Level 3

Suffocation, Strangulation, & Choking Prevention

In Alberta, there are an average of 565 visits to emergency departments each year among children ages 10 - 14 as a result of suffocation, strangulation, and choking.¹ 

Deaths and injuries due to suffocation, strangulation and choking are the result of asphyxia, a lack of oxygen to the brain.²

All living things need air to live. Injuries like suffocation, strangulation, and choking occur when a person’s body and brain are not able to get the oxygen needed to work and function. Suffocation occurs when there is not enough oxygen in the body due to an external object blocking the nose and mouth. Children may unintentionally suffocate themselves if they are playing with objects that are not toys. For instance, children should never go in or put a plastic bag over their head, as they could suffocate. It is also important for children to understand that it is not safe to play inside objects that they could get trapped in. For example, children should never play in trunks, freezers, or toy boxes where they could get trapped and run out of oxygen to breathe.

Strangulation occurs when there is external constriction around a person’s neck. This makes it hard for their body and brain to get the oxygen they need. Strangulation may lead to asphyxiation, which can cause injury or death. Children may unintentionally strangle themselves when they are playing with objects that can wrap around their neck. Examples of objects that can be dangerous to children include necklaces, shoe laces, scarves, and hoodie drawstrings. Even older children have been in tragic incidents where they have unintentionally strangled themselves. It is important to teach children to never tie anything tightly around their neck, and to remove drawstrings from hoodies.

Choking can occur when a person’s airway becomes obstructed. Common ways that older children may choke involve food that has not been properly chewed. Older children may feel tempted to eat quickly, or eat while moving around. This can be dangerous, as a piece of food may get lodged in their airway, which may prevent them from breathing. It is important for children to always chew their food thoroughly, and to never run or play while they are eating.

If a person is choking, there is a sequence of  first aid steps that can be taken to help including a technique called First Aid for Choking which includes back blows and abdominal thrusts. It is important to be trained to use the appropriate actions to ensure safe and effective support. In Alberta, training on how to properly assist a choking person is available through the Canadian Red Cross or St. John Ambulance.

There are things that adults, parents and caregivers can do to help prevent strangulation, suffocation, and choking. Key strategies to protect children from being strangled, suffocating, or choking include the following:

  1. Remove drawstrings from children's hoodies and jackets. Remind older children of the risks of tying objects tightly around their neck, like shoe laces, rope, or drawstrings.
  2. Remind older children to never place their head in plastic bags or to play in objects where they could get trapped, like trunks, toy boxes, freezers, or refrigerators.
  3. Teach children to eat slowly and to chew their food thoroughly. Remind children to never walk, run, or play while eating.
  4. Learn First Aid for Choking in the event that a child is choking. Being able to dislodge an object in a child's airway may prevent them from suffering a serious injury or death.
  5. Teach children how to recognize the signs of choking and when to call an adult for help.

References

* This lesson plan has been adapted from the National Fire Protection Association (NFPA)’s RiskWatch Safety Program on Choking, Suffocation, and Strangulation Prevention.This module has also been adapted from the TD Think First for Kids lesson on Choking, Strangulation, and Suffocation Prevention.
1. Injury Prevention Centre, Edmonton. Database held by Injury Prevention Centre (data accessed February 2019 database, unpublished data, available upon request).
2. Position Statement: Preventing choking and suffocation in children [Internet]. Ottawa, ON: Canadian Paediatric Society; 2020 [cited 22 April, 2022]. Available from: https://cps.ca/documents/position/preventing-choking-suffocation-children

GRADE 5 - Physical Education and Wellness Curriculum

ORGANIZING IDEA

Safety: A lifetime of optimal well-being is supported by prioritizing health and safety.

GUIDING QUESTION

How can responsibility lead to a desired outcome? 

LEARNING OUTCOME

Students analyze responsibility and consider the impact on well-being. 

Responsibility is being accountable for actions and decisions and accepting the results or consequences.

Safety of self and others can be enhanced through community programs, such as first aid training, and supports, including health professionals.

Responsibility to ensure the safety of self and others includes following:

  • laws
  • rules
  • practices
  • protocols
  • digital citizenship (responsible conduct and safety)

Personal actions and decisions can affect physical, social-emotional, and financial well-being.

Responsibility includes ensuring the safety of self and others.

Reflect on how the results or consequences of personal actions and decisions can affect the wellbeing of self and others.

Identify laws, rules, practices, and protocols that support safety and well-being in a variety of contexts. Practise digital citizenship by being considerate of others.

GRADE 5 - Science Curriculum

ORGANIZING IDEA

Living Systems: Understandings of the living world, Earth, and space are deepened through investigating natural systems and their interactions.

GUIDING QUESTION

How are organisms supported by biological processes and systems?

LEARNING OUTCOME

Students investigate the internal systems of organisms and explain how they support biological processes.

Human biological systems include the:

  • digestive system
  • respiratory system
  • circulatory system
  • musculoskeletal system

The respiratory system includes the trachea, lungs, and diaphragm.

Humans are organisms with systems that serve various functions.

Human body systems are composed of organs that each perform a specific function.

Research the function of the human digestive, respiratory, circulatory, and musculoskeletal systems.

Identify the digestive, respiratory, circulatory, and musculoskeletal systems of the human body and the major organs of each system as represented in diagrams or models.

Create a simple diagram or model of a human body system and label the major organs.

GRADE  6 - Physical Education and Wellness Curriculum

ORGANIZING IDEA

Safety: A lifetime of optimal well-being is supported by prioritizing health and safety.

GUIDING QUESTION

 In what ways might risk influence the outcome of an action? 

LEARNING OUTCOME

Students examine risk and identify the factors that influence action. 

Risk is the overall assessment and identification of hazards related to personal safety and vulnerability.

Short-term and long-term risk can be managed or reduced through planning, rehearsal, and evaluation.

Aspects of life impacted by risk include:

  • mental health
  • physical well-being
  • safety

Measured risks can be taken in stages and are more likely when individuals feel safe, respected, and trusted. 

Risk can lead to an increased likelihood of complications in various contexts.

Risk has potential to positively or negatively impact several aspects of life.

Discuss how feelings associated with risk taking affect actions and decisions.

Describe consequences that may result from risk taking in various contexts. 

Reflect on the positive and negative impacts of risk taking in a variety of contexts.

Learning Objectives

  1. Identify at least 3 ways to prevent strangulation, suffocation, and choking.
  2. Identify the basic anatomy of the respiratory system.
  3. Identify the signs that someone may be choking, and what to do.

Key Messages

  • Keep your airway clear.
  • Eating is important - always remember to eat slowly and chew your food.
  • Tell an adult if you identify someone is choking or call 911 to get help.

Required Materials / Teacher Preparation

1. Copies of the 'Breathing' worksheet (1 per student) found in the link. You will need to register for an account on www.education.com to download the worksheet online.
2. Copies of the 'Respiratory System' diagram (1 per student) found in the link or as a one-pager at the end of this module. You will need to register for an account on www.education.com to download the worksheet online.
3. Copies of the Hidden Risks Worksheet for each student, a journal and pencil, or Chromebook for each student, pair or group.
4. Paper bag, a straw, and a small object to block the straw, for example, a small piece of cardboard, and a string.
5. Tealight candle, mason jar, re proof plate or surface, and a lighter / matches.

Time Required to Teach Lesson

  • Approximately 60 minutes.

Safety Considerations

IMPORTANT

Check with your school’s administration about having a lit candle in the classroom as some smoke detection systems are sensitive enough to trigger with a lit candle.

IMPORTANT

Do not use candy or other small food items to demonstrate this activity - this could pose a choking hazard.

Activities

1. Explain to students that "today we will be learning about breathing and the respiratory system." Instruct students to "take a big, deep breath, and fill up your lungs with air." Ask students to place their hands on their ribs and feel their diaphragm. "The diaphragm is an important muscle in your body that helps control breathing." Explain to students that "they will be learning about the respiratory system, which includes the diaphragm. You will also be learning about why it is important to prevent choking, suffocation, and strangulation."

2. Watch this KidsHealth Nemours Video (5min) How Your Lungs Work to introduce the concept.

3. Distribute copies of the 'Breathing' worksheet and 'Respiratory System' diagram to each student. Have students review and fill in the worksheets.
Note: Have students hand in the worksheets for assessment.

4. Prepare the paper bag, straw, string, mason jar and candle, matches / lighter, and small piece of cardboard at the front of the classroom. Instruct students to find the windpipe, or trachea, on the 'Breathing' worksheet. Hold up the straw in front of the class. Explain to students that "the straw is like our trachea, or our windpipe. The trachea connects the upper respiratory system to the lungs. If something happens to our trachea, that could seriously impact our breathing."

a. Ask the class "what are three things that could affect our trachea, and our ability to breathe?"

i. Answers include: choking, suffocation, and strangulation.
ii. Go over each of these topics with the class, doing a demonstration for each.

      • Suffocation demonstration - Using the lighter / match, light the candle and place it in the mason jar. If the class has previously completed the Fire Safety Module you can recall the Fire Triangle as shown in the The Science of Fire slidedeck.
      • Explain to the class to "recall the fire triangle (if taught previously from the Fire module), and that fire needs oxygen to burn." Put the lid on the mason jar until the candle is extinguished.

a. Explain to the class that "Suffocation (asphyxiation) can occur when there is not enough oxygen in the body. Suffocation can happen in a number of ways. For example, people may suffocate if they put a plastic bag over their head and use up all of the oxygen. Someone may also suffocate if they get trapped in a small, enclosed space, like a trunk. It is important to never put anything over your head or face, or play in an area where you could get trapped to prevent suffocation."

      • Choking demonstration - Using the straw and the paper bag, blow into the straw and fill the paper bag with air. Then block the straw with a small piece of cardboard.

a. Explain to the class that "choking can occur when our trachea becomes obstructed. A common cause of choking is when a piece of food gets stuck in the trachea, blocking air from reaching the lungs. When someone is choking they may be coughing, wheezing, making weird noises. They may be unable to speak or breathe. They may also gesture at their throat to communicate that they are choking. If you see someone who is choking, get an adult right away, and ask them if they know how to do First Aid for Choking. First Aid for Choking can dislodge the object that is blocking the person's trachea, and may save their life."

      • Strangulation demonstration - Using the straw, the paper bag, and the string, tie the string around the straw and blow into the bag.

a. Explain to students that "strangulation is a type of suffocation that occurs when there is external constriction around your neck. This makes it hard for your body to get the amount of air it needs. Strangulation may lead to suffocation, which can cause injury or death. Never tie anything tightly around your neck to help prevent strangulation."

5. For the next activity, handout a copy of the Hidden Risks Worksheet to each student in the class. This activity can be done individually, in pairs or groups; using Chromebooks or journals. Teacher instructions are found in the worksheet. This activity has students identifying hidden hazards, writing about the hazard and identifying what should be done to be safer.

Respiratory System - Activity

Handout a copy of the Respiratory System diagram below to each student. Have students look at the diagram and read about what each part of the respiratory system does. Then they can find each part on the diagram.

ANSWER KEY:

Nose - 1
Mouth - 2
Trachea or windpipe - 3
Bronchi - 4
Lungs - 5
Diaphragm - 6

Class Discussion Questions

a. A friend saw a post on social media where people try to put as many marshmallows in their mouth as possible. Your friend wants to try this and starts filling their mouth with marshmallows but then starts choking and can’t breathe. They put their hands up to their neck and are having trouble making any noise. What should you do?
Prompts: Help your friend by removing the marshmallows from their mouth. Get help, call for an adult or call 911. If trained, use First Aid for Choking techniques to dislodge the marshmallows. Talk to your friend about not trying this type of activity because there is a chance they could choke or suffocate if their airway gets blocked.

Let's Review

Today we learned about how to prevent suffocation, strangulation, and choking.

Suffocation, Strangulation, & Choking Prevention

Are you ready to review what we learned? Complete the following short-answer questions:

 

1. Describe three ways to prevent strangulation, suffocation, and choking.

2. How does air travel to our lungs? Describe the basic anatomy of the respiratory system.

3. Describe the signs that someone may be choking, and what to do.

ANSWER KEY:

  1. Appropriate answers may include any three of the following: never tie objects tightly around your neck, especially shoe laces, rope, or drawstrings; never place your head in a plastic bags; never play in objects where you could get trapped, like trunks or toy boxes; eat slowly and to chew your food thoroughly; never eat and run.
  2. We breathe air in through our nose and mouth. Air then travels through the trachea (or windpipe) to our bronchioles. Once air has reached the bronchioles, it travels to our lungs.
  3. When someone is choking they may be unable to speak, cough, make noise, or breathe. They may also gesture at their throat to communicate that they are choking. If you see someone who is choking, get an adult right away, and ask them if they know how to administer First Aid for Choking.

Home Connections

Inform caregivers that their child will be learning about strangulation, suffocation, and choking prevention. Encourage caregivers to do a home safety walk through looking for potential hazards to breathing, and ways to keep kids safe.

A sample letter is provided below.

Community Connections

  • Invite a representative from a local first aid organization to provide training on using First Aid for Choking.

Sample Letter

(may be printed on school letterhead or used as a template for SchoolZone / SeeSaw)

Dear Parent / Caregiver,

Today our class learned about the importance of breathing, and how to prevent choking, suffocation, and strangulation.

In Alberta, there are an average of 565 visits to the emergency department each year among children ages 10 -  14 as a result of suffocation, strangulation, and choking. Deaths and injuries due to suffocation, strangulation and choking are the result of asphyxia, a lack of oxygen to the brain (Canadian Paediatric Society, 2020).

It is important to recognize hazards in the home that pose a risk for choking, suffocation, and strangulation. As a parent / caregiver, there are things you can do to help keep your child safe:

  1. Remove drawstrings from children’s hoodies and jackets. Drawstrings can pose a risk of strangulation.
  2. For younger children, window blind cords can also pose a risk for strangulation. If you have younger children in the home, anchor the cords so they are not within reach of children.
  3. For all children, remind them to not eat while they run, jump or play.
  4. Remove old fridges, freezers, toy trunks or other items that children can get locked inside. These items can also be locked / tied shut so children cannot play inside them.
  5. As a parent / caregiver, learn First Aid for Choking to help in the event that a child is choking. Being able to dislodge an object in a child’s airway may prevent them from suffering a serious injury or death. In Alberta, training on how to administer First Aid for Choking is included in CPR courses.
    For more information on how to obtain CPR certi cation, please refer to the Canadian Red Cross (https://www.redcross.ca/in-your-community/alberta) or St. John Ambulance (https://stjohn.ab.ca).

By using these strategies, you can help prevent serious choking, suffocation, and strangulation risks in the home.

Sincerely,

[Insert Teacher Name Here]

Additional Resources

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