Report: The Un-Usual Suspects – Main Causes of Choking Deaths in the UK

Child eating fruit which is a choking hazard

Each year, hundreds of people across the UK are at risk of choking-related deaths. This is especially true for the elderly and young children, who are more vulnerable to the dangers of choking and are typically more prone to accidentally ingesting or inhaling something they shouldn’t.

Choking is a particular danger due to how quickly it can happen. Parents innocently taking their eyes off their child for a split second can sadly have catastrophic consequences. In 2019, we analysed choking deaths in England and Wales and the areas in which these typically occur. Now, we’re bringing you a concerning update on our original findings.

It’s recommended that if you work with the elderly or children you take an emergency first aid in the workplace training course, or for children specifically a paediatric first aid training course. Having this training could make a positive difference to someone’s life in an emergency situation.

What is choking?

According to the NHS, the act of choking involves the airways becoming blocked with fluid or a foreign object – most often food. This causes us to have difficulty breathing, and in some cases, may cause us to stop breathing altogether – which can lead to cardiac arrest if oxygen is blocked from entering the lungs for too long.

Furthermore, According to recent ONS government statistics, 219 people die on average every year as a result of choking on food substances, while an average of 60 people die each year due to choking on other objects.

While this is lower than the figures uncovered in our 2019 report, there is still much more that needs to be done to prevent this from happening.

Choking deaths in the UK

Following our initial choking deaths report in 2019, we at CE Safety conducted an analysis of the data from the past 5 years between 2018-2022 and found that, in total, 1,399 people have died directly due to choking on either food or other small objects – with 1,097 deaths caused by choking on food substances, while 302 deaths were as a result of other small objects.

These are deaths wherein choking was recorded as the underlying cause of death.

In 2022, we saw 276 deaths caused by choking on food – that’s an average of 23 deaths every month. Breaking that down by age group, we see that the biggest victims of choking deaths are over-50s who, according to the data, equate to 90% of all food-related choking deaths in 2022 (250 deaths). However, young children are at risk too.

Additionally, 2022 saw 83 choking deaths as a result of ingesting or inhaling non-food-related objects. Of these deaths, 51 occurred in victims over the age of 50 (60%).

According to data from the ONS, there were an additional 512 deaths involving choking on food substances in 2022, alongside 646 choking deaths that involved other small objects.
In this instance, choking was listed as either the underlying, secondary, or contributory cause of death on the victim’s death certificate.

The elderly are still the most at-risk of choking to death

According to the ONS, 256 over-65s have died in 2022 as a result of choking, up 33% from 192 deaths in the previous year. Since 2018, the number of elderly people dying from choking has risen by a shocking 57% with most occurring within hospitals, at home or care homes.

Risks associated with choking in the elderly

The data has revealed that elderly people are sadly at an increased risk of choking to death. There are a wide range of reasons for this, including eating too fast, attempting to swallow large portions of food without chewing, and simply due to naturally having less saliva as we age.

As we get older, we naturally produce less saliva. Certain medical conditions – such as Parkinson’s – can exacerbate this issue. The less saliva we have, the more difficult it is to swallow when we eat.

Similarly, we lose more teeth as we age. Having fewer teeth, or having ill-fitting dentures, can also increase the risk of choking. This is because our teeth help us to break down food when we eat, which makes the size of our food more manageable. With fewer teeth, many elderly people simply attempt to eat food whole or in pieces that are still too big to swallow comfortably.

Because of this, it’s crucial to think about what foods are being consumed by the elderly in your life.

Over-65s are still more likely to die in hospital than at home

In our 2019 report, we revealed that the over-65s were actually at significantly more risk of passing away from a choking-related death in hospital or care homes, rather than in their own home. Unfortunately, the latest data still supports this revelation.

This is likely because, within both care homes and hospitals, staff are tasked with being responsible for large amounts of people while more often than not dealing with understaffing issues. This means that staff have less time to ensure that each elderly person is receiving suitable food and that it is being prepared in a way that prevents choking risk.

In total 184 people died in hospital as a result of choking in 2022, 180 of those were over the age of 65. A hospital setting is the most likely place to die of choking than anywhere else, including at home. Care homes are also a risk with 48 deaths occurring in 2022 due to choking on food or other small objects.

A nightmare for parents: the data surrounding child choking deaths

Our analysis of ONS data revealed that 6 children under the age of 5 have died as a result of choking on food in the past 5 years. While this number may seem relatively low, it’s important to remember that many more children choke and are able to recover with treatment – meaning the total number of children that choke on food is much higher.

Accidental choking is unfortunately more likely to occur during our early years. This is largely due to the ways in which children experience the world during these formative years, often using their mouths to taste-test objects and foods around them. This can very quickly lead to choking if the child is unsupervised and manages to ingest something they shouldn’t.

It’s important for parents to remember that children are not able to fully master the chewing/swallowing technique until they’re aged between 4-6 years old. For this reason, it is vital that any food served to children is cut into small pieces, and that they are fully monitored when eating or when playing with toys – as these may sometimes also be ingested.

According to the ONS, 6 children under the age of 10 years old have died as a result of choking in the last 5 years. The majority are aged between 1 and 4 years old, usually when a child starts to eat a diet of mostly solid foods.

According to the NHS, parents should ideally start to introduce their children to solid foods – called ‘complimentary feeding’ – around the age of 6 months. However, this should always be done with the parent’s supervision at all times to ensure that there is no risk of choking.

In our 2019 report, we compiled the 12 most-dangerous foods for children and elderly people due to their likelihood of causing choking-related deaths in young people. Let’s recap these foods again to help parents and carers understand foods that are either unsuitable for children and the elderly, or require additional care when feeding.

A gag reflex often protects children from choking, but because a child’s windpipe (trachea) is narrow compared to that of an adult, choking is a serious hazard.

According to ONS, 20 children under the age of 10 years old have died as a result of choking in the last 4 years. The majority are aged between 1 and 4 years old, usually when a child starts to eat solid foods.

According to the NHS, you should introduce solid foods around the age of 6 months old. However, you should always accompany your child when eating and make sure they are chewing and swallowing correctly.

100% of all child deaths from choking occur within the hospital according to the ONS data and food which isn’t chopped up correctly is the biggest cause.

Because of this we at CE safety, have compiled a list of the 12 deadliest foods for both elderly and children.

What food causes the most choking deaths?

  1. Chicken with bones
  2. Marshmallows
  3. Fruit – particularly apples and other hard fruits
  4. Whole grapes
  5. Chunky peanut butter
  6. Popcorn
  7. Hard-boiled sweets
  8. Crackers or rice cakes
  9. Uncooked vegetables
  10. Cheese chunks
  11. White bread
  12. Chewing gum
The deadliest foods

It may seem unbelievable, but water is actually highly dangerous to the elderly. This is because water is a very thin liquid, meaning that those with unsteady hands – such as older people – may accidentally pour too much into their mouths without meaning to, and this may then cause them to choke.

Because of this, many nursing homes use thickening agents to increase the viscosity of water and prevent this from happening. However, this alone cannot entirely eradicate the risk of choking, and carers and nursing staff should still be vigilant about watching elderly people when they are drinking.

Similarly, while hard-boiled sweets may seem innocent enough – and are oftentimes popular with the older generations – they also pose a significant choking risk if care isn’t taken. Because of this, it’s far more ideal for elderly people to be given a treat that quickly melts and becomes a liquid – preventing it from becoming lodged in their throat. Some good examples include flavoured ice-poles or ice cream.

Does size influence choking risk?

The size of an object is very important when determining how much of a choking risk it poses. This is because a child’s trachea – or windpipe – is approximately the size of a drinking straw in diameter. This is extremely small, meaning that anything larger than this can easily become stuck and may cause the child to choke. For parents who are concerned about identifying which objects may cause a potential choking hazard, you can purchase a Safetots choke tester, which allows you to measure both food and toys. If they fit, then it’s a choking hazard.

This handy tool is composed of a cylindrical tube that has a 1.25-inch diameter and is between 1 and 2.25 inches deep.

Sadly, many children’s toys are actually smaller than this and can prove to be a high choking risk – despite being marketed at young children. Trading Standards have had to recall thousands of toys in recent years – including 91 in 2022 alone – due to them being a choking hazard or posing some other form of risk to children. Our 2019 report outlined some of the deadliest from 2018-2019.

But it isn’t just toys and food items that can cause a choking hazard to young children.

Other items that might be lying around your house that can pose a significant threat include: Latex balloons, toys with small parts, button-type batteries, medicine syringes, holiday decorations (including tinsel, ornaments, and lights), buttons, coins, marbles, small balls, pen or marker caps, screws, stuffing from a bean bag chair, rings, earrings, crayons, erasers, staples, safety pins, small stones, and tiny figures.

Watch this video from St. John Ambulance to learn how to save a choking baby’s life in just 40 seconds:

How to help a choking baby (under 1 year old)

According to statistics from St. Johns Ambulance, over 40% of parents have seen their baby choke at least one, with almost 80% admitting that they haven’t been sure what to do when this happens. Knowing what to do when a baby is choking could be the difference between that baby surviving or sadly adding to the growing choking death statistics.

To help parents know exactly what to do, we have put together this step-by-step guide.

1. Assess the situation as quickly as you can

If you notice that your baby is choking, you should immediately shout for help to alert others. However, it is vitally important that you don’t leave the choking baby alone.

Naturally, if the baby is choking, they may attempt to cough to clear the blockage in their throat. If this happens, allow them to continue to cough. Coughing is the most effective way to dislodge a blockage. However, if this doesn’t work, do the following…

2. Pat the baby on the back

Lay the baby down with the head below the chest and give 5 sharp but not overly hard blows to the middle of the baby’s back between the shoulder blades. If these back blows do not dislodge the object, move on to step 3.
Number of choking deaths registered each year

Back blows baby choking

Image credit: BabyCenter

3. Chest thrusts
If nothing else has worked so far to dislodge the blockage, it is time to deliver chest thrusts. Babies are fragile, so it’s important to use caution when performing these manoeuvres. Give up to five chest thrusts. To do this, push firmly in the centre of the breastbone. You should use 2 fingers for a baby, or the palm of your hand for a child.

Baby chest thrusts

4. Perform mouth-to-mouth

If the baby stops breathing at any point while choking, you should make 5 attempts to blow air gently into their mouth, ensuring that you make a tight seal with your lips.

5. Call 999
You should continue to repeat the cycles of back blows and chest thrusts until either the blockage dislodges, help arrives, or the child becomes unresponsive.

However, if you have tried each of the steps and the blockage still isn’t dislodged, it’s vital to call 999 while you repeat the steps for a second time. If you are unable to call 999 yourself, you should get someone else to do it immediately.

How to help a choking adult/young child (over the age of 1)

If someone is choking and they are over the age of one year old, it’s first important to instruct them to cough as hard as they can in order to try and dislodge the blockage.

1. Perform back blows

You should first shout for help to ensure that others are alerted to the situation and can call 999 if required. While doing this, make sure that the person who is choking isn’t left alone at any point.

In order to perform back blows and try to dislodge the blockage, lean the casualty forward (lean them over the knee if they are a child) and give up to 5 sharp blows to the middle of the shoulder blades with the heel of your hand (the part just below the palm).

If this step doesn’t help to dislodge the blockage, move on to the next step.

Image credit: British Red Cross

2. Move on to abdominal thrusts

If the patient is still choking, you should next move on to performing abdominal thrusts. To do this, stand behind the casualty and wrap your arms around their waist. You should make a fist with one of your hands, and use the other to grab it.

Next, sharply pull inwards and upwards 5 times – being careful not to pull too hard and injure the person.

Image credit: British Red Cross

3. Call 999 as soon as possible

You should continue to repeat the steps listed above in cycles of back blows and abdominal thrusts until the blockage dislodges, help arrives, or the casualty becomes unresponsive. If none of these steps are working to dislodge the blockage, you should call 999 before proceeding to repeat the steps for the second time.

If you are unable to dial 999, get someone else to do it.

Precautions to help prevent choking

  • Always supervise small children closely during meals; direct supervision is essential.
  • Avoid offering drinks while a child is eating. This practice is often used to help food go down, but it can increase the risk of choking.
  • Discourage eating while lying down.
  • Provide constant supervision for elderly individuals when they are consuming small foods.
  • Ensure that children sit upright while eating.
  • Discourage children from eating while walking, riding in a car, or playing.
  • When preparing food for children, remember to cut it into small, manageable pieces and remove any seeds or pits. For vegetables, consider cooking or steaming them to make their texture softer. When serving hot dogs, slice them both lengthwise and widthwise and remove the skin.
  • When selecting foods for young children, consider their shape, size, consistency, and combinations to minimize choking risks.
  • Be attentive to potential choking hazards among foods, toys, and household items to prioritise child safety.

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