On average, 57 children in the United States choke to death on food each year, and beyond the fatalities are a concerning number of non-fatal, food-related choking episodes that send an average of 34 children a day to the emergency room, according to a new study published in Pediatrics.

Dr. Gary Smith, who worked on the study at Nationwide Children's Hospital in Columbus, Ohio, and his colleagues analyzed injury surveillance data from 2001 through 2009 to come up with the figures.

"These numbers are high," said Smith. What's more, he added, "This is an underestimate. This doesn't include children who were treated in urgent care, by a primary care physician or who had a serious choking incident and were able to expel the food and never sought care."

They determined that candy was the most common cause of choking; but children choking on hot dogs, nuts and seeds were two to three times more likely to require hospitalization than those who choked on other foods. Ten percent of children visiting the emergency room for choking required hospitalization.

"We know that because hot dogs are the shape and size of a child's airway that they can completely block a child's airway," Smith told Reuters, noting that seeds and nuts are hard to swallow when children put too much in their mouths at once.

Here's the list of foods culled from the study that cause the most choking incidents:

1. Hard candy

2. Other candy

3. Meat other than hot dogs

4. Bone

5. Fruits and vegetables

6. Formula/breast milk/milk

7. Seeds/nuts/shells

8. Chips/pretzels/popcorn

9. Biscuits/cookies/crackers

10. Multiple specified foods

11. Hot dogs

We have so much legislation requiring labeling of toys as choking hazards; the same doesn’t yet exist for food. Most parents know to keep marbles away from their babies, for example; but how about gumballs, which provide the same choking risk?

The NY Department of Health offers these tips to help prevent choking on food:

  • Never leave a small child unattended while eating. Direct supervision is necessary.
  • Children should sit up straight when eating, should have sufficient number of teeth, and the muscular and developmental ability needed to chew and swallow the foods chosen.
  • Children should have a calm, unhurried meal and snack time.
  • Children should not eat when walking, riding in a car or playing.
  • Cut foods into small pieces, removing seeds and pits. Cook or steam vegetables to soften their texture. Cut hot dogs lengthwise and widthwise.
  • Offer plenty of liquids to children when eating, but solids and liquids should not be swallowed at the same time. Offer liquids between mouthfuls.
  • Use only a small amount of peanut butter when the child is ready and use with jelly, or cream cheese on whole grain breads (Remember peanut butter can stick to the roof of a child's mouth and form a glob.)
  • Think of shape, size, consistency and combinations of these when choosing foods.
  • Become familiar with life-saving techniques such as child cardiopulmonary resuscitation, abdominal thrusts (Heimlich Maneuver) and Automated External Defibrillators (AED).
11 foods that children choke on most
A new study uncovers the surprising numbers about food choking hazards and warns parents what to watch out for.