34 kids a day end up in ER for choking on food, use these 5 tips to prevent

Teresa Tanoos's picture
Study finds 34 kids a day end up in E.R. for choking on food
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If you’ve ever seen your child choke on food, gagging until they turn pale, you know how terrifying the experience can be. Chopping your child’s food into smaller bites helps, as does knowing CPR, especially when a study published Monday in the journal Pediatrics confirms that choking is a common hazard of childhood.

According to the study, a whopping 34 children a day are admitted to hospital emergency rooms because they’ve choked on food, which equates to over 12,000 E.R. visits a year by kids ages birth to 14 years, although the actual number of children who choke on food is even greater considering that most kids who choke don’t end up in the emergency room.

“As dramatic as this study is, this is clearly an underestimate,” says the study’s senior author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Choking is a common cause of injury and death in young children, primarily because their small airways are easily obstructed. For babies, mastering the ability to chew and swallow food takes time. Moreover, infants may not be able to cough forcefully enough to dislodge an airway obstruction; thus, as babies start exploring their environments, they commonly put objects in their mouths that can easily lead to infant choking.

In some cases, health conditions increase a child’s risk of choking. For example, kids with swallowing disorders, neuromuscular disorders, developmental delays and traumatic brain injury have an increased risk for choking compared to healthy children.

The age group most likely to choke are those between the ages of birth to 4, with hard candy being the culprit for 15 percent of choking episodes. Other kinds of candy and gum accounted for 13 percent of choking episodes, followed by meat (not including hot dogs) and bones.

Hot dogs, nuts and seeds are the foods children are hospitalized for choking on the most. Hot dogs are notorious for causing severe choking because they can easily be sucked into a child’s airway.

“If you were going to get the best engineer in the world, you couldn’t design a better plug for a child’s airway than a hot dog,” says Smith.

Meanwhile, nuts and seeds are difficult for children to chew and swallow because they have smaller teeth and their airways are relatively small compared to those of adults.

The American Academy of Pediatrics recommends that foods like hot dogs, nuts, chunks of meat or cheese, whole grapes and hard candy should be kept away from children younger than 4. Any food given to babies and young kids should be chopped into pieces no larger than half an inch.

According to Dr. Phyllis Agran, a pediatric gastroenterologist and professor emerita at the University of California, Irvine’s medical school, parents and caregivers also need to educate older siblings not to feed their younger brothers and sisters. Agran points out that there was a case several years ago of an older sibling who gave a baby an almond, with the baby tragically dying after choking on the nut.

“All parents need to know CPR and the Heimlich maneuver,” says Agran. “But the best thing we have is prevention.”

For the study led by Dr. Smith, researchers tracked only nonfatal episodes of choking between the years 2001 and 2009. Nearly 30 years ago, however, a similar study in the Journal of the American Medical Association was conducted about children who died after choking on food.

“Roughly a child every five to six days chokes to death on a food,” said Smith. “I have no reason to think those numbers have changed because there haven’t been major changes in surveillance or protection.”

For that reason, Smith and his researchers suggest boosting public awareness about choking hazards and attaching warning labels to food with a high choke factor, similar to the warnings that are on many toys with small and potentially dangerous parts.

Indeed, Congress passed legislation almost 20 years ago in 1994 prohibiting manufacturers from marketing toys with small balls, marbles or balloons to children under the age of 3 – and, if such items are part of toys for older kids, the legislation requires the toy manufacturer to put a warning label on the product.

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“All these protections have existed for years for toys, but none of this exists for food,” says Smith. “And children choke more often on food than on toys. If we take everything we’ve learned over the past two decades on protecting children from choking on toys and apply it to food, we will save lives and prevent injuries.”

This is the first nationally representative study to focus exclusively on nonfatal pediatric food-related choking treated in U.S. emergency rooms over a multiyear period. The researchers concluded that improved surveillance, public education, food labeling and redesign are strategies that can help reduce the number of children who choke on food.

In the meantime, you can take simple steps to prevent infant choking, such as the following from Mayo Clinic:

• Properly time the introduction of solid foods. Introducing your baby to solid foods before he or she has the motor skills to swallow them can lead to infant choking. Wait until your baby is at least 4 months old to introduce pureed solid foods.

• Don't offer high-risk foods. Don't give babies or young children hot dogs, chunks of meat or cheese, grapes, raw vegetables or fruit chunks, unless they're cut up into small pieces. Don't give babies or young children hard foods, such as seeds, nuts, popcorn and hard candy that can't be changed to make them safe options. Other high-risk foods include peanut butter, marshmallows and chewing gum.

• Supervise mealtime. As your child gets older, don't allow him or her to play, walk or run while eating. Remind your child to chew and swallow his or her food before talking. Don't allow your child to throw food in the air and catch it in his or her mouth or stuff large amounts of food in his or her mouth.

• Carefully evaluate your child's toys. Don't allow your baby or toddler to play with latex balloons — which pose a major hazard when uninflated and broken — small balls, marbles, toys that contain small parts, or toys meant for older children. Look for age guidelines when buying toys for your child. Also, regularly examine toys to make sure they're in good condition.

• Keep hazardous objects out of reach. Common household items that might pose a choking hazard include button batteries, coins, and pen or marker caps.

So what can you do if your child still chokes on food despite your best efforts to prevent it?

• First and foremost, be prepared to act.

• If your baby is choking, don't use a finger sweep, which could lodge the particle further down in the airway.

• Instead, hold your baby face-down on one of your forearms. The baby's head should be lower than his or her body.

• Then thump your baby firmly on the middle of the back using the heel of your other hand. The combination of gravity and the force from your hand will help dislodge the object that's blocking your baby's airway.

• If you're concerned about your baby's breathing, call 911 or your local emergency services provider.

• To be prepared in case of an emergency, take a class on cardiopulmonary resuscitation (CPR) and choking first aid for children.

• Encourage everyone who cares for your child to do the same.

SOURCE: Pediatrics journal, "Nonfatal Choking on Food Among Children 14 Years or Younger in the United States, 2001–2009", published online on July 29, 2013 (doi: 10.1542/peds.2013-0260).

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