UCLA surgeon Dr. Nina Shapiro notes that most parents are totally unaware that their children’s favorite foods can pose choking hazards. She describes a typical case. Fifteen-month old Landon Jones was walking around eating a handful of nuts when a cashew became lodged in his bronchi (wind passage to his lung) causing wheezing and coughing. His mother explained, “At the time, Landon had a cold so it was not obvious if the coughing was related to his illness or choking.” recalled his mother, Ula Jones. Eventually, the nut in his bronchi was detected by his doctor and had to be removed in a delicate surgery under general anesthesia. Fortunately, the toddler made a full recovery.
“Landon’s situation is surprisingly common,” explained Dr. Shapiro, a professor of head and neck surgery at the David Geffen School of Medicine at UCLA and the director of pediatric ear, nose and throat at Mattel Children’s Hospital UCLA. She added, “In many kids, the food object passes down to their bronchi where it gets lodged and they present with coughing, wheezing, or even what might appear to be pneumonia. At first, it is not always clear that the child has had a choking incident.” She explains that food, not toys that cause most choking accidents in children under five years of age. More than 10,000 children visit emergency rooms each year due to choking on food. While most of these incidents are not fatal, one child dies every five days from a food-choking accident. This is primarily due to the child’s anatomy.
Dr. Shapiro explained, “Young children have underdeveloped swallowing mechanisms, immature teeth, and narrow airways which put them at a higher risk for choking on food. Plus, the diameter of a child’s airway is about the size of their pinky, so high-risk foods can easily block their tiny airways and prevent their ability to breathe.” If a child does choke and is unable to breathe, call 9-1-1 and perform the Heimlich maneuver. The Heimlich maneuver can be used safely on both adults and children; however, most experts do not recommend it for infants less than one year of age. You can also perform the maneuver on yourself. For a conscious person who is sitting or standing, position yourself behind the person and reach your arms around his or her waist. Place your fist, thumb side in, just above the person’s navel (belly button) and grab the fist tightly with your other hand. Pull your fist abruptly upward and inward to increase airway pressure behind the obstructing object and force it from the windpipe. If the person is conscious and lying on his or her back, straddle the person facing the head. Push your grasped fist upward and inward in a maneuver similar to the one above. You may need to repeat the procedure several times before the object is dislodged. If repeated attempts do not free the airway, seek immediate medical attention.
Dr. Shapiro note that even if the child seems to choke but then coughs and appears to be fine, the object may have become lodged and the child should see a physician. She provides a list of high risk food and explains, “The good news is that not all high-risk foods should be completely avoided. Many are healthy for young children, as long as they are served in the right form.”
The list of high-risk foods for children under age 5 years includes many of children’s favorites:
- Cheese sticks
- Chewing gum
- Chunks of meat or cheese
- Chunks of peanut butter
- Chunks of raw vegetables
- Dried fruit
- Hard or sticky candy and lollipops
- Hot dogs
- Seeds such as pumpkin seeds and sunflower seeds
Dr. Shapiro offers some helpful food preparation tips:
- Vegetables should be cooked and cut into small pieces.
- Hot dogs and cheese sticks should be cut lengthwise, then widthwise, and then into the shape of small moons.
- Grapes should be peeled and cut in half or quarters.
- Nut butters should be spread thinly onto crackers or bread.
- Young children should always be attended to by an adult when they eat and only eat developmentally appropriate foods.
- Children should sit up straight and not play or run while eating.
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