Food choking hazards in child care

The Center for Disease Control and Prevention (CDC) conducted a study of choking episodes treated in hospital emergency departments during 2001. They found of the estimated 17,537 children aged 14 years old or younger who were treated for nonfatal choking, more than half (59.5%) were treated for food-related choking.  Furthermore, the CDC report indicates that choking rates were highest among infants, and decreased consistently with increasing age.  Almost one-third of choking episodes occurred among infants, and more than three-fourths occurred among children age 3 years or younger.

The American Academy of Pediatrics (AAP) outlines that choking on food poses an important and relatively under-addressed problem for U.S. children.  Approximately 66 to 77 children younger than 10 years old die from choking on food each year in the United States.  AAP further reports that choking is a leading cause of morbidity, and mortality among children, especially those who are 3 years old or younger.

Causes of food-related choking depend on a number of factors.  According to the AAP, “Despite a strong gag reflex, a young child’s airway is more vulnerable to obstruction than that of an adult in several ways.  The smaller diameter is more likely to experience significant blockage by small foreign bodies. Resistance to air flow is inversely related to the radius of the airway to the fourth power, so even small changes in the cross-section of the airway of a young child can lead to dramatic changes in airway resistance and air flow. Mucus and secretions around a foreign body in the airway will reduce the radius of the airway even further and may also form a seal around the foreign body, making it more difficult to dislodge by forced air, such as with a cough or Heimlich maneuver. The force of air generated by a cough in an infant or young child is less than that in an adult; therefore, a cough may be less effective in dislodging a complete or partial airway obstruction during early childhood.”

Steps to help reduce the likelihood of a food related choking event at your center include:

• Know high-risk foods that can most likely cause a child to choke.  Hard candy, peanuts/nuts, seeds, whole grapes, raw carrots, apples, popcorn, chunks of peanut butter, marshmallows, chewing gum, sausages, and hot dogs.  Hot dogs are the food most commonly associated with fatal choking among children.  Small spaghetti meatballs are another food to have on the watch list.
• Foodservice staff must be vigilant with the identification and removal of small food items that may cause a child to choke.
• Remind staff to closely supervise children, with particular focus on the vulnerable age group of 3 years old or younger.
• Designate specific staff members to call 911 immediately when any potential choking episode occurs.  Don’t wait to see if you can clear the airway first, as this may be too late. Without oxygen, brain damage can occur in as little as 4 to 6 minutes.
• Don’t just certify in CPR; also learn proper procedures on how and when to execute abdominal thrusts on someone that may be choking.  Then practice both frequently.  Practice helps to support your ability to respond should an emergency strike.

References

Policy Statement – Prevention of Choking Among Children,  Pediatrics Official Journal of The American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention, Pediatrics: February 22, 2010; DOI: 10.1542/peds.2009-2862

Nonfatal Choking-Related Episodes Among Children – United States, 2001. Morbidity and Mortality Weekly Report, 25 Oct. 2002./ Vol. 51/ No.42