Reducing the risk of food-related choking in early learning services

Eating comes easily to adults, but it’s important to remember that babies and young children are still practising how to bite, chew and grind food in a safe way.

Tasty morsels, like grapes, peanut butter and popcorn can get stuck in youngsters’ small air and food passages, and children aged five and under are at an increased risk of choking on their food.

In the early learning setting, there is a risk of choking whether food is brought from home or prepared on-site, and we’ve seen the terrible impact that a piece of raw apple can have on a young child, with Neihana Renata suffering brain damage after choking on the fruit at his day care.  

In recognition of this, the Ministry of Education has taken action to minimise food-related choking risks for babies and young children at early learning services.

It has amended the licensing criteria for services to help ensure a safe physical environment when eating and appropriate provision of food, so let’s look at the changes in more detail.

How has the licensing criteria been amended to reduce choking risks?

Although the government says it’s not possible to remove all risk of food-related choking at early learning services, they’ve made changes to the licensing criteria around ‘Supervision while eating’ and ‘Food and nutrition’ to reduce choking risks at centre-based services, kōhanga reo and home-based services.

This means that, as of 25 January 2021:

• Children at early learning services must be supervised and seated while eating (before that date, they just needed to be supervised).

• It is now compulsory for early learning services to follow Ministry of Health guidelines around the safe provision of food.

Specifically, services that provide food must not serve foods that pose a high choking risk, ‘Unless prepared in accordance with best practice as set out in Ministry of Health: Reducing Food-related Choking for Babies and Young Children at Early Learning Services.’

These guidelines say early learning services should exclude the following high-risk foods:

• Dried fruit
• Whole or pieces of nuts
• Large seeds, e.g. pumpkin or sunflower seeds
• Popcorn
• Hard or chewy sweets or lollies
• Marshmallows
• Crisps or chippies
• Hard rice crackers
• Sausages, saveloys and cheerios

Services should alter other high-risk foods to reduce their choking risk for babies and young children.

The guidelines set out ways to change the texture or size and shape of high-risk foods for ages one to three and four to six; and, as an example, services should grate or cook raw carrots, apple and celery, instead of serving them in hard pieces.

The guidelines don’t stop services from growing their own food in veggie gardens and on fruit trees, but the rules apply if this food is provided to children. For instance, a service-grown plum will need to have its stone removed and be cut into small pieces – not eaten straight off the tree.

• Early learning services that don’t provide food must promote the guidelines to parents.

Specifically, the licensing criteria say that where food is provided by parents, services must promote best practices as set out in the Ministry of Health guidelines and must provide a copy of this guidance to all parents at the time of enrolment.

It’s important to note that the new requirements don’t apply to food that parents pack for their children to eat at care, but parents should be aware of the guidelines.

Services don’t need to check children’s lunchboxes and remove food that poses a high choking risk.

That said, services may choose to set their own food policies (developed in consultation with parents), and restrict the sorts of food that parents can provide. The government says, ‘It is the choice of each service as to whether they want to have a food policy for parents that matches the requirements services must follow in providing food.’

• Early learning services must also ensure that the food it provides meets the nutritional and developmental needs of each child.

What further change can you expect soon?

The government is also going to amend the licensing criteria around ‘First Aid Qualifications’ at centre-based services and kōhanga reo.

From 8 April 2021, there must be one first aid-trained adult per 25 children (or part thereof) present at all times.

This means they:

• Hold a current First Aid qualification from a New Zealand Qualification Authority accredited first aid training provider, or
• Are a registered medical practitioner or nurse with a current practising certificate, or
• Are a qualified ambulance officer or paramedic.

Until 8 April 2021, the licensing criteria requires one adult with a first aid qualification per 50 children.

Going forward, Stuff reports that the Ministry of Education is following up these licensing criteria changes with a review into the regulatory system for early learning. It’s looking at the parts that cover risk to children’s health, safety and wellbeing, and is seeing where further clarification is needed.

How else can early learning services provide a safe physical environment when youngsters are eating?

Early learning services must ensure that children are seated and supervised while eating, and the Ministry of Health guidelines recommend that services also take the following action to reduce the risk of food-related choking:

• Have an appropriate ratio of adults to children at mealtimes
• Minimise distractions and encourage children to focus on eating
• Make sure there is a designated time where children sit down to eat, instead of continuously grazing
• Ask children not to talk with their mouths full
• Encourage children to sit up straight when eating, and do not allow walking, running or playing while children are eating, and
• Place food directly in front of the child, so they’re not twisting to either side and losing control of the food in their mouth.

What can parents take from all this?

It’s important to remember that food-related choking is a risk whenever – and wherever – your baby or young child is eating.

The Ministry of Health says it takes some years for children to learn how to bite, chew, grind food and move it around their mouths, and explains that, ‘Many [children] don’t truly master chewing until four years of age.’

For this reason, it’s important to read the guidelines that your early learning service provides you with.

The Ministry’s advice for early learning services was adapted from its advice for parents and care-givers, so you’re encouraged to look at these tips and resources, too.

At the end of the day, thoughtful food preparation and careful eating practices will lower the risk of choking in early childhood, so let’s support safe and healthy consumption at care, at home and everywhere food is enjoyed.

Additional references

Ministry of Education FAQs

Ministry of Education Early Learning Bulletin

Licensing Criteria Amendments

Stuff