Choking, strangulation and suffocation: Birth to 11 months

How big a problem is it?

Suffocation is the leading cause of fatal injury and death among children. The death rates from suffocation have increased in the years since 2000, most likely because it is recognised as a contributing factor in many cases of Sudden Unexplained Death of an Infant (SUDI). Approximately 60,000 babies are born each year in Aotearoa New Zealand. The current sudden unexpected death in infancy (SUDI) rate in Aotearoa New Zealand is approximately 0.7 in every 1,000 babies born. Most of these deaths are preventable and it is, sadly, most prevalent among Māori and Pacific babies. It has its own focused programme of injury prevention work that is delivered separately from the one Safekids Aotearoa is responsible for. The information focused on the prevention of SUDI is here at HAPAI SUDI Prevention Coordination Service and Safe Sleep for P.E.P.E 

The focus for Safekids Aotearoa is on preventing strangulation and choking injury among our very young children. We present advice on that here. 

Who does it affect?

Nearly half of suffocation injuries are caused by choking on food or other objects. This is particularly so for those under one year of age and male. Māori and Pacific children have high rates of suffocation injury. Suffocation and strangulation in the bed is also a significant cause of injury.

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.

Food Preparation

Chop or process food finely. Very young children of this 0-12 months age group have a windpipe with a diameter little bigger than a large straw. Supervise them when eating.


First Aid 

If the baby is conscious, follow these steps to clear an obstruction:

  1. Call for help

  2. Hold the baby down lengthwise on your arm or knee.

  3. Firmly support the head by holding the jaw.

  4. Give 5 back slaps between the shoulder blades with the heel of your hand – not too hard – to create an artificial cough.

  5. If the obstruction still hasn’t come out, turn the baby over face up with head lower than the trunk (or body).

  6. Give 5 chest compressions in the same place as for CPR, but at a slower rate (1 every 3 seconds).

  7. Only remove the object if you can see it. Do not try to fish for it as you may push the object down further.

  8. Continue back slaps and chest thrusts until the object comes out. If the baby becomes unconscious, follow the basic life support steps and perform CPR. 

Source: Well Child My Tamariki Ora My Health Book

If the baby is unconscious, follow the steps 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.

The CPR advice is from the KidsHealth website 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 

Link to Safekids resources

Download Choking reference card

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 

Safe Kids International Choking and Strangulation Injury Prevention Advice