Level 1

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. Suffocation occurs when there is not enough oxygen in the body due to an external object blocking air to 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. Scarves should be tucked inside coats or ideally replaced by neckwarmers.

Choking can occur when a person’s airway becomes blocked. It is important that children eat foods that are cut into appropriately-sized pieces to help prevent them from choking. It is also important for children to learn to chew their food thoroughly, and to never run or play while they are eating. Children should also be reminded not to place non-food items like marbles, button batteries, or coins in their mouths.

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 or toy boxes.
  3. Teach children not to put non-food objects in their mouth, like batteries, coins, or balloons.
  4. Teach children to eat slowly and to chew their food thoroughly. Remind children to never walk, run, or play while eating.
  5. Take a first aid course to learn how to help a child who is choking. Being able to dislodge an object in a child’s airway may prevent them from suffering a serious injury or death.
  6. 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 1 - 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 boundaries contribute to safety?

LEARNING OUTCOME

Students explain how boundaries connect to safety.

Safety includes understanding the differences between situations that are safe and those that are unsafe or uncomfortable.

Personal and group boundaries can be expressed through

  • rules
  • symbols
  • signs
  • body language

It is important to ask for help in situations that do not feel safe.

Boundaries are expressed to indicate a need or a want related to feelings of safety and security.

Describe differences between safe situations and unsafe or uncomfortable situations.

Discuss needs and wants that connect to feelings of safety and security.

GRADE 1 - 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

What is investigation?

LEARNING OUTCOME

Students engage in and describe investigation.

Scientists perform investigations to answer questions.

Investigation can involve:

  • asking a question
  • making predictions about what the answer will be
  • gathering information
  • forming conclusions

Scientists keep records of data using:

  • record books
  • computers
  • recordings (sound and video)
  • photographs

Investigation includes safety and respect toward:

  • people
  • plants
  • animals
  • environment

Investigations are carried out as a way to try to understand the world.

There are steps to be followed during an investigation.

Recording data accurately helps ensure observations can be referenced in the future.

Investigation requires safety and respect.

Discuss why investigation is important in science.

Ask a question and make a prediction about what the answer will be.

Carry out a simple investigation with guidance.

Describe the process of investigation using pictures and oral communication.

Use recorded data to reflect on an investigation.

Demonstrate safety and respect during investigations.

GRADE 2 - 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 safety be promoted in various contexts?

LEARNING OUTCOME

Students examine and apply personal safety in a variety of situations.

Safety strategies are developed for a variety of contexts, such as

  • home
  • school
  • online
  • emergencies

Safety is when individuals are free from physical harm or injury, illness, and emotional harm.

Situations and contexts may present different safety concerns.

Safety strategies and procedures can be practised in a variety of ways.

Safety is needed for survival.

Trusted adults in the school and community can support individuals in unsafe and uncomfortable situations.

Safety involves assessing for potential risk or injury by identifying safe and unsafe situations and substances.

Safety is when individuals are free from physical harm or injury, illness, and emotional harm.

Discuss ways to respond in unsafe or uncomfortable situations.

Classify situations that are safe and unsafe.

Describe situations where substances may be harmful.

Examine how safety can be improved in a variety of situations.

GRADE 2 - 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

What methods and processes can be used in scientific investigation?

LEARNING OUTCOME

Students examine investigation and explain how it is influenced by purpose.

Procedures scientists use to guide investigations include:

  • asking questions
  • making predictions
  • planning the investigation
  • observing and recording data
  • analyzing data
  • reaching conclusions
  • discussing observations and conclusions

Being objective means not being influenced by personal thoughts, feelings, or expectations.

Techniques that scientists use to remain objective can include:

  • recording accurate observations
  • choosing appropriate tools
  • carefully measuring
  • basing conclusions on facts and data

Investigations have systematic procedures to guide the study of natural phenomena.

Investigation in science involves collecting and analyzing data objectively to form conclusions.

Make various predictions based on questions to be investigated.

Test predictions by observing and recording data.

Carry out simple investigations in an objective manner using appropriate tools and techniques.

Learning Objectives

  1. To understand the importance of breathing and a clear airway.
  2. To identify ways to prevent strangulation, suffocation, and choking.
  3. To explain why items should not be tied around a person’s neck.
  4. To understand the dangers of placing non-food items in the mouth.
  5. Identify steps to be taken to prevent choking while eating.

Key Messages

  • Your body and brain need oxygen to live. The brain is important for everything we do. When we move, touch, see, think and feel emotions, we are using our brain.
  • Non-food items like marbles, coins, or batteries should not be put in your mouth.
  • Eating is important, and always remember to eat slowly and chew your food.

Required Materials / Teacher Preparation

1. Tealight candle, mason jar, and a lighter / matches, fire extinguisher.
2. Adults should keep a 1 metre (3 foot) no-student zone around the experiment for fire safety and to reduce hazards.
3. Paper bag, a straw, and a small object to block the straw, for example, a small piece of cardboard, and a string.
4. Flipchart paper, a whiteboard / SMART board and markers.
5. Copy of the IPC's "Suffocation, Strangulation and Choking Hazards Activity" presentation slides and materials (make sets of cards if working in small groups or use the slidedeck to present to the class).

ACTIVITY MATERIALS:

Pictures of safe and dangerous objects related to suffocation, strangulation and choking.

  • Print images on separate cards if this activity is to be done in small groups. A set of cards is required for each group. You can also load one set of images into slides if being presented to the class.
  • As an additional activity, children could be asked to draw a picture of themselves doing something to keep themselves or someone else safe from choking, strangulation or suffocation.
  • Slides can be found at: Suffocation, Strangulation and Choking Hazards Activity.

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.

Activities

1. Explain to students that "even if we cannot see it, air is all around us, and that air has oxygen in it. Breathing is important because when we breathe, we fill our body with oxygen. Oxygen is important for our body and brains to stay healthy. Our brain is important for everything we do. When we move, touch, see, think, hear and feel emotions, we are using our brain."

2. Use the straw and the paper bag as a demonstration. Blow into the paper bag through a straw to demonstrate to the class that air is all around us, and that air can fill up spaces, like the inside of a paper bag.

a. Explain to the class that "each of us has an 'airway'. We breathe air in through our nose, and this air travels to our lungs. Our lungs take the oxygen from the air and work with our heart and blood to get the oxygen to all parts of our body."

i. 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.
ii. Explain that "our airway needs to be clear so that we can get air into our lungs. If our airway is blocked or restricted, we might not be able to breathe. Not being able to breathe is dangerous because our body and brain need oxygen."
iii. Explain that "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. Do not put things in your mouth that are not food. Small objects like LEGO® pieces, coins, or button batteries could also get stuck in your airway and make it hard for you to breathe."

      • In front of the class, try to blow air into the paper bag, but this time, block the straw with a small object, like a piece of cardboard. Demonstrate to students that if something gets stuck in your airway, you might not be able to breathe.
      • Explain that "if you or your friend are ever choking, get the attention of an adult right away. An adult may be able to help you clear your airway using first aid, or they will be able to phone 911 to call for help."

iv. 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 is also dangerous."

      • Use the straw and the paper bag once more. Blow air into the bag through the straw, but this time, tie a string around the straw. Demonstrate to the class that "if your airway is cut off, it is harder to fill your lungs with air"
      • "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. This includes drawstrings, shoe laces, ribbons, and ropes."

3. Explain to the class that “if we cannot breathe air, we can suffocate, and we could die. Our brains need oxygen to live and work. Suffocation occurs when a mouth and nose are blocked or there is no oxygen present." In front of the class, place the candle in the mason jar or on the non-flammable plate, and light the candle. 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." (For more information, refer to the module on Fire Safety).

a. Ask the class what will happen if you put the lid on the jar or a cup over the candle.
b. Close the lid on the mason jar or place the cup over the candle until the candle is extinguished. Explain to the class that “the candle used up all of the oxygen in the jar / cup. If we are in enclosed spaces, we can use up all of the oxygen, just like the candle did in the jar. If we use up all of the oxygen, then this means that we might not be able to breathe, and that we could die.”

      • Explain to students "never go in 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 that you can’t get out of."

4. If you are choking, place your hands around your neck so that others know you need help. If you are unable to make any noise, slam one hand on a table or wall to get others' attention. Show what a person who is choking might look like. You can find an image in the Suffocation, Strangulation and Choking Prevention Activity slidedeck.
Signs that a person may be choking can be:³

a. Pointing to or grasping their neck with their hands
b. Being unable to talk
c. Coughing
d. Turning blue or dusky in colour
e. Passing out

5. Explain to the class that “we will be looking at a number of objects and we are going to sort them into two groups - whether the object is a ‘suffocation, strangulation or choking danger’ or if it is ‘safe’.”

a. Have the objects printed on separate cards, or present them using slides, and show one at a time to the class. Use the Suffocation, Strangulation and Choking Prevention Activity slidedeck.
b. Have the class sort the cards into the two categories ‘safe’ and ‘suffocation, strangulation or choking danger’.

Class Discussion Questions

a. Your friend found an old skipping rope on the playground and wants you to play a game where you are the dog and they will tie the skipping rope around your neck like a leash. What should you do or say?
Prompts: No, tying a rope around your neck is not a good idea, it can stop you from breathing. Let’s just use the skipping rope to skip. Never put it around your neck to play. Tell an adult.

References

1. Injury Prevention Centre, Edmonton. Database held by Injury Prevention Centre (data accessed February 2019 database, unpublished data, available upon request).
2. Canadian Paediatric Society. (2021). Position Statement: Preventing choking and suffocation in children.
3. Mayo Clinic. (2021). Choking: First aid.

Let's Review

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

Let's Review: Suffocation, Strangulations, & 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 like a rope or scarf.

2 / 6

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

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. We need to breathe air.

6 / 6

6. Toys in your mouth can cause you to choke.

Your score is

The average score is 0%

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.
  2. Additional resources:

Community Connections

  • Invite a representative from a local first aid organization to provide parent first aid training to learn how to respond when someone is 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. 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.
  • Children can be strangled if something gets wrapped around their neck that pinches off their airway. 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 keep your child safe:

  1. Remove drawstrings from children's hoodies and jackets.
  2. Trim window blind cords and make sure they are not in reach of children.
  3. Have your child sit down when eating. Walking or running when eating can cause choking.
  4. Teach your child not to put non-food items in their mouth.
  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.
  6. Consider taking first aid training so you know what to do if someone is choking. In Alberta, training on how to respond to someone 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).

For more information see https://parachute.ca/en/injury-topic/choking. By using these strategies, you can help prevent serious choking, suffocation, and strangulation risks in your home.

 

Sincerely,

[Insert Teacher Name Here]

Additional Resources

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