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Researchers found that candy was the most common culprit - although choking on hot dogs, nuts and seeds most often required kids to be hospitalized.

"These numbers are high," said Dr. Gary Smith, who worked on the study at Nationwide Children's Hospital in Columbus, Ohio.

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."

The estimated 12,435 children ages 14 and younger who were treated for choking on food each year also doesn't include the average 57 childhood food choking deaths reported by the U.S. Centers for Disease Control and Prevention annually, the researchers noted.

Smith and his colleagues analyzed injury surveillance data covering 2001 through 2009.

They found that babies one year old and younger accounted for about 38 percent of all childhood ER visits for choking on food. Many of those infants choked on formula or breast milk.

Overall, candies caused just over one in four ER trips, followed by meat, bones and fruits and vegetables.

Ten percent of children had to be hospitalized after choking. Kids who choked on a hot dog or on seeds and nuts were two to three times more likely to require hospitalization than those who choked on other foods, according to the findings published Monday in Pediatrics.

"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 Health, noting that seeds and nuts are also difficult to swallow when children put a lot in their mouths at once.

Dr. Ronald Litman, an anesthesiologist at Children's Hospital of Philadelphia, said it's hard to tell from this study how many kids are "seriously affected" after a choking incident.

"The vast majority of these kids, by the time they get to the emergency room, they've coughed or choked it out," Litman, who wasn't involved in the new research, told Reuters Health.

However, he said that he and his colleagues see a few kids every year who have inhaled peanuts and end up in intensive care because their lungs mount an inflammatory response to the fat in the nuts.

Smith, also the president of the non-profit Child Injury Prevention Alliance, said many choking incidents could be prevented with better food design and labeling from manufacturers and with extra precautions taken by parents of young children.

"Clearly, rule number one is supervision" when kids are eating, said Dr. James Reilly, from Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Making sure food is in small enough pieces is also important, Reilly, who has studied choking but wasn't part of the study team, told Reuters Health.

For example, he said, grapes should be cut in half for young children, but raisins are probably okay whole.

SOURCE: bit.ly/cxXOG Pediatrics, online July 29, 2013.