Infants under 1 year old are more likely to die from choking on objects than on food, according to a new analysis of Centers for Disease Control and Prevention (CDC) data presented at the American Academy of Pediatrics (AAP) conference in Denver.

The study reviewed CDC WONDER mortality data from 2018 to 2023, comparing food- and object-related choking deaths across the lifespan. Researchers found that during the first year of life, object-related choking deaths significantly outnumbered food-related deaths. Food-related choking peaked at age 1, when self-feeding becomes more common, while overall rates declined through early childhood. 

Lead study author Rachel Ruiz, MD, a pediatric gastroenterologist at Santa Clara Valley Medical Center in California, said she pursued the analysis after questioning long-held assumptions. 

“As a pediatrician I was always taught that choking [on food] is one of the leading causes of accidental death among young children and what I found was that’s not true,” Ruiz said. 

Ruiz said the findings point to the importance of counseling families about hazards beyond the highchair. 

“Infants explore the world with their mouths, and as parents and caregivers we’re very vigilant when it comes to feeding them when they’re at the table, but when they’re crawling or taking their first steps, there are potentially a lot of other choking hazards around them,” she said.

“Make sure you get down on the ground, or make sure you’re really diligent about vacuuming,” she said.

Ruiz recommended practical counseling strategies that could be incorporated into anticipatory guidance. 

Hailey Nelson, MD, a pediatrician at Valley Children’s Hospital in Madera, California, who was not involved in the study, said the results should prompt clinicians to rebalance prevention messaging. 

“This tells us that while we’ve done a great job educating families on food textures and portion sizes, we also need to be just as vigilant about nonfood items in the home — things like coins, button batteries, small toy parts, and latex balloons,” Nelson said.

According to Nelson, for infants under 1 year, counseling should emphasize object hazards, while at around age 1, when self-feeding accelerates, food risks become more prominent. 

Ruiz added that vigilance shouldn’t wane once children become toddlers.

“Food-related choking deaths don’t disappear when your infant turns 1; if anything, they actually increase,” said Ruiz. The safest way for babies to eat is to be seated and not distracted, she said.

Nelson said that choking prevention should be viewed as an ongoing clinical conversation. 

“Families may need to hear these messages multiple times, tailored to their child’s stage of development,” she said.

Ruiz agreed that the goal is not to create fear but to better equip families and clinicians. 

“I’m not trying to invite fear but just empower parents and physicians alike,” she said. “Just because it was something that I was never taught in medical school.”

Ruiz is a consultant for Solid Starts, LLC. Nelson reported no relevant disclosures. 

Lara Salahi is a health journalist based in Boston.