Minimising the risk of choking at home

Choking hazards at home

· Every day, at least three children worldwide choke to death on food or other things. [Available at https://tinyurl.com/3zve4ynt Accessed on 22 October 2025]

· In European Union countries alone, 50,000 children aged 0 to14 experience choking incidents annually, with 500 fatalities. [Inj Epidemiol 2018;5:30]

· Choking is more common among males. [MMWR Morb Mortal Wkly Rep 2002;51:945-8]

These are not just statistics. They represent preventable tragedies that could happen to any family, anywhere.

As an ENT specialist who sees foreign body cases frequently, I witness firsthand how quickly a curious child's exploration can turn into a medical emergency. What many parents do not realise is that some seemingly harmless household items pose far greater dangers than others.

Choking most dangerous in youngest children

Children up to 14 years old face the highest risk of choking, but the danger peaks in the youngest age groups.

A study conducted by the Universiti Kebangsaan Malaysia (UKM) Faculty of Medicine and Hospital Canselor Tuanku Muhriz (HCTM) revealed that:

· 3.5% of all ENT visits involve foreign bodies: every 3 to 4 patients out of 100 seek help because something is stuck where it should not be.

· 1.65% of these cases involve children.

· The most common inorganic foreign bodies are plastic, metal, and graphite (mechanical pencil fillings, broken pencil tips, pencil stubs, etc).

· 87.5% of children with foreign bodies in their airways or digestive system require hospitalisation, with 25% needing intensive care unit treatment. [Med J Malaysia 2001;56:463-470]

What makes these incidents particularly challenging is that most of the cases are unwitnessed. Parents often have no idea their child has swallowed or inhaled something dangerous until symptoms appear and by then, precious time may have been lost.

Common foreign bodies involved in choking cases
Foreign bodies fall into two main categories:

Organic materials

· Natural substances like food that the body can potentially break down.

· Common culprits include peanuts, watermelon seeds and coconut kernels.

· While these can cause choking, they may eventually dissolve or pass through the system. If they remain, they may cause infections.

Inorganic materials

· Include metals, plastics, and other manufactured items that the body cannot break down.

· Research shows these are more common in children.

· Items like beads, toy parts, springs, hair clips, ballpoint pen tips, and pencil caps frequently cause problems.

However, two types of inorganic objects deserve special attention due to their unique dangers: button batteries and magnets.

Button batteries

Button batteries may look harmless, but they are medical emergencies waiting to happen. [Available at https://www.ncbi.nlm.nih.gov/books/NBK470298/ Accessed on 24 October 2025]

· The warm, moist environment inside the human body causes these batteries to leak corrosive chemicals that burn surrounding tissues.

· Additionally, the battery creates small electrical currents between its positive and negative poles, causing electrical burns.

These dual actions can eat into and create holes in delicate tissues—whether in the nasal septum (the wall between nostrils), airways or intestinal walls.

· If holes develop in the intestine, gut contents can spill into the abdomen, causing life-threatening infections that may spread throughout the body.

· The danger is compounded by the fact that button batteries look remarkably like coins on X-rays, potentially delaying proper diagnosis.

· Only subtle signs like a faint halo or ring around the battery can help doctors differentiate between the two.

Button batteries power countless household devices such as television remotes, watches, and car key fobs, and are easily accessible when battery compartments are not properly secured.

Magnets

A single magnet poses minimal risk, but multiple magnets create a catastrophic scenario. [Front Pediatr 2021;9:727988]

· When two or more magnets are swallowed, they attract each other with tremendous force.

· If they end up in different parts of the intestine, they will pull toward each other, trapping intestinal walls between them.

· This magnetic attraction cuts off blood supply to the trapped tissue, eventually creating holes in the intestinal wall.

· Like button batteries, this can lead to spillage of intestinal contents into the abdomen causing life-threatening infections.

The fact that magnets are commonly found at home in the form of decorative refrigerator magnets makes the danger even more pressing.

When a child arrives with a suspected foreign body, every second counts more so when it results in choking indicating an airway compromise. The challenge intensifies with unwitnessed incidents.

We rely heavily on detective work, such as examining the child for signs like unusual breathing patterns, listening for abnormal lung sounds, and sometimes using imaging studies.

While metal objects show up clearly on X-rays, plastic items often require more advanced imaging or direct visualisation with scopes. The treatment approach depends on where the object is located and what type it is.

Foreign objects stuck in the airway [Available at https://www.ncbi.nlm.nih.gov/books/NBK553186/ Accessed on 24 October 2025]

· We typically need to place the child under general anaesthesia and use specialised scopes to locate and remove the foreign body.

· This procedure requires careful coordination between ENT specialists, paediatricians, anaesthesiologists, and intensive care teams to ensure adequate oxygen supply throughout the process.

· In severe cases where the airway is completely blocked, we may need to perform a tracheostomy to access the trachea for breathing and foreign body removal.

Sometimes, children may aspirate on food substances. Aspiration occurs when food goes down into the airways rather than the oesophagus. These children may develop recurrent lung infections that require multiple hospitalisations.

 

Foreign objects stuck in the digestive system

· Objects in the digestive system may require similar scope procedures through the mouth, or sometimes surgery if complications have already developed.

· For small inert objects within the gut, we may have to wait for the child to defecate it out to confirmed that it has passed.

Prevention is key

The most effective treatment for foreign body incidents is prevention. Here are critical steps every parent and caregiver should take:

 

Secure the environment

· Never leave remote controls uncovered or batteries lying around.

· Avoid leaving small decorative items within reach.

· Regularly scan carpeted floors where small objects can easily hide.

· Be cautious with beads or buttons from clothing that children may pick.

 

Food safety practices

· Introduce solid foods only at appropriate ages after teething begins. Consult a paediatrician or dietitian for more information.

· Read food labels and age warnings carefully.

· Cut large or chewy/stretchy foods into small pieces. Spherical foods are particularly common choking hazards e.g. rambutan, longan, whole nuts, glutinous rice balls, hard or sticky sweets and jellies, and chewing gum.

· Supervise young children during meals.

· Avoid feeding children in moving vehicles.

· Discourage playing while eating, as more than half of choking incidents occur during such playtimes.

 

Know the warning signs

Learn to recognise these red flags:

· The universal choking sign: holding both hands at the throat

· Inability to speak

· Stopping breathing and turning blue

· Sudden coughing fits

· Noisy breathing during inhalation, exhalation, or both

· Complaints of shortness of breath

· Unresponsiveness

· Recurrent chest infections over a short period

 

The risk of choking increases if the child has a habit of inserting objects into ears, nose, or mouth. Parents should supervise their children closely if they have this habit and firmly discourage this habit.

 

Be prepared for emergencies

Every parent, teacher, and caregiver should learn basic first aid for choking, including the Heimlich manoeuvre, and how to check for obstructing material in the mouth.

When every second counts, this knowledge saves lives.

A cause that is shared by father and son

As a curious child, I once inserted tissue paper into my nose, leading to my first hospitalisation. The experience of having it removed was far from pleasant, and it gave me firsthand understanding of what these young patients endure.

Since then, I have been striving to promote greater awareness on choking hazards to both healthcare professionals and the public. This led to my collaboration with my father, Professor Dato’ Dr Balwant Singh Gendeh, on foreign body research that stems from professional duty and personal experience. As ENT specialists, we see these preventable injuries regularly, and we feel compelled to raise public awareness about dangers lurking in plain sight.

 

Our shared mission focuses on four key beliefs:

· Foreign body injuries are entirely preventable. Every case represents a missed opportunity for education or environmental modification that could have saved a child from trauma.

· We must raise awareness about seemingly harmless objects that pose serious dangers. Button batteries and magnets appear harmless to most people, but their potential for harm is enormous especially to curious children.

· As medical professionals who witness these incidents regularly, ENT specialists have a responsibility to educate the public and advocate for safety measures.

· We need better systems in place. Malaysia lacks a comprehensive foreign body registry like the European Union’s Susy Safe Project, which tracks choking incidents and guides industry safety standards. We also need stronger regulations governing food safety and toy manufacturing, particularly regarding items sold near schools and online.

The way forward

Foreign body prevention requires coordinated effort from parents, schools, healthcare providers, and government agencies. While individual vigilance is crucial, we need systematic changes to create truly safe environments for children.

The stakes could not be higher. Behind every statistic is a child whose life hangs in the balance, and a family facing their worst nightmare. With proper awareness, preparation, and prevention, these tragedies can become increasingly rare.

Our children’s safety depends on recognising that the most dangerous objects are often the ones we overlook every day. By understanding these risks and taking appropriate precautions, we can transform our homes from potential danger zones into truly safe havens for curious young minds to explore and grow.

Note: Associate Professor Hardip is attached to the Department of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia