Choking, suffocation, and strangulation: 1 - 2 Years

How big a problem is it?

Children at this age explore their environment through touch and taste. They will start to grab and put things in their mouths from as young as two months and it continues into this second year. It’s how they learn about their world. Around 92 children each year will either die or be hospitalised from unintentional suffocation. This is 10 in every 100,0000 children. Nearly half of suffocation injuries are caused by choking on food and other objects. Inhaling the contents of their stomachs was also a leading cause, but suffocation and strangulation in bed is a significant problem. 


Who does it affect? 

Since 2007, suffocation has overtaken motor vehicle traffic crashes as the leading cause of fatal injury leading to death for children. The rates have increased since 2001 and this is probably related to recognition of suffocation as contributing to Sudden Infant Death in Infancy (SUDI) among children under the age of 12 months. Male, Māori and Pacific People’s children have a disproportionately high rate of suffocation injury. Children under the age of five are at a higher risk especially children under three. There are lots of things around the home that could cause choking, suffocation or strangulation to little kids. Here’s some ways you can make your home a lot safer by taking simple precautions.


Top Tips 

  • Window cords and strings are a risk at this age, so keep beds away from windows and make sure cords and strings are tied up and out of reach.

  • Button batteries are still a risk and can also result in severe burning of the throat. Place items containing button batteries out of reach and sight, and keep loose batteries locked away. As an extra precaution put some duct tape over the TV controller.

  • Plastic bags that can fit over your child's head can cause suffocation, so keep those out of reach.


First Aid for Choking 

  • If a child is choking or having trouble breathing, call 111 immediately. 

  • Encourage a choking child to relax, as they may be able to dislodge the object by coughing. 

  • If the airway is completely obstructed and the child is conscious but not breathing: 

  • Call for help

  • Stand to the side of and slightly behind the child. Give up to 5 slaps between the shoulder blades with the heel of your hand, firmly enough to try to clear the obstruction. 

  • If the obstruction has not come out of their mouth, wrap your arms around the child’s chest and grasp one of your fists with the other hand. 

  • Give up to five quick inward thrusts.

  • If the obstruction still has not come out, repeat the sequence of five back slaps followed by five inward thrusts until the obstruction comes out of their mouth. The aim is to clear the obstruction with each new back slap or chest thrust, rather than necessarily giving all five.

  • If you can’t remove the object in these ways, do mouth-to-nose (or mouth-to-mouth) breathing on the child until help arrives. 

If the child becomes unconscious continue CPR following the instructions below.


Loss of consciousness First Aid 

Follow DRS ABCD to start CPR

D Dangers? Check for any dangers to yourself such as electricity or traffic. 

R Responsive? Check responsiveness by calling loudly and shaking the child's arm. 

S Send for help. Dial 111 and confirm an ambulance is on its way. Use the appropriate emergency number in other countries. 

A Airway. Open the airway by moving the head into a neutral position and lifting the chin. Do not tilt the head back too far. 

B Breathing. Look and feel for movement of the lower chest and stomach area. Listen and feel for air coming from the nose or mouth. 

C CPR. If the child is not breathing, start CPR - 30 compressions to 2 breaths. Put the child on a firm surface. Place 2 fingers of one hand (for a baby) or the heel of one hand (for a child) in the centre of the chest just below the nipples. Push down hard and fast 30 times in about 15 seconds (push down one-third of chest depth). Once you have completed 30 compressions (pushes) on the chest, breathe into the baby's mouth 2 times. Seal your lips around the baby's mouth and nose. For a child over 1, you may need to breathe into their mouth and pinch their nose closed. Gently puff into the child until you see their chest rise. Continue with the cycle of 30 chest compressions and 2 breaths until the ambulance arrives. 

D Defibrillator. Attach defibrillator as soon as it is available and follow prompts.

This page includes a link to the KidsHealth website CPR advice and a page containing the Basic Life Support Flow Chart. The Basic Life Support Flow Chart is developed by the New Zealand Resuscitation Council and Australian Resuscitation Council. For more information see www.nrc.org.nz


Link to Safekids' resources 

Buttabean Safety Tips - Choking 

Links to other organisations’ resources 

Kids Health Choking Checklist 

St Johns Choking Advice 

Well Child Tamariki Ora - Choking 

NZ Ministry of Health - Food-related Choking 

Safekids International Choking and Strangulation Injury Prevention Advice