All attentive parents spend great effort looking after their children. It is especially tragic then, when a threat to life comes from something common and seemingly harmless. In the US, choking is the fourth-leading cause of unintentional deaths in children under age 5. Every five days, at least one child dies after choking on food. In Thailand, national estimates are not available, but a recent study identified choking as a top cause of unintentional death. The trachea (windpipe) of a young child is about the width of a drinking straw, and if food or a small object is inhaled, it can block the airway. After just four minutes without oxygen, a child’s brain can be permanently damaged.
Prevention is Key!
At playgrounds and parks, it is common to see parents, grandparents and nannies giving children various snacks and candies and then allowing them to immediately run back to their activities — while still chewing. This is a disaster waiting to happen! A child should not get up from the table until her food has been thoroughly chewed and her mouth is empty, and snacks should never be eaten while playing. A child should not eat in a moving vehicle, either. If the driver stops short or the vehicle is bumped from behind, the sudden lurch may cause a child to inhale food or to swallow it unchewed.
Food accounts for the majority choking cases, and almost any food can become a choking hazard. Some foods are worse than others. Hot dogs, meats, sausages, fish with bones, cheese cubes, popcorn, chips, pretzel nuggets, hard candy, gum, lollipops, jelly beans, marshmallows, whole grapes, raw vegetables, cherry tomatoes, nuts, peanut butter (especially eaten from a spoon or on soft bread) and even ice cubes can easily cause choking. Grapes should be halved for a young child, and hot dogs should be cut lengthwise for a child until at least age 4. Parents should always supervise meals and snacks when babies and children feed themselves.
Objects cause about one-third of choking cases in children. Among the most common offenders are coins, buttons, marbles, small balls, deflated balloons, watch batteries, jewelry, pen caps, paper clips, arts and crafts supplies, small toys and detachable toy parts. Keep in mind that toys and games that are safe for an older sibling may not be for a younger brother or sister. Keep toys meant for older children away from younger ones.
What to do if a child is choking
It is critical to know what to do if a child appears to be choking. This is why it is so important that all parents take a First Aid and CPR class. I teach First Aid and CPR regularly and I encourage all parents who have never taken a First and CPR class, to do so in 2014!
If the child can cough, speak or cry, the airway is not completely blocked. Encourage the child to cough, and if that fails to dislodge the object, call an ambulance or rush the child to the emergency room, whichever is faster. Always keep the number of the hospital in your mobile phone and also on the refrigerator in your home.
If a choking baby can make little or no sound, ask someone to call an ambulance (if you are alone, attempt a rescue for two minutes before calling). Place the baby face down over your arm with the head lower than the chest and support the baby’s head with your hand. Then, using the heel of your other hand, give five quick blows between the shoulder blades. If no object is dislodged, turn the baby face up on a firm surface, place the heel of your hand in the middle of the breastbone just below the nipples and give five quick thrusts. Repeat this sequence until the baby begins breathing or help arrives. If breathing is not restored within a few minutes, CPR needs to be applied.
For a child over 1 year of age who is choking, stand or kneel behind the child and wrap your arms around her. Make a fist and place it just above the navel. Grasp the fist with the other hand, and make quick upward thrusts with it. Repeat until the object is dislodged or the child begins breathing. A physician should examine any child who required a choking rescue afterward.
Tips for CPR on the Very Young
A baby or child who cannot breathe and loses consciousness — because of choking, an accident or any other reason — will need CPR modified for the young. If you are alone, perform CPR for two minutes before stopping to call the ambulance.
- Place an infant face up on a firm surface. Place two or three fingers at the center of the baby’s chest, just below the level of the nipples. Give 30 gentle chest compressions at the rate of at least 100 a minute. Each should depress the chest about an inch and a half (~4 cm).
- Then tilt the baby’s head by lifting the chin; cover the baby’s nose and mouth with your mouth and give two short, gentle breaths. Look to see that the chest rises with each breath.
- Continue this cycle until the baby starts breathing or help arrives.
- For an unconscious older child, place the heel of one hand on the breastbone, just below the level of the nipples. Administer 30 fast and hard chest compressions, depressing the chest about two inches each time
- Then lift the chin with one hand, place the other hand on the forehead to tilt the head back, pinch the nose and put your mouth tightly over the child’s mouth. Give two breaths, each for one second, to make the chest rise.
- Repeat this sequence until the child resumes breathing or help arrives.