In the United States alone, a child chokes to death every five days. That’s right, 73 children die annually because they choke on food. Further, over 10,000 children, a majority of whom are four years old or younger, are rushed to emergency rooms every year the result of choking on food.
Because of their immature swallowing control, lack of a complete set of molars (which usually fully develop at age six), rare ability to sit still while eating, and poor coordination to protect their breathing passages, young children are the group most frequently affected by food choking, although there are cases in older children as well. Choking on food is one of the leading causes of accidental injuries in the home for this age group, and it is the fourth leading cause of accidental death in kids under age 14 years.
The toddler years are a time when a child gains more independence from parents and caregivers. Since toddlers are playful, adventurous, and rarely like to sit still, safe eating is not on their minds. But it should be on ours. Unfortunately, parents and caregivers do not have access to established guidelines regarding food safety in children. While we can go into any toy store and find labels for safety, ‘small-parts’, and a toy’s suitability based on the ‘age’ label, there is virtually no such guidance in grocery stores.
The Child Safety Protection Act of 1994 mandated that the Consumer Product Safety Commission place choking hazard labels on all toys intended for children under age six years if they contain small parts, and on all balloons and marbles intended for all children. Although the number of choking-related injuries in US children is greater for food items than non-food items, there is no similar mandate for food choking risks. While the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) give specific guidelines and recommendations regarding which foods to avoid for young children, there are no legislative guidelines in place.
The Food and Drug Administration (FDA) investigates foods that pose an unusual choking hazard and will periodically issue a recall or special labeling — in 2001, for example, the FDA banned mini-cup gel candy for causing one pediatric death and two near-deaths over a short-term period — this occurs infrequently and does not include common ‘kid friendly’ foods.
Preliminary research is now underway to develop a set of specific guidelines for food-choking risks in infants and young children, in order to reduce morbidity and mortality from these devastating, preventable events. Once guidelines are established in the research sector, the information will provide data for policy discussions related to food safety labeling. Naturally, this work is not being encouraged by the food product industry, and therefore must be carried out in a methodical, evidence-based manner within academia.
Until guidelines are developed and food labeled, here is a list of foods that the AAP (with some additions) considers to be choking hazards for children under three years old:
1. Hot Dogs (unless cut lengthwise, and then in half-circle or quarter-circle shapes) (These are one of the few foods that may occasionally have vague choking risk labeling.)
2. Any nuts of any kind; children do not have the teeth to properly pulverize them and thus prevent choking.
3. Seeds; especially those with shells, such as sunflower seeds or pumpkin seeds
4. Whole grapes; these may be peeled, a la Ancient Rome, and then cut into quarters
5. Popcorn
6. Raw vegetables
7. Chewing gum
8. Hard candy/taffy/caramel
9. Lollipops, especially spherical shaped suckers.
We’ve all fed our kids some of the items from the list above. It’s not worth the risk. As an airway doctor, I’ve treated kids who have choked on all of these items. Even older kids (and adults, for that matter) can choke on food but the risk drops dramatically once molars are fully developed.
If your child chokes on a foreign object, whether it’s food or not, first assess whether or not he’s crying or coughing. These are signs that your child’s airway is NOT completely blocked. Let him try to clear the object on his own. If he has choked, and is not able to make any sound, the object is blocking his airway. First attempt the Heimlich maneuver. To perform this, stand behind your child, wrap your arms around his upper belly area, grasp your hands together, and give five quick thrusts in an inward/upward direction. If your child is under one year, place him on your lap with his belly on your knee, and give five back blows.
If he begins coughing or crying, the object may be partially or completely dislodged. Do not continue the maneuver, but see if he can clear the object on his own. If he continues to be unable to make a sound, and is not breathing, begin CPR. If you are with someone, have him or her call 911. If you are alone, perform CPR for two minutes, and then call 911 and resume CPR after the phone call.
If you have ANY questions about food safety, check with your doctor, if they don’t have an answer, err on the side of caution. Public awareness of food safety is in its own infancy. Hopefully, in time, it will become as routine and sunscreen and car seats.
For more information about the gel candy incident: http://www.usatoday.com/money/consumer/2001-08-16-candy.htm
For illustrated steps on how to perform the Heimlich maneuver on:
A conscious child under the age of one, http://www.nlm.nih.gov/medlineplus/ency/presentations/100221_1.htm
For a conscious child or adult over the age of one,
http://www.nlm.nih.gov/medlineplus/ency/presentations/100222_1.htm
For an unconscious adult,
http://www.nlm.nih.gov/medlineplus/ency/imagepages/17172.htm
About the Author:
Nina L. Shapiro, MD
Director of Pediatric Otolaryngology, Mattel Children’s Hospital UCLA Associate Professor of Head and Neck Surgery, UCLA School of Medicine and Author of “Take a Deep Breath: Clear the Air for the Health of Your Child†.
