MEALTIME SUPERVISIONBest Practices:

CHOKING FACTS Children under the age of 5 are at the

greatest risk of choking 2/3 of all choking victims are under the

age of 1, according to the American Academy of Pediatrics

Esophagus of an infant/toddler is the size of a straw

CHOKING FACTS In 2000, 160 children ages 14 years or

younger died from an obstruction of the respiratory tract due to inhaled or ingested foreign bodies. Of these, 41% were caused by food items and 59% by nonfood objects (CDC, unpublished data). 

CHOKING FACTS It takes as little as 4 minutes for brain

damage or death to occur if oxygen is not getting to the lung or brain.

CHOKING FACTS For every choking-related death, there

are more than 100 visits to U.S. emergency departments. In 2001, an estimated 17,537 children 14 years or younger were treated in U.S. emergency departments for choking episodes.

CHOKING FACTS Sixty percent of nonfatal choking

episodes treated in emergency departments were associated with food items; 31% were associated with nonfood objects including coins; and in 9% of the episodes the substance was unknown or unrecorded.

CHOKING FACTS Candy was associated with 19% of all

choking-related emergency department visits by children ages 14 years or younger; 65% were related to hard candy; and 12.5% were related to other specified types of candy (chocolate candy, gummy bears, gum, etc.). The type of candy was not specified in the remaining 22.5% of the cases.  Candy was associated with 5% of all choking-related visits for infants less than one year of age; 25% of visits for children ages 1 to 4 years; and 28% of visits for children ages 5 to 14 years.

DHS GUIDELINES Food as Behavior Management. 1. Foods served as part of the

meal/supplement pattern shall not be used as

reward; nor shall food be used or withheld as a form of discipline.

2. Desserts and sweets shall not be used as rewards or a form of discipline.

DHS GUIDELINES Due to the extreme risk of choking,

solid foods (including cereal) shall not be given in bottles or with infant feeders to children with normal eating abilities unless authorized by a physician. Violation of this rule may result in suspension, revocation or denial of the agency’s ability under its license to provide infant care.

DHS GUIDELINES To avoid choking, foods shall be

appropriate for the eating and chewing abilities of children. Hotdogs, if served to preschool children, shall be finely chopped or quartered lengthwise because they swell if trapped in a child’s throat.

DHS GUIDELINES At mealtime, children shall be seated at

tables and chairs of appropriate size, and adults shall sit with them.

DHS GUIDELINES Food shall not be forced on or withheld

from children. The feeding schedule for infants shall

be in accordance with the child’s need rather than according to the hour.

Children shall not be permitted to carry a bottle with them throughout the day.

DHS GUIDELINES The adult must be able to hear the

child at all times, must be able to see the child with a quick glance and must be able to physically respond immediately.

SUGGESTIONS Children should eat or drink only when

sitting upright. Children should not be forced to feed

when they are sleepy. Toys should be appropriate for the age

and be sure to keep older children’s toys away from any young child.

TIPS TO SUCCEED What do you need to have at the table with you

to avoid any momentary lapse in supervision?

Sit with the children

Have pleasant conversation

If you get up from the table, make sure you keep your eyes on the children.