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Choking can occur when an object or food becomes lodged in the throat or windpipe that blocks airflow. Choking can be a medical emergency and requires immediate attention.
Choking is a common occurrence and almost everyone can relate at least one time when “something went down the wrong hole.” It is uncommon, though, for choking to be fatal because we have a number of reflexes that prevent choking.
Mouth and throat anatomy
At first glance, your mouth seems simple. You chew, you swallow, you feel full after a big meal. It lets you speak, it helps you breathe, it lets you kiss a loved one. But behind all of these simple actions is some complex anatomy. There are two tubes heading down from the mouth: the trachea, through which air passes to the lungs, and the esophagus, through which food passes to the stomach. If food falls down the trachea, it can block air from getting to the body. Each time you swallow, however, the trachea closes, forcing food down the right pathway. Unfortunately, this process does not always work how it should. If you aren’t careful while you are eating, you can upset this delicate process and send a piece of food down the wrong pipe. Your body fights this by gagging and coughing — trying to force the food out or away from the lungs. If this doesn’t work, however, the food can become lodged, partially or fully blocking airflow and leading to choking.
Common accompanying symptoms of choking
Choking may be associated with these common symptoms:
Most choking episodes are simply due to a mistake made during eating — eating too quickly, laughing while eating, taking too big of a bite. Such mistakes can send chunks of food hurtling down the throat and into the lungs. However, some people can develop difficulty swallowing foods due to other medical conditions or frailty.
Mechanical causes that can lead to choking include the following.
- Not eating carefully: Taking too large of bites, eating while speaking or laughing, or eating too quickly can lead to food being swallowed at the wrong point in the swallowing cycle, when it may more easily lodge itself into the airway.
- Swallowing non-food objects: Your mouth is a highly tuned machine that turns solid foods into a “bolus” — a lubricated blob shaped perfectly to fall down the throat. Non-food objects may not conform to this shape and can fall down the trachea instead.
Swallowing is directed by a complex interplay of signals from the brain to the muscles of the mouth and throat. Disorders of the brain or nerves can cripple this mechanism and lead to choking.
Weakness of the muscles of the mouth or throat can make swallowing less effective or less orderly, leading to choking.
Severe allergic reactions can cause swelling in the back of the mouth that can block airflow and cause a choking sensation.
Rarely, an infection in the back of the throat can lead to swelling significant enough to block the airway, leading to a choking sensation.
This list does not constitute medical advice and may not accurately represent what you have.
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Esophageal obstruction (steakhouse syndrome)
When a large piece of food or an object gets stuck in the lower esophagus, it can produce some mild chest pain and excessive salivation (drooling).
Top Symptoms: vomiting, deep chest pain, behind the breast bone, trouble swallowing, choking, swallowing of something potentially harmful
Symptoms that always occur with esophageal obstruction (steakhouse syndrome): swallowing of something potentially harmful
Urgency: Hospital emergency room
Foreign body aspiration
Foreign body aspiration can be a life-threatening emergency. An aspirated solid or semisolid object may lodge in the larynx or trachea. If the object is large enough to cause nearly complete obstruction of the airway, asphyxia may rapidly cause death.
Rarity: Ultra rare
Top Symptoms: cough, fever, shortness of breath, cough with dry or watery sputum, wheezing
Symptoms that always occur with foreign body aspiration: swallowing of something potentially harmful
Urgency: Emergency medical service
Choking treatments and relief
Most episodes of choking are acute emergencies requiring quick action, such as the Heimlich Maneuver and calling 911. Even if the choking incident has resolved, it is important to seek professional evaluation afterward to make sure no significant damage was done to the throat. If you have choked and are able to breathe but feel like something is stuck in your throat, you should also seek professional treatment. It is possible an object is still stuck in your throat — this can dislodge and completely block your ability to breathe.
Before you are in the care of a medical team you can try the following remedies.
- Back Blows and the Heimlich Maneuver: This easy-to-implement maneuver is relatively effective at pushing out a piece of food stuck in someone’s throat. It can be done on anyone who is choking, including yourself. Instructions can be found elsewhere online. If this is ineffective and the victim loses consciousness, you should start CPR.
- Call for help: It is important to call for bystanders and for 911 if someone is choking.
- Drink water: If you feel like something is stuck in your throat, drinking water can help coax it to go down the esophagus. This should not be done when actually choking.
When to see a doctor
If at-home or conservative methods do not provide relief, your medical provider may complete the following.
- Removal of the offending object: Healthcare providers will attempt the Heimlich maneuver or CPR as needed. They also have tools to manually remove objects stuck in the throat including snake-like cameras and long graspers.
- Surgery: Rarely, surgery will be required to bypass the root cause of the choking and allow a person to breathe.
When it is an emergency
If you or someone you're with experiences these symptoms, seek care immediately.
- Difficulty breathing or speaking
- Loss of consciousness
FAQs about choking
Why do I keep choking on my food?
Chronic or long term choking on food is referred to as dysphagia and should be taken seriously. There are many causes of dysphagia and to properly define the cause you should speak to a medical professional and relate which foods cause choking, when it tends to occur, and how frequently it takes place. Disorders that make cause dysphagia include a narrowing of the esophagus, esophageal cancer, inflammation of the esophagus, stroke or disorders of the muscles that conduct swallowing.
Why am I frequently choking on saliva?
Choking frequently on saliva should be evaluated by a clinician. It may be caused by an uncoordinated swallow reflex, and in most cases is not something to be alarmed about. However, it could be a sign of any number of neuromuscular, throat or esophageal problems. Most notably, multiple sclerosis. Choking on reflux of gastric acid or gastric contents is a different problem.
Can anxiety cause a choking feeling?
Yes, anxiety can cause a feeling of restricted breathing, especially in individuals with asthma or a similar disorder of the pharynx (throat). It can also cause accelerated breathing or hypoventilation, which can lead to lightheadedness and exacerbate feelings of choking or inability to inhale enough air.
What are the most common foods babies choke on?
Foods that babies choke on are usually overly large, easy to swallow whole, hard, sticky, or prone to speedy consumption. For example, peanuts and popcorn can be eaten by the fistful and may not be chewed properly before swallowing. Additionally, sticky and hard foods like caramels and other candies also represent a significant choking hazard.
Can a baby choke on spit up while sleeping?
Yes, it is possible for a baby to vomit and choke on its vomit while sleeping. However, this is uncommon. There is a myth that children that sleep on their backs may vomit and choke on that vomit while sleeping. In reality, the baby will either swallow or cough up their vomit if they vomit while they sleep rather than choke.
Questions your doctor may ask about choking
- Have you experienced any nausea?
- Did you swallow something that could have caused your symptoms?
- Are there specific situations that cause your anxiety, or does it seem that almost anything will make you anxious?
- Have you vomited?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
- Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing - normal and abnormal. Physical Medicine and Rehabilitation Clinics. 2008;19(4):691-707. NCBI Link
- Swallowing disorders. Sutter Health: Palo Alto Medical Foundation. PAMF Link
- Dysphagia (swallowing problems). NHS. Updated January 19, 2018. NHS Link
- Shafique M, Yaqub S, Lie ES, Dahl V, Olsbo F, Rokke O. New and safe treatment of food impacted in the esophagus: A single center experience of 100 consecutive cases. Hindawi. Updated October 18, 2013. Hindawi Link