Level 2

Suffocation, Strangulation, & Choking Prevention

In Alberta, there are an average of 1,000 visits to emergency departments each year among children ages 5 - 9 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 young children include necklaces, shoe laces, scarves, jacket drawstrings, and window blind cords. It is important to teach children that these objects are not toys, and that they should never tie things around their neck.

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 running. 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. Teach children to never tie objects around their neck, like shoe laces, rope, or drawstrings.
  2. Teach children to never place their head in plastic bags or to play in objects where they could get trapped, like trunks, toy boxes, 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 3 - Physical Education and Wellness Curriculum

ORGANIZING IDEA

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

GUIDING QUESTION

How is safety connected to health?

LEARNING OUTCOME

Students investigate and explain safety and its correlation to health.

Proactive planning includes:

  • awareness of instructions and guidelines

Specific rules or guidelines can:

  • determine a course of action
  • prevent accidents
  • protect safety of self and others

Experiences that involve challenges and taking risks can develop knowledge around safety.

Resources that support personal safety include:

  • safety networks
  • emergency services
  • safety manuals or guidelines

Safety involves prevention that requires proactive planning.

Rules and guidelines can promote safety in various contexts.

Safety is impacted by the environment and behaviours.

Safety of self and others can be met through awareness of supports.

Examine situations that require proactive planning.

Explain the function or purpose of specific rules or guidelines within various contexts.

Generate examples of situations where behaviours would be appropriate and others where they would involve risk.

Identify available resources that support safety.

GRADE 3 - Science Curriculum

ORGANIZING IDEA

Scientific Methods: Investigation of the physical world is enhanced through the use of scientific methods that attempt to remove human biases and increase objectivity.

GUIDING QUESTION

How can investigation help to develop knowledge in science? 

LEARNING OUTCOME

Students engage in investigation and consider its potential to build understanding of the natural world. 

Observations and results from investigations can be analyzed by:

  • making connections to previous knowledge
  • asking questions
  • noticing changes
  • discussing
  • collaborating

Observations and results from investigations should be analyzed to confirm accuracy and build knowledge.

Discuss observations and the results of investigations.

Analyze observations and the results of investigations.

Ask questions about observations and the results of investigations.

GRADE 4 - 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 taking responsibility impact safety?

LEARNING OUTCOME

Students analyze and explain responsibility and how it can impact personal and group safety.

Responsibility includes making decisions to ensure self or others are not in unsafe and uncomfortable situations.

Responsibility occurs in a variety of contexts, such as:

  • home
  • learning environment
  • community
  • online

Responsibility includes the opportunity, ability, or right to act independently or make decisions.

Responsibility includes an awareness of surroundings to determine the safety of a situation.

Describe responsibility and its impact on personal and group safety in a variety of contexts.

Examine how responsibility can impact safety in a variety of situations.

Learning Objectives

  1. Describe the importance of oxygen, breathing, and a clear airway.
  2. Identify at least 3 ways to prevent strangulation, suffocation, and choking.
  3. Describe how to recognize that someone may be choking and what to do.

Key Messages

  • You need air to breathe.
  • Eating is serious business. Chew food thoroughly and remain seated while eating.
  • Tell an adult if you think someone is choking.

Required Materials / Teacher Preparation

1. For each child you will need a paper bag, a straw, and a small object to block the straw, for example, a small piece of cardboard, and a string. String should be approximately 10 cm (4 inches) long.
2. Suffocation, Strangulation and Choking Prevention Observation Worksheet or students will need a piece of paper and a pencil.
3. Tealight candle, mason jar, fire proof plate or surface, and a lighter / matches, fire extinguisher.
4. Adults should keep a 1 metre (3 foot) no-student zone around the experiment for fire safety and to reduce hazards.

Time Required to Teach Lesson

  • Approximately 45 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 the importance of oxygen. Even if we cannot see it, air is all around us, and air has oxygen. Breathing is important because when we breathe, we fill our body with oxygen. Oxygen is needed for our body to stay healthy. Each of us has an ‘airway’. We breathe air in through our nose, and this air travels to our lungs. Our lungs need air so that we can breathe."

a. Explain to the class that "they will be conducting experiments on why it is important to keep a clear airway. There are 3 main ways that our airway can get blocked - by strangulation, suffocation, and choking. For this activity, we will be researchers. We will be recording our observations after each activity."

i. Hand out 1 paper bag, straw, piece of cardboard, and string to each student. Also hand out the Suffocation, Strangulation and Choking Prevention Observation Worksheet or a piece of paper and a pencil to each student so they can write their observations. Students will need the paper bag and straw for two experiments.
ii. Explain to the class that "first, we will be conducting an experiment on choking. Choking can happen when we have something stuck in our airway. If something is stuck in our airway, we might not be able to breathe. There are things that we can do to prevent choking. For example, always chew your food thoroughly, and never eat when you walk, run or play. With our straw, cardboard, and paper bag, we will be demonstrating how our airway can get blocked. When our airway is blocked, choking can happen."

      • Using the Suffocation, Strangulation and Choking Prevention Observation Worksheet, have students hypothesize what will happen when they blow through a clear straw.
      • In front of the class, use the straw and the paper bag as a demonstration. Blow into the paper bag through the straw, and explain to the class that "the straw is like our airway, and that the paper bag is like our lungs." Ask the class to use their straw to blow into their paper bag. Get the class to record what it is like to blow through their clear "airway".
      • Using the Suffocation, Strangulation and Choking Prevention Observation Worksheet, have students hypothesize what will happen when they blow through a blocked straw.
      • In front of the class, try to blow air into the paper bag, but this time, block the straw with a piece of cardboard (You can put a piece of cardboard into the bottom end of the straw or tape it to the end of the straw). Demonstrate to students that "if something gets stuck in your airway, you might not be able to breathe."

a. Ask the class to try and blow air into their paper bag (they should start with the bag flat so that they can see that it doesn't inflate with the blockage), but this time, to block the bottom of the straw with their piece of cardboard. Have students put a piece of cardboard into the bottom end of the straw or tape it to the end of the straw. Ask students to "record what it is like to blow into the paper bag with a piece of cardboard blocking the straw. Is it harder to blow into the bag?" Reiterate to the class that when something is blocking your airway, it is difficult to breathe, and this can be dangerous.

      • Explain that "when someone is choking they may show signs and symptoms of choking in various ways, including clutching at their throat, not being able to speak, breathe or swallow, they may be coughing, gagging or wheezing, or even change colour or have blue lips or red face."
      • Explain that "if you or your friend are ever choking, get help right away. An adult may be able to help you clear your airway using First Aid for Choking techniques, or they will be able to phone 911 to call for help."

iii. Explain that "our airway can also get ‘cut off’. This is called strangulation. Having your airway cut off can happen if something gets wrapped around your neck. When this happens, it can be hard to breathe, and that is also dangerous."

      • Using the Suffocation, Strangulation and Choking Prevention Observation Worksheet, have students hypothesize what will happen when they blow through a straw with a string tied around it.
      • Use the straw and the paper bag once more. Blow air into the bag through the straw, but this time, tie a string tightly around the straw. Demonstrate to the class that "if your airway is cut off, it is harder to fill your lungs with air." Ask the class to "complete their own demonstration with their paper bag, straw, and string, and to record their observations. Is it hard to breathe into the straw when the string is tied around it?" Reiterate to the class that when something gets wrapped around your neck too tight it can cut off your airway and it is difficult to breathe, and this can be dangerous.
      • Explain to the class that "it is important not to wear things that can get wrapped around your neck and cut off your airway. Never tie anything around your neck that wasn’t designed to be there like a necklace. This includes drawstrings, shoe laces, ribbons, and ropes. These things could cut off your airway, and that could be dangerous."
    •  

iv. Explain to the class that "if we cannot breathe air, we could suffocate." In front of the class, light the candle, and place it into the mason jar. Note: only the teacher will be conducting this experiment. Explain again to students "that even though we can’t see air, it is all around us, and that air has oxygen in it. Just like us, fire needs oxygen too."
v. Ask the class to "record what happens to the candle when the lid is placed on top of the mason jar." Close the lid on the mason jar until the candle is extinguished. Explain to the class that "the candle used up all of the oxygen in the jar. If we are in enclosed spaces, or spaces where there was no window, door or other opening, we can use up all of the oxygen, just like the candle. If we use up all of the oxygen, then this means that we might not be able to breathe, and that we could suffocate."

      • Explain to students "never climb into a plastic bag or put a plastic bag over your head. You could use up all of the air in the bag, and this could be very dangerous."
      • Remind students "not to play in objects that they could get trapped in. This includes trunks, toy boxes, old fridges or freezers, or other small spaces."

b. Close the lesson by asking students to share their observations with the class. How did their hypotheses hold up against what actually happened?

Class Discussion Questions

a. You see a younger child playing with a plastic bag and putting it on their head like a hat. What would you do?
Prompts: Tell an adult. Tell the child not to put the bag on their head as it could be dangerous. Remove the plastic bag from the child.

Let's Review

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

Let’s Review: Suffocation, Strangulation, & Choking Prevention

Are you ready to review what we learned?
Select ‘true’ or ‘false’ for each question.

1 / 6

1. It is okay to tie things around your neck.

2 / 6

2. You should never put a plastic bag over your head or face.

3 / 6

3. It is okay to climb into a toy trunk.

4 / 6

4. It is not important to eat slowly, and chew your food well.

5 / 6

5. If someone is choking they may not be able to speak, breathe or swallow.

6 / 6

6. Breathing is important because it helps fill our body with oxygen.

Your score is

0%

Home Connections

  1. Inform caregivers that their child will be learning about strangulation, suffocation, and choking prevention. Encourage caregivers to do a home safety walk with their child to look for potential hazards to breathing, and discuss ways to prevent choking, strangulation and suffocation. A sample letter is provided below.

Community Connections

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

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.

Every year, there are about 1,000 emergency department visits by children 5 to 9 years of age for treatment of choking, suffocation and strangulation injuries. Children can choke when their airway becomes blocked by things like hard candy, food, small batteries, balloons, and small toys. Suffocation occurs when a child’s mouth and nose are blocked or there is no oxygen present. This can occur when a child places a plastic bag over their head or climbs into an enclosed space like an old freezer or toy box. If a child gets something wrapped around their neck, this can pinch off their airway and strangle them. Items which can strangle children include scarves, jacket or hoodie drawstrings, skipping ropes and window blind cords.

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. Window blind cords can also pose a risk for strangulation. Trim cords so they are not within reach of children.
  3. As a parent / caregiver, 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. In Alberta, training on how to do First Aid for Choking is included in CPR courses. For more information on how to obtain CPR certification, please refer to the Canadian Red Cross (https://www.redcross.ca/in-your-community/alberta) or St. John Ambulance (https://stjohn.ab.ca).
  4. Have your child sit down when eating. Walking or running when eating can cause choking.
  5. 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.

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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