Top 10 food choking hazards for kids

With two young children, meal time prep usually involves cutting food into small pieces to avoid any potential chozing hazards. Despite my best efforts, there have been some near choking incidents – my 1-year-old stuffing too much fruit in her month at once and my 3-year-old swallowing meat that wasn’t chewed well enough. Luckily for me, coughing cleared things up.

A study in Pediatrics released online today captures how common non-fatal food choking incidents are for children. Almost 112,914 children from ages 0 to 14 years had a nonfatal food-related choking episode that required a trip to the emergency room from 2001 to 2009. That’s an average of 12,435 children per year or 34 children per day.

In fact, choking is a leading cause of injury among children, and can sometimes be fatal, especially in children 4 years of age or younger. The size, shape, and consistency of certain foods make them more likely to be a choking hazard for these kids. In the study, infants under the age of 1 accounted for 37.8 percent of all the choking cases.

Here's the list of foods that caused the most choking incidences. The first four food types accounted for more than half of choking episodes with a known food type.

  1. hard candy
  2. other candy
  3. meat other than hot dogs
  4. bone
  5. fruits and vegetables
  6. formula/breast milk/milk
  7. seeds/nuts/shells
  8. chips/pretzels/popcorn
  9. biscuits/cookies/crackers
  10. multiple specified foods
  11. hot dogs

Certain foods posed more of a hazard to a particular age group. For example, babies had the most incidents of formula/milk/breast milk choking. By age 4, 55.2 percent of choking episodes involved candy.

We asked study senior author Gary A. Smith MD, DrPH, a professor of pediatrics, emergency medicine and epidemiology at The Ohio State University;  president of the Child Injury Prevention Alliance; and director of the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital, to tell us more about the study’s findings.

What should parents take away from this study?

First, parents should know that choking on food is common among young children, but there are ways to prevent it.

The study points to several things that we can do based on recommendations by the American Academy of Pediatrics. These include children under 4 years of age should not be given hard candies or gum, and raw fruits and vegetables should be cut into small pieces. 

Kids don’t master proper chewing and swallowing until they’re at least 4-years-old. In addition, kids can be easily distracted and are active, which can contribute to the risk of choking. Therefore, young children should be supervised while eating, should eat sitting down, and should never run, walk, play, or lie down with food in their mouth.

Why was it important to look at just non-fatal choking incidences?

This is the first nationally representative study to focus solely on nonfatal pediatric food-related choking treated in US emergency departments over a multiyear period.

When studying the causes of injury, we must examine the entire spectrum of severity, including the near misses, and not just the deaths.  All of the cases in this study resulted in an ER visit, and in some cases, the child required an operation where a piece of food was removed from the lungs under general anesthesia via bronchoscopy.

Some children with near-miss choking episodes may have had a life-threatening blockage of the airway – they may have been unable to breathe or make a sound and turned blue from lack of oxygen, but a Heimlich or other rescue maneuver saved them. Grapes and hot dogs are especially high risk foods because they are the perfect size and shape to completely block a young child’s airway.

The study notes high risk food items for choking don't have the same regulations as toys that are choking hazards. What accounts for this?

We have known for at least three decades that foods and toys that pose a high choking risk for young children often share common characteristics. We’ve done a great deal to prevent choking on toys with laws and regulations, and a very good data surveillance system to monitor injuries, but we have done none of that to prevent choking on food, even though kids are more likely to choke on food than a toy.

I often show people a rubber ball and a gum ball, which are identical in size and shape and would be life-threatening if they lodged in the back of a child’s throat during a choking episode. The rubber ball cannot be legally marketed for use by children under the age of 3 years because of its high choking risk. However, the gum ball is available at many corner convenience stores by simply dropping a quarter into a machine.

We hope that the findings of this study will encourage government agencies, injury prevention experts, child advocacy groups (such as the AAP), and industry representatives to work together to develop and implement strategies to prevent pediatric choking on food. No one wants to see an injury or have a child die. I think that all parties share a common goal.

There are some man-made foods that present a high choking risk to young children that can be redesigned to be made safer. An example is the safety lollipop, which is a flat candy with a looped handle, rather than the higher-risk round lollipop on the end of a stick. Other high-risk foods, that cannot be redesigned, should have appropriate labeling to give parents more information at point of purchase.

What should a caregiver do when he/she suspects a child is choking?

If a child is coughing and can move air, the best thing to do is leave them alone. The cough is more likely to expel the food than any rescue maneuver.

You have an emergency if the child is not able to move air adequately, has difficulty speaking, or is turning blue. In this situation, for infants, you would immediately perform back blows and chest thrusts. You would use the Heimlich maneuver for children 1 year of age and older. Contact 911, and continue these rescue attempts until you are successful in expelling the food blocking the airway and restoring breathing or until emergency medical service personnel arrive.

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