Choking prevention

Many foods and other objects that fit in a child’s hand can cause severe choking or internal burns!

Choking -- what are the risks?

Dr. Jeffrey Ludemann, Otolaryngologist (Ears, Nose and Throat Specialist) at BC Children’s, has seen his share of families traumatized by choking.

From 1997 to 2003, BC Children’s Otolaryngology Department performed rigid bronchoscopy on 145 children who had aspirated food and non-food items into their airways; and rigid esophagoscopy on 185 youngsters who had swallowed foreign bodies. While the most common offenders were coins, nuts, and raw carrots; the most dangerous recent choking episodes occurred with grapes and disc batteries.
Dr. Ludemann warns, “uncut hot dogs, whole grapes, gel candies, balloons, disc batteries and household cleaners can all cause catastrophic choking, resulting in death or permanent disability. Children under two years of age are at greatest risk, but choking can occur at any age.”

“Many parents are unaware of the risks certain foods pose to young children,” says Dr. Ludemann. “To address this, we have developed practical guidelines for safer feeding of young children.”

What types of food can cause choking?

Dangerous foods can be grouped in four categories:

Crisp, crunchy foods

These include peanuts and other nuts, raw carrots and celery, popcorn kernels, sunflower seeds, fruits with pits, dried peas and beans. These foods can cause a severe coughing fit and end up in the bronchi (breathing tubes for the lungs), causing wheezing and eventually pneumonia.

Don’t introduce these foods to children until they are at least three years old and can chew and swallow crusty bread and raw apple and pear without coughing. Never give unpopped popcorn kernels to a toddler.

Round and rubbery foods

These include hot dogs, whole grapes and gel candies (such as “Fruit Poppers”), which are the most deadly foods. They can become stuck between the vocal cords and completely block breathing.

Cut hot dogs and grapes lengthwise and into small pieces until children are at least four years old and can chew and swallow steak without coughing. Avoid gel candies, which are banned but still available in certain stores in Canada.

Gum and hard candies

These can be inhaled and get stuck between the vocal cords.

Don’t give children gum or hard candies until they are at least five years of age and can understand the danger.

Fish bones (and other small bones)

Small and fine bones can become stuck higher in the throat and cause severe pain.

Carefully pick out bones before serving fish and poultry.

How can I keep my child safe at mealtimes?

Children are less likely to choke if they chew food thoroughly before swallowing. Teach children to sit quietly during meals and always supervise them while they eat. These activities will put your child at high risk for a choking episode:

Talking, laughing or walking, running, jumping with food in the mouth
Unsupervised snacking
Incomplete chewing
Tipping chairs backwards

Which non-food items cause choking?

It’s not only foods that pose a choking hazard. Common non-food risks include:

Small hard objects

Examples of these include plastic toy parts, metal hardware and fishing tackle. They can cause coughing fits and end up in the bronchi.

Teach children not to put non-food objects in their mouths and not to hold them between their lips or teeth. Keep these objects out of reach of young children.

Coins

These are the most common foreign bodies. Coins can become stuck in the esophagus (swallowing tube) and can cause pain and often drooling and retching.

Teach children to keep coins out of their mouths. Never store coins in open bowls or containers that are within reach of toddlers.

Disc batteries

Like coins, disc batteries are tempting to young children. However, they are much more dangerous because they cause severe internal burns and even death.

Keep toys and electronics with removable disc batteries away from young children. Store unused or discarded batteries where children cannot find them.

Balloons

Deflated balloons can become stuck between the vocal cords and completely stop a child’s breathing. Keep deflated balloons away from all young children.

Dishwasher powder and caustic liquids

Most household cleaners and hair straightners or relaxers can cause severe burns of the swallowing and breathing passages. Not all are marked with warning labels. Keep all caustic substances out of reach of children.

How can I prevent choking?

Remember choking deaths in children are mainly caused by foods and small objects such as gel candies, hot dogs, grapes, balloons, disc batteries and handfuls of nuts. Follow these simple steps to prevent choking:

Keep a careful eye on the child during meals and snacks
Introduce new food textures slowly and carefully
Check for small items of any type that a child may choke on
Choose toys that are labeled appropriate for the age of your child
Teach older siblings NOT to give small items or toys to younger children
Know how to give first aid to a choking child

If you suspect that a child has choked on an object, please explain that to medical personnel as soon as possible. Bring an example of the foreign body if possible. A Heimlich maneuver is necessary only if someone is unable to speak clearly and is turning blue.

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PHSA improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners. For more information, visit http://www.phsa.ca

PHSA agencies include: BC Cancer Agency, BC Centre for Disease Control, BC Children’s Hospital and Sunny Hill Health Centre for Children, BC Mental Health & Addiction Services, BC Provincial Renal Agency, BC Transplant, BC Women’s Hospital & Health Centre, and Cardiac Services BC.