Preventing Toy Chokings

With Alan L. Nager, M.D., M.H.A.

choking preventionHoliday time is “toy time,” which means it’s time to talk about toy safety. Alan L. Nager, M.D., M.H.A., division director of emergency and transport medicine at Children’s Hospital Los Angeles, says that ingestion (swallowing) and aspiration (sucking into the airway) of toys and toy pieces is a problem year-round. “We have a child getting something pulled out of their esophagus or airway several times a week,” he says. 

To become better prepared for emergencies, complete first-aid and CPR classes, remember to never put your fingers into a child’s mouth to try and remove an object, and take a look at Nager’s guidelines for preventing toy emergencies. 

What are the most common things kids swallow or aspirate? 

Toys and games with small pieces, wheels from little toy cars and toys with small parts that are just clicked on or glued on. We see a fair number of coins, earrings, little hair barrettes, watch batteries and magnets – which can do significant damage when kids ingest two or more. 

At holiday time, we’ve had children ingest little bows from packages, curling ribbon, little pieces of wrapping paper and plastic wrap.  

What toy-shopping guidelines do you have for parents? 

Look at the age recommendations, but understand your child and their developmental abilities. It’s not as if every 3-year-old is identical or every 1-year-old is identical.  

Find toys that are well manufactured. And if you can fit a toy or part of the toy through an empty toilet paper roll, the toy is not safe for ages 3 and younger.  

What other factors contribute to ingestion or aspiration of toys or small objects? 

The vast majority of foreign-body ingestions and aspirations are because of improper supervision. A parent will give a child a toy or put them in a room with a variety of toys and then walk out to wash their hands, get the newspaper or take a phone call. 

Another risky time is during holiday gatherings, where the adults are all engaged with each other and no one’s watching the child.  

Every parent who has a kid who ingests something or chokes on something says, “I was just gone for 30 seconds.” It’s during that 30 seconds that the child will find something that is dangerous. So if you’re leaving, designate someone to watch that child or take the child with you. And if you’re at a party, one adult should be responsible for watching the children at all times. 

What should we do when it’s time to put the toys away? 

Some parents have toys jammed in a corner of the room or in a big bag or box that the child can get into. They’ve got to be placed in a safe zone where the child can’t get to them, either up high or in a locked box or cabinet.  

Do we have to lock up all of the toys? 

Lock up the ones that are dangerous. For instance, my 2-year-old granddaughter comes over all the time. The giant LEGOs are on the ground because those are huge. The magnetic letters are in a special box, and the rule is that someone literally is two feet away from her when she is playing with them. And when she’s done, they get put back in the designated place six feet up.  

You have to have those rules, and everyone who’s caring for the child has to know them. Because the best rules, if they’re not enforced, are as though they don’t exist.  

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