Choking, suffocation and strangulation: 3 - 4 years

How big a problem is it?

It is a relatively small problem, but a problem, nonetheless. Around 83 children each year will either die or be hospitalised from unintentional suffocation. Nearly half of non-fatal suffocation injuries were caused by choking on food or other objects. Children are always exploring their environment and will start to grab and put things in their mouths from as young as two months. There are lots of things around the home that could cause choking, suffocation or strangulation to little kids, so it’s important to be mindful and take precautions to prevent this.

Who does it affect?

Suffocation almost exclusively affects very young children under the age of four. Since 2007, it has overtaken motor vehicle traffic crashes as the leading cause of fatal injury. Male, Māori and Pacific children have a disproportionately high rate of suffocation injury. Children under the age of five are at a higher risk.

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 these out of reach.

First Aid

  • 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 five 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 the heel of one hand 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 child’s mouth breathe into their mouth while pinching 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

Safekids International Choking and Strangulation Injury Prevention Advice