. Or, it may possibly be even safer to offer huge pieces of pepper, like half of a pepper or even a full pepper, so that they’re forced to bite into it. These options are actually what I would consider to be less of a risk than offering them diced pieces of pepper. With diced pieces there is no necessity to take bites, and therefore they don’t need to be as intentional when eating. Having larger pieces that promote the need to take small bites is a better way for them to learn, and prevents mouth stuffing.

Cucumbers:

With cucumbers, I encourage only offering the inner center portion where the seeds are in the beginning, but start offering more of the outer core after 12 months. You can slice it in rings and remove the skin to start, and then offer it with just a bit of skin on it, and then with all of the skin left on it. Honestly, they may spit it out as they first try to work through it, but this is part of learning and I would be much less concerned about the skin than I would be for large chunks of unchewed inner portion of the cucumber to be swallowed.

Watch this video to see how I suggest you prepare cucumber based on your baby’s age!

Apples:

With apples, these are actually one of the top choking hazards for young kids when served in slices, because the possibility of breaking off a larger chunk that can get lodged in the airway is high. I would start by actually offering the whole apple, and get them to take bites out of it. This way they can control the size of the bites, and often kids mush it up a bit in the process of biting it, so it’s not perfectly broken off pieces of apples that they’re getting, which can easily happen when offering wedges.

Carrots:  

For carrots, offer pre-shredded pieces (not grated). This is actually the one that I’d hold off on for the longest. Shards of carrot are easy to break off, even with baby carrots. So my recommendation would be to gradually introduce raw carrots to them by beginning to cook them less and less as you see they’re able to handle it.

Bread:

Bread is one of the choking hazards that can often be overlooked, when it is un-toasted it easily globs up in your child’s mouth and forms a ball that can be easily choked on. The modification is to toast bread lightly to prevent this globbing from happening, and so to gradually introduce un-toasted bread, I would recommend offering small, tiny pieces of un-toasted bread, and gradually increasing in size, being careful to watch for mouth stuffing.

Crackers:

Crunchy crackers specifically are a choking hazard for young children, between being hard to chew and having irregular, sharp edges when broken off, they can be difficult to manage. I would begin by encouraging them to take bites out of it, and again watch for mouth stuffing. You can also begin by offering crunchy crackers with a moist topping on it, such as hummus or avocado, to naturally soften the cracker slightly.

My Final Reminder

I’m often asked why certain foods are choking hazards, and others are not, and the truth is that this list is actually very un-scientific in how it was developed. We can look at children who are brought to the hospital for choking incidents, and what it is they choked on, and that’s how they began to come up with this list. It’s basically based on the most often occurring foods in choking incidents.

What isn’t considered, or controlled, is how commonly children are eating these foods over other foods – which may be why they show up more on the list of food more commonly choked on. So it’s difficult to determine whether the choking hazard is in itself because of the food, or is it related to another variable as well. For example, choking in young children seems to be correlated with distracted eating, and many of the foods identified as the most dangerous (candy, hot dogs, grapes) appear in places where kids might be distracted (or not sitting down to eat, less supervised than usual, etc.), like birthday parties, cookouts, and fast food restaurants.

Of course, it’s still possible that grapes are more dangerous than other foods (for example) – there is certainly that theoretical possibility given their shape – but the frequency of choking alone isn’t sufficient to make that claim. We need to see what children are eating, and in what volume, in order to make claims about what foods are most dangerous.

I want you to remember this because choking can technically happen on anything, and at the same time, just because these foods are listed as the top choking hazards doesn’t mean they can never be offered. It also doesn’t mean that just because you modify their food they’re 100% safe – other factors need to be considered and accounted for as well. Remember to supervise them while they eat, encourage them to sit still while eating, chew and swallow sufficiently (and before they talk, laugh, etc.) – all of these things combined with teaching them how to take bites, will help to keep your child safe.

If you want to feel prepared for the worst case scenario – which I highly recommend, I’ve been through a choking incident with my son, I was unprepared, and it was the worst moment of my life. One of my favourite, and one of the most comprehensive, online courses for child/infant CPR is by Safe Beginnings. They are truly amazing, very thorough, with video, and everything online – you’ll be prepared for if the worst happens, which is something truly worth investing in. Enroll in their course today, and use code MYLITTLEEATER for 20% off your course purchase.

And finally, if you want all the info you could ever hope to know about feeding your babies and toddlers, be sure to check out my online courses! My Baby Led feeding course will teach you all about introducing solids to your baby, from the necessary nutrition info, to everything about safety when preparing their food, and more. My Feeding Toddlers course includes everything on what and how to feed your toddler, so you can be prepared for the next stages of your child’s life – the feeding journey doesn’t end once you introduce solids, that’s only the beginning.


Some of the links on this page are affiliate links. That means, I get a small commission if you purchase through this link. However, I make it a point to only share tools and resources I truly love and use.

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meet edwena

Registered pediatric dietitian, mom of two and lover of all things related to baby and toddler feeding!

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