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In the last few weeks, we have had four elementary children choke on food during school, requiring staff to perform the Heimlich maneuver. Fortunately, staff responded quickly and appropriately with immediate resolution of all episodes. However, we wanted to remind all staff of the dangers of choking and steps to take to lessen the risk of choking. The younger the child, the greater the risk of choking, due to their small windpipe. In 2001, an estimated 17,537 children 14 years or younger were treated in U.S. emergency rooms for choking episodes. Sixty percent of those were from food items. Candy was associated with 19% of all choking episodes; specifically 65% were related to hard candy. We strongly recommend that hard candy not be given in classrooms as a reward. A child can virtually choke on anything; however there are certain items that pose a greater risk, such as: hot dogs, nuts, seeds, whole grapes, popcorn, hard, gooey or sticky candy. Objects such as balloons, coins, marbles and pen or marker caps also pose a risk. Remind students to sit down when eating and not to talk or laugh with food in their mouth. They should not eat or drink while playing, running around or riding in a vehicle. Discourage students from putting pens or marker caps in their mouths. If a child is choking and coughing, but can breathe and talk, the airway is not completely blocked and it’s best to do nothing. The child will likely be fine after a good coughing spell. Stay with the child and remain calm until the episode passes. If a child is conscious but can’t breathe, talk or make noise, or is turning blue, perform the Heimlich maneuver. Following a major choking episode, especially if there is a persistent cough, drooling, gagging, wheezing, difficulty swallowing, or difficulty breathing, a child should be taken to an emergency room for further medical evaluation.