Can you die from choking on food. How can we prevent choking in children. What are the most common choking hazards for kids. How to create a safe eating environment for children. What emergency techniques can save a choking child’s life. Why are children under 5 at the highest risk of choking. Which foods pose the greatest choking risk to young children.

The Alarming Reality of Choking Hazards in Children

Choking is a serious and potentially fatal risk for children, especially those under the age of 5. The tragic story of “J.T.”, a young boy who died after choking on a hot dog while on vacation, highlights the urgent need for increased awareness and prevention measures. This incident led to the enactment of “J.T.’s Law” in New York State, aimed at educating parents, caregivers, and providers about common choking hazards and prevention strategies.

Choking ranks as the fourth leading cause of unintentional death in children under 5 years old. This statistic underscores the critical importance of understanding and mitigating choking risks. Every five days, at least one child in the United States dies from choking on food, while more than 12,000 children are rushed to emergency rooms annually due to food-choking injuries.

Why are young children particularly vulnerable to choking?

Young children, especially those under 5, are at the highest risk for choking injuries and deaths. This increased vulnerability stems from several factors:

• The size of a young child’s trachea (windpipe) is approximately the diameter of a drinking straw, making it easy for small objects to become lodged.
• Children may not have fully developed chewing and swallowing abilities.
• Young kids often put objects in their mouths as part of their exploratory behavior.
• They may not yet understand the dangers associated with certain foods or objects.

Common Choking Hazards: Foods, Toys, and Household Items

While toys and household items can pose choking risks, food remains the most common cause of nonfatal choking in young children. It’s crucial to be aware of the various items that can present a choking hazard:

Food Choking Hazards

• Hot dogs (especially when cut into coin shapes)
• Meats, sausages, and fish with bones
• Popcorn, chips, pretzel nuggets, and snack foods
• Hard or sticky candy, cough drops, gum, lollipops, marshmallows, caramels, and jelly beans
• Whole grapes, raw vegetables, raw peas, fruits with skins, seeds, carrots, celery, and cherries
• Dried fruits, sunflower seeds, and all types of nuts
• Peanut butter (especially in spoonfuls or on soft white bread)
• Ice cubes and cheese cubes

Non-Food Choking Hazards

• Small toys or toy parts
• Marbles
• Balloons
• Coins
• Button batteries
• Small magnets

It’s important to note that while some toy and food manufacturers voluntarily label their products as potential choking hazards, any food or small object can present a risk. The shape, size, and consistency of an item play crucial roles in determining its choking potential.

Creating a Safe Eating Environment for Children

Preventing choking incidents requires creating a safe eating environment and adopting proper feeding practices. Here are essential guidelines to follow:

1. Never leave a child unattended while eating. Direct supervision is necessary.
2. Ensure children sit up straight when eating.
3. Assess a child’s developmental readiness for certain foods, considering their number of teeth and muscular ability to chew and swallow.
4. Provide calm, unhurried meal and snack times.
5. Discourage eating while walking, riding in a car, or playing.
6. Cut foods into small, manageable pieces. Steam vegetables to soften their texture.
7. Model safe eating habits and thorough chewing.
8. Offer plenty of liquids between mouthfuls, but avoid simultaneous consumption of solids and liquids.

How should foods be prepared to minimize choking risk?

Proper food preparation is crucial in reducing choking hazards. Consider the following techniques:

• Cut hot dogs lengthwise and widthwise
• Remove seeds and pits from fruits
• Grate or cook hard vegetables until soft
• Spread peanut butter thinly and pair it with jelly or cream cheese on whole grain bread
• Cut grapes and cherry tomatoes into quarters
• Avoid giving whole nuts or large chunks of cheese to young children

The Importance of Education and Community Awareness

Preventing choking incidents requires a collective effort from various stakeholders in a child’s life and the broader community. Pediatricians, family practice physicians, health care workers, parents, grandparents, daycare workers, school personnel, older children, siblings, and babysitters all play crucial roles in injury prevention.

Education should focus on:

• Recognizing potential choking hazards
• Understanding the developmental stages of children and their eating abilities
• Learning proper food preparation techniques
• Identifying emergency resources and contacts
• Mastering life-saving techniques

What life-saving techniques should caregivers learn?

To be prepared for potential choking emergencies, caregivers should become familiar with the following life-saving techniques:

• Child cardiopulmonary resuscitation (CPR)
• Abdominal thrusts (Heimlich Maneuver)
• Use of Automated External Defibrillators (AED)
• Proper procedure for calling emergency services (911)

Special Considerations for Children with Health Needs

Children with special health care needs are particularly vulnerable to choking risks. These children may have difficulties with swallowing, muscle control, or cognitive understanding of food safety. Parents and caregivers of children with special needs should:

• Consult with healthcare providers about specific dietary recommendations
• Be extra vigilant during meal times
• Consider using adaptive feeding equipment if recommended
• Ensure all caregivers are trained in the child’s specific feeding needs and emergency procedures

The Role of Legislation and Product Safety

Legislation like “J.T.’s Law” plays a crucial role in raising awareness and promoting choking prevention measures. However, product safety is also a significant factor in reducing choking risks.

How do manufacturers address choking hazards?

Manufacturers take several steps to address choking hazards:

• Toy manufacturers label products with choking hazard warnings based on size and age recommendations
• Some food manufacturers voluntarily label products that pose potential choking risks
• Product designs may be modified to reduce choking hazards (e.g., larger toy parts, changes in food shapes)

Despite these measures, it’s important to remember that any small object or food can potentially cause choking. Parental supervision and education remain the most critical factors in prevention.

Beyond Food: Addressing Non-Food Choking Hazards

While food is the most common cause of choking in young children, it’s crucial to address non-food choking hazards as well. Many household items and toys can pose significant risks if swallowed or aspirated.

What are some common non-food items that pose choking risks?

• Small batteries, especially button batteries
• Coins
• Marbles
• Small magnets
• Balloons (both inflated and uninflated)
• Small toy parts
• Pen or marker caps
• Small balls
• Hair beads or barrettes

To prevent choking on these items:

1. Keep small objects out of reach of young children
2. Regularly check the floor and low surfaces for small items
3. Choose age-appropriate toys and check them regularly for loose or broken parts
4. Be cautious with older siblings’ toys, which may contain small parts
5. Secure battery compartments on electronic devices
6. Dispose of broken toys and objects immediately

The Science of Choking: Understanding the Mechanism

Understanding how choking occurs can help in prevention and quick response. Choking happens when an object becomes lodged in the throat or windpipe, blocking airflow to the lungs. This can happen in two ways:

1. Mechanical obstruction: An object physically blocks the airway.
2. Laryngospasm: The vocal cords spasm and close the airway, often in response to an irritant.

Why is the size and shape of an object crucial in choking risk?

The size and shape of an object play a significant role in its choking potential:

• Objects that are round or cylindrical and about the size of a child’s airway pose the highest risk
• The trachea of a young child is approximately the diameter of a drinking straw
• Foods or objects that can conform to the shape of the airway (like hot dogs or grapes) are particularly dangerous
• Small, hard objects can become lodged in the airway and be difficult to dislodge

This understanding underscores the importance of proper food preparation and vigilant supervision to prevent choking incidents.

Recognizing and Responding to Choking Emergencies

Quick recognition and response are crucial in choking emergencies. Every caregiver should be able to identify the signs of choking and know how to respond appropriately.

What are the signs that a child is choking?

• Inability to cry or make much sound
• Difficulty breathing or noisy breathing
• Skin, lips, or nails turning blue
• Weak, ineffective coughing
• Soft or high-pitched sounds while inhaling
• Panic or distress signals (such as clutching at the throat)

If you suspect a child is choking:

1. For infants under 1 year:
   • Give 5 back blows between the shoulder blades
   • If unsuccessful, give 5 chest thrusts
   • Alternate between back blows and chest thrusts until the object is expelled or the infant becomes unconscious
2. For children over 1 year:
   • Perform abdominal thrusts (Heimlich maneuver)
   • Continue until the object is expelled or the child becomes unconscious
3. If the child becomes unconscious:
   • Start CPR immediately
   • Call emergency services if not already done

Remember, prevention is always better than response. By implementing proper safety measures and maintaining vigilant supervision, we can significantly reduce the risk of choking incidents in children.

Choking Prevention for Children

Choking Injuries and Deaths are Preventable!

Vacations should be a time for fun. Unfortunately this was not the case for one New York family. “J.T.” died after choking on a hot dog while on vacation. In response to this preventable death, New York State enacted legislation to help parents, caregivers and providers recognize common choking hazards for children and prevention tips. The choking prevention legislation is known as ” J.T.’s Law”. The following information is provided to help educate parents, caregivers, and providers about how to prevent choking incidents and possible deaths.

• Choking is the fourth leading cause of unintentional death in children under the age of 5.
• Children under age 5 are at greatest risk for choking injury and death.
• Toys, household items and foods can all be a choking hazard.
• The most common cause of nonfatal choking in young children is food.
• At least one child dies from choking on food every five days in the U. S., and more than 12,000 children are taken to a hospital emergency room each year for food-choking injuries.
• Toy manufacturers label toys for choking hazards and some food manufacturers voluntarily label food products as posing a potential choking risk; however, any food can present a choking risk.
• Education regarding choking risks, precautions to take in avoiding these risks, and known life saving procedures are necessary to eliminate senseless and tragic injuries and deaths caused by choking.
• Pediatricians, family practice physicians, health care workers, parents, grandparents, day care workers, school personnel, older children, siblings, babysitters and communities as a whole play a key role in the prevention of injuries and need to share information with caregivers to identify potential choking hazards.
• The size of a young child’s trachea (windpipe) or breathing tube is approximately the size of a drinking straw in diameter. Imagine a piece of popcorn being lodged in this small area!

Precautions and Prevention

• 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. Remember, not all children will be at the same developmental level. Children with special health care needs are especially vulnerable to choking risks.
• 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.
• Model safe eating habits and chew food thoroughly.
• 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.
• Pay particular attention to those foods, toys and household hazards mentioned that pose choking hazards to ensure child safety.
• Educate caregivers and the community about choking hazards and precautions to take to prevent choking. Identify emergency resources and contacts.
• Become familiar with life-saving techniques such as child cardiopulmonary resuscitation, abdominal thrusts (Heimlich Maneuver), Automated External Defibrillators (AED) or calling 911.

Choking Hazards

Foods:

• Hot dogs (especially cut into a coin shape), meats, sausages, and fish with bones
• Popcorn, chips, pretzel nuggets, and snack foods
• Candy (especially hard or sticky candy), cough drops, gum, lollipops, marshmallows, caramels, hard candies, and jelly beans
• Whole grapes, raw vegetables, raw peas, fruits, fruits with skins, seeds, carrots, celery, and cherries
• Dried fruits, sunflower seeds, all nuts, including peanuts
• Peanut butter, (especially in spoonfuls or with soft white bread)
• Ice cubes and cheese cubes
• Foods that clump, are sticky or slippery, or dry and hard textured
• Food size and shape, especially round or a shape that could conform to the shape and size of the trachea (windpipe). The size of a young child’s trachea (windpipe) or breathing tube is approximately the size of a drinking straw in diameter.
• Combinations of food size, texture, and shape can pose a threat. For example, a slippery hard candy with a round shape about the size of a drinking straw could block an airway (windpipe)

Household Items/Toys:

• Latex balloons, coins, marbles, toys with small parts, small balls, pen or marker caps, button type batteries, medicine syringes, screws, stuffing from a bean bag chair, rings, earrings, crayons, erasers, staples, safety pins, small stones, tiny figures, and holiday decorations including tinsel, or ornaments and lights
• Any toy or other object that is labeled as a potential choking hazard

Remember: Choking Injuries and Deaths are Preventable!

Helpful Resources/Websites

• Choking Hazard Product Recalls
• Cardiopulmonary Resuscitation Equipment Required in Restaurants, Bars, Theatres and Health Clubs (PDF)
• First Aid Choking Poster (PDF, available in English and Spanish)
• New York State Division of Consumer Protection
• American Academy of Pediatrics Choking Prevention
• US Consumer Product Safety Commission, CPSC recall hotline choking hazard number 1-800-638-2772
  
• Child Food Choking Prevention
• JT’s Law Foundation
• JT’s Law – Child Food Choking Prevention Act

Common choking hazards and how to avoid them

Written By: Simone Sonnier, UT Physicians | Updated: August 31, 2021

It’s every parent’s or caregiver’s worst nightmare — seeing their child struggle to breathe. Unfortunately, it’s all too common, according to the American Academy of Pediatrics. Food-related choking causes the death of approximately one child every five days in the U.S.

Pediatric experts from UT Physicians and UTHealth break down common choking hazards and how to keep your child safe from them.

Food and snacks

Some food or snack items are considered high risk for choking due to their size, preparation, or consistency. Children under 4 years old are still learning how to chew and swallow foods properly and their airways are small and narrow.

Sandra L. McKay, MD

Sandra L. McKay, MD, pediatrician with UT Physicians, recommends parents carefully prepare these common choking hazards:

• Grapes
• Hot dogs
• Cherries
• Cherry tomatoes
• Carrots

“I always recommend parents cut food into quarters, not halves,” said McKay, associate professor of pediatrics at McGovern Medical School at UTHealth. “That way, if a child forgets to chew enough or they take too big a handful, they can swallow more easily and without choking.”

Although some foods can be prepared by serving a safe portion size, McKay does suggest avoiding nuts, hard candies, and popcorn until 5 years of age.

Another way to stay safe during meal or snack time is to eat at the table and supervise children while eating. Sitting down for meals is safer, promotes better nutrition, and is an important family time that contributes to child development.

“Letting your child walk or crawl while eating is not recommended,” said McKay. “I know there are many products on the market for on-the-go eating, but food should be limited to table-time.”

Household items

While food does account for the majority of choking incidents among children, small objects around the house can also be dangerous.

Mary E. Aitken, MD

“Button-sized batteries are the most lethal small object a child could swallow and choke on,” said Mary E. Aitken, MD, professor and Dan L Duncan Distinguished University in Pediatrics at McGovern Medical School.

These coin-sized batteries are found in many household objects, such as children’s toys or remote controls. When swallowed, they can become lodged in the esophagus of a small child. They can cause severe internal burns, serious injury, long-term disability, or even death.

Other items to be aware of around kids are deflated balloons, small toys, coins, pen or marker caps, and pet food.

To ensure a home is safe for little ones, Aitken recommends getting on a child’s level and crawling around to see what they see. This view can help identify risks and provide a safe environment for the exploration that is normal and important for a child’s development.

“Every day you have to childproof your home because every day your child is going to show you what you’ve missed,” she said.

Responding to an emergency

Choking hazard safety is broken down into prevention and response. Prevention includes watching what a child has access to and how their food is prepared and served. It is also critical to respond to an emergency should it happen.

“All parents and caregivers should know CPR and how to respond if a child chokes,” said Aitken. “If a child is choking and cannot breathe, 911 should be called immediately and families should perform choking first aid or possibly CPR based on how the child is responding.”

Depending on the age and size of a child, procedures for choking first aid and performing CPR can be different. For example, the Heimlich maneuver is appropriate in older kids but not small infants.

Many local and national organizations offer online or in-person classes to receive CPR and choking procedures training. Aitken recommends the American Red Cross and the American Heart Association for guidance.

For additional information on choking hazards, visit the Centers for Disease Control and Prevention’s page or the American Academy of Pediatrics’ page.

“These things stick with you when you see them because they can be devastating,” said McKay. “If parents or caregivers have any questions about child safety, please know that your pediatrician is there to help answer them for you.”

Scientists figured out why babies die from suffocation

Infants in the United States began to die from suffocation four times more often than in 1999, American scientists found. Most often this is due to blankets and pillows blocking the airways, most deaths occur in the first months of life.

Accidental strangulation is one of the leading causes of death for infants under one year of age in the United States. As experts from the Centers for Disease Control and Prevention, the University of Virginia and the DB Consulting Group found out, this is most often due to unsafe sleep. The study was published in the journal Pediatrics .

Researchers found that between 2011 and 2014, 250 babies suffocated in their sleep. More often they were boys – white or African American. Bedding was the cause of death in 69% of cases.

“Pillows, mattresses and blankets were the most common airway blockers,” the researchers note.

In 19% of cases, children slept with their parents or siblings and suffocated because they squeezed their throat or chest. 12% suffocated when stuck between two surfaces, such as a wall and a bed.

An analysis of infant mortality has shown that the rate of infant deaths from asphyxiation has almost quadrupled in recent years, from six deaths per 100,000 newborns in 1999 to 23 deaths per 100,000 newborns in 2015.

However, there is nothing surprising in this, says professor of pediatrics Rachel Moon from the University of Virginia.

“Every day I talk to parents who have lost children. They thought they were doing everything right, and their actions seemed safe to them until they led to the death of the child, ”she says.

The child’s risk of suffocation depended in one way or another on the child’s age. 68% of deaths caused by overly soft beds occurred before the age of one month, 71% – before two months. After seven months, no such deaths were recorded. The peak mortality from getting stuck between a crib and a wall was between five and eight months. 84% of deaths occurred in the children’s home.

The researchers also noticed that in 49% of cases when children suffocated while sleeping with someone, their mothers smoked before pregnancy. Among those who suffocated because of bedding, there were 36% of such people, among those stuck somewhere – 27%.

Those of the children who suffocated in a too soft bed were in their parents’ bed in 49% of cases at that time, in their own crib or cradle in 27%.

In 92% of cases, they were in a position other than the safest position – on their back, face up.

Most often, blankets blocked their airways, this happened in 34% of cases. Children also suffocated because of mattresses for adults and pillows.

When sleeping together, children in 47% of cases were strangled by mothers, in 25% by fathers, in 22% by brothers and sisters. In 41% of cases, the child slept with several people at once. 23% of adults who killed children admitted to using alcohol or drugs when they went to bed.

Trapped children died in 73% of cases in their parents’ bed, caught between a wall and a mattress or bed frame.

“The safest way for an infant to sleep is on its back, on a smooth surface, in a crib or cradle in the same room as a caretaker, without soft bedding (blankets, pillows, and other soft objects),” the authors conclude. . “Improving our understanding of the characteristics and risk factors for death from asphyxiation (such as age differences and the characteristics of the environment in which a child sleeps) can help develop more targeted strategies to prevent death.”

Previously, Australian specialists found out that brain malformations in infants may also be the cause of death from sleep apnea.

Using the method of autoradiography, scientists found that in children who died from sudden infant death syndrome, the mechanism of binding of substance P to the NK1R receptor was impaired. Substance P is a neuropeptide found in the brain and spinal cord, part of the nervous system, thyroid gland, skin and muscles. It affects, in particular, vasodilation, causes smooth muscle contraction and is responsible for the transmission of pain impulses to the central nervous system.

According to the researchers, the brain of an infant with this disorder is not always able to create a motor response to life-threatening moments that occur during sleep – for example, when a pillow or blanket closes the child’s airway.

Is it possible to “gorge yourself” to death?

Is it possible to contain so much food that you die? We used to joke about Americans’ problems with overeating, but what’s wrong with that? No one has died from eating three Big Macs. People have been more likely to die from eating three Big Macs twice a week for thirty years. But each of us found ourselves in a situation where, after three servings of salad, chicken, potatoes, bread, appetizers, sausages, mayonnaise, fish, another salad . .. “this dessert” didn’t fit in any way. Would you get in?

Gizmodo interviewed professional doctors who are seriously concerned about the problems of overeating and regularly experience bursting stomachs in their practice.

Chief Medical Officer John O. Clark, Stanford University School of Medicine:

“Feeding yourself to death is extremely difficult, but theoretically possible. It seems that stomachs burst often, but in reality this is a rare event – the stomach is much stronger than any other segment of the intestine and is able to expand. It’s great for large meals, but if you stretch your stomach too much, it will cause you to vomit. Therefore, although there have indeed been cases of stomach rupture, overeating to this extent is extremely rare, because the stomach expands rapidly and simply has time to escape from the critical pressure of food. The average person’s stomach expands by about a liter after any meal, but of course it can expand further. People who can eat fifty to sixty hot dogs usually have an extremely expandable stomach and, amazingly, they actually slow gastric emptying. It is not yet entirely clear why this is so. Perhaps the slow emptying of the stomach eliminates hunger to some extent, so they can continue to eat. In such situations, despite the massive amounts of food they ingest, none of them have ever had a stomach rupture.

Vomiting from overeating is much more common. There is, for example, Boerhaave’s syndrome, in which vomiting and strong movements of the esophagus can lead to a rupture of the esophagus. In my career, I have never seen a stomach rupture, but with Boerhaave’s syndrome, I have seen a couple.

There is another variant that is not quite similar to a rupture – the Mallory-Weiss rupture, when the esophagus is torn at the gastroesophageal junction. It can cause significant bleeding, although not such that the person bleeds to death on the spot. But if it happened away from medical care, theoretically you could die from it.

In theory, if you overeat something high in a metal or mineral that could overdose, you’d be in trouble. Personally, I have not seen this in practice, but a friend told me that someone ate a huge amount of lobster – three kilograms – and ended up in the hospital with iodine poisoning. But you would have to eat a lot of really high mercury or iodine foods or anything that is usually found in trace amounts.”

Chief Physician Barbara Young of the University of Illinois:

“In the long run, definitely: you can feed yourself to death. The rise in obesity among the populations of developed countries is a clear sign. The high mortality rate we have in the United States is directly related to obesity, either from complications caused by obesity or related problems – cardiovascular disease, cancer, and so on.

If people are worried about not dying from a festive feast: you must understand that the body wants to live, so it will tell you when it’s enough and when you can no longer eat anything. Very few people will be able to overcome themselves and continue to eat, because it is hard.

You could die from overeating if the temperature of the food was too low and you simply became supercooled by swallowing a large amount of cold food. Or if you ate much more than your stomach can hold. Food goes to the stomach, passing through the intestines, and if the stomach is full, it can only move up, that is, in the opposite direction. Complications caused by vomiting may include choking (when food enters the respiratory tract) or bleeding associated with a ruptured esophagus. But this happens very rarely, because the body regulates itself and does not want to overeat.

Merlin Butler, Professor of Psychiatry, Behavioral Science and Pediatrics at the University of Kansas Medical Center:

of people. This is a rare disease – maybe about 400,000 people around the world suffer from it.

Individuals with Prader-Willi syndrome go through two main clinical stages. The first stage is the inability to develop normally: they are born very weak, with reduced fetal activity. They are also hypotonic, which leads to different feeding.

This goes on for several months, up to a year, maybe longer, and then their appetite starts to grow. It grows extremely – hyperphasia develops. The body gets fat quickly. Everything that comes to hand is eaten until a person falls asleep or his stomach bursts. Gastric rupture is a common cause of death in Prader-Willi syndrome. This is the main feature.

Often they are placed in a controlled environment with a strict diet so they don’t have access to food and their stomachs get smaller. And then it can happen that they overeat, and their stomach will be like shriveled prunes: they overeat, and the stomach bursts.

They know that they are overeating because they have been restricted in food, but they continue to eat and do not feel full. The brain says, “I’m hungry, I’m hungry, I’m hungry,” but it doesn’t say, “I’m full, I can’t eat anymore.