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.