Table 1.
Summary of the guidelines retrieved.
| Institutional guideline | Nation | Year | Age for which the recommendations were developed | Dangerous food items listed | Food preparation | Behavioral rules/recommendations besides food preparation |
|---|---|---|---|---|---|---|
| Ministry of Health (20) | New Zealand | Published in 2008, partially revised in 2012 | Under 5 years of age | - Small hard foods (e.g., nuts, large seeds, popcorn husks, raw apples, carrots and celery) | - Do not give candies, bubble gum, or marshmallows to children under the age of 3 | - Supervise mealtimes |
| - Small round-shaped foods (e.g., grapes, berries, raisins/sultanas, peas, watermelon seeds, candies) | - Remove skins and fibers | - Do not allow children to play and run with food in their mouths | ||||
| - Foods with skins or leaves (e.g., sausages, chicken, lettuce, nectarines) | - Cook food until is soft | - Require children to eat at the table | ||||
| - Compressible foods (e.g., hot dogs) | - Thinly spread thick pastes | - Never force children to eat | ||||
| - Thick pastes (e.g., chocolate spreads, thick peanut butter) | - Cut dangerous food items into small pieces | - Require children to eat in a high-chair and away from distractions | ||||
| - Fibrous or stringy foods (e.g., celery, raw pineapple) | - Learn first aid for dealing with choking. | |||||
| - Offer food that matches each child's chewing and grinding skills | ||||||
| U.S. Department of Agriculture and U.S. Department of Health and Human Services (Nutrition and Wellness Tips for Young Children: Provider Handbook for the Child and Adult Care Food Program) (21) | US | 2012 | Under 4 years | - Food smaller than a nickel - Smooth, or slippery foods (e.g., cherries, berries, canned fruit, peanuts and nuts, hard or round candy, jelly beans) - Small, dry, or hard foods (e.g., potato and corn chips, apples or other hard pieces of raw fruit, peanuts, nuts, and seeds) - Sticky or tough foods (e.g., pieces of uncooked or dried fruits or vegetables, fish with bones, chewing gum, sticky candies) |
- Cook food until it is tender and then mash it with a fork - Chop foods into small pieces - Always remove bones from fish and meat - Remove seeds |
- Kids must stay seated during the meal - Create a quiet environment - Supervise the child while eating - Children should eat slowly |
| - Thinly spread peanut butter or seed butter | - Give food for which children are developmentally ready | |||||
| - Do not give food in the car | ||||||
| American Academy of Pediatrics (15) | US | 2010 | Under 4 years, even if it has been noted that the problem is relevant until 14 years (with 10,000 emergency department visits) | - Cylindrical, airway sized, and compressible foods (e.g., hot dogs), hard candy, peanuts/nuts, seeds, whole grapes, raw carrots, apples, popcorn, chunks of peanut butter, marshmallows, chewing gum, and sausages. | Activities recommended to the FDA for food choking injury prevention - Surveillance of the phenomenon - Sensitizing campaign about the problem of choking injuries - Warning labels for dangerous food products - Recalls of dangerous food products from the market Additionally: - Health professionals should provide choking prevention counseling to families |
|
| - Food manufacturers should redesign hazardous products | ||||||
| Canadian Pediatric Society (16) | Canada | 2012 | Under 4 years | Small, round, cylindrical shaped foods (e.g., hot dogs, peanuts, seeds, hard candies) | - Food that should be avoided under the age of 4: hard candies, cough drops, gum, gummy candies and chewable vitamins, peanuts, sunflower seeds, fish with bones, snacks on toothpicks or skewers - Foods that could be given to children if adequately prepared: grapes, hot dogs and carrots (chop lengthwise); raw carrots, apples (cut or finely grate) |
- Surveillance of the phenomenon - Develop legislations and standards (and monitoring the compliance) - Improving product design |
| - Counseling to families and choking prevention campaigns | ||||||
| U.S. Department of Agriculture (Building Blocks for Fun and Healthy Meals: A Meal Planner for the CACFP) (22) | US | 2000 | Under 4 years | - Small hard foods (e.g., nuts, seeds, popcorn, pieces of raw vegetables) | - Cook food until tender | - Sit quietly while eating |
| - Tough or sticky foods (e.g., peanut/seed butters, marshmallows, bubble gum) | - Cut round foods lengthwise | - Serve small portions | ||||
| - Firm, smooth or slippery foods (e.g., hot dogs, hard candies, cherries) | - Chop food into small pieces | - Encourage children to eat slowly and chew well | ||||
| - Remove bones, seeds and pits | ||||||
| - Thinly spread peanut butter | ||||||
| U.S. Department of Agriculture (Feeding Infants: A Guide for Use in the Child Nutrition Programs) (23) | US | 2001 | The guide was aimed at infants | - Small, dry or hard foods (e.g., popcorn, peanuts, pieces of raw fruits and vegetables) | - Cook food until it is tender | - Sit quietly while eating |
| - Sticky or tough foods (e.g., peanut/seed butters, meat, marshmallows, bubble gum) | - Cut food into small pieces | - Serve small portions | ||||
| - Firm, smooth or slippery foods (e.g., hot dogs, hard candies, berries, cherries) | - Remove bones, seeds and pits | - Encourage children to eat slowly and chew well | ||||
| - Cut round foods lengthwise | ||||||
| U.S. Department of Agriculture (Infant Nutrition and Feeding. A Guide for Use in the WIC and CSF Programs) (24) | US | Revised in 2009 | The guide was aimed at infants | Chunks of meat, hot dogs, fish with bones, chunks of cheese, nuts and seeds, nut/seed butters, beans, corn kernels, cherry and grape tomatoes, raw (or partially cooked) vegetables, grapes, berries, cherries, fruits with seeds or pits, pieces of canned fruit, popcorn, pretzels, chewing gum, sticky and hard candies | - Actively supervise children - Maintain a calm atmosphere - Encourage children to eat slowly |
|
| - Avoid teething pain medicine before mealtimes | ||||||
| - Do not give food in the car | ||||||
| Department of Health (19) | South Australia | 2011 | Under 4 years | - Food with skins (e.g., hot dogs) | - Remove bones, seeds, pips, stones, skins | - Make sure children are calm |
| - Round-shaped foods (e.g., grapes) | - Cut into small pieces | - Eat sitting upright | ||||
| - Foods with stones, seeds or pips (e.g., cherries) | - Do not give corn chips, hard or sticky candies, popcorn, nuts and hard crackers | - Actively supervise children | ||||
| - Hard, crunchy or stringy food (e.g., crackers) | - Eat slowly and never force children to eat | |||||
| - Chewy and tough foods (e.g., meat) | ||||||
| - Foods with bones | ||||||
| Health Canada, Canadian Pediatric Society, Dietitians of Canada, Breastfeeding Committee for Canada (17) | Canada | 2014 | From 6 to 24 months | Hard, small and round, smoothy and sticky, solid foods | - Grate raw carrots - Remove pits - Chop grapes - Thinly spread peanut butter - Chop foods with fibrous or stringy textures |
- Actively supervise children - Do not feed children in the car |
| Scientific Advisory Committee on Nutrition (SACN) (18) | United Kingdom | 2018 | First year of life | Whole nuts | - Actively supervise children | |
| WHO (25) | 2005 | From 6 to 24 months | Items with shape and/or consistency that make them get stuck in the trachea (e.g., whole nuts, whole grapes, raw carrots) | Gradually increase food consistency according to infant abilities |