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SALEM COMMUNITY HOSPITAL...Advice to prevent choking in children

February 26, 2012
Salem News

Every five days, a child in the U.S. chokes to death while eating, according to the Centers for Disease Control and Prevention (CDC). Even more children die after swallowing items like balloons and small toys.

"When children begin crawling or eating table foods, parents must be aware of the dangers and risks of choking," explained Board certified Pediatrician Laurie Penix, M.D. "Choking occurs when food or small objects get caught in the throat and block the airway. This can prevent oxygen from getting to the lungs and the brain. When the brain goes without oxygen for more than four minutes, brain damage or even death may result.

"Most of the time, the food or object only partially blocks the airway and it's likely that it will be coughed up. A child who seems to be choking and coughing but is still able to breathe and talk probably should recover without assistance within a few seconds."

Hot Dogs, Balloons Most Deadly

"Objects such as safety pins, coins and small toy parts cause choking, but latex balloons and food are responsible for most incidents," Dr. Penix said. "What makes certain foods more dangerous is their shape and size. For example, after latex balloons, hot dogs pose the highest choking risk due to their shape, which is similar to a child's airway."

According to the American Academy of Pediatrics (AAP), the following foods are high risk, which means that children under 4 years old should not eat them:

-hot dogs or sausage

-hard, gooey or sticky candy

-peanuts, nuts, seeds, whole grapes

-chunks of meat or cheese


-chunks of peanut butter


-chunks of raw fruits or vegetables (such as carrots or apples)

-?chewing gum

Besides food size and shape, the quantity of food should also be considered to prevent choking. "If you put 20 Cheerios on a baby's tray, he's going to try to scoop them up and swallow them all at one time," Dr. Penix warned. "It's best to limit the quantity to one or two bite-sized pieces that are no larger than inch in size."

The AAP has also identified these non-food objects as choking hazards: coins, buttons, marbles, deflated balloons, small batteries (like those found in watches), jewelry, paper clips, small toys and toys with detachable parts.

What Parents Can Do To Prevent Choking

"Don't give your child round, firm foods unless they are chopped completely," Dr. Penix advised. "Cut or break food into bite-size pieces, no larger than inch, and encourage your child to chew thoroughly.

"Supervise mealtime for your infant or young child. Older brothers and sisters are often not aware of what foods may cause a younger sibling to choke.

"Don't let your child eat while playing or running. Teach your child to chew and swallow food before talking or laughing.

"In addition, parents should keep balloons, coins, marbles, buttons, batteries, pen or marker caps, and toys with small parts away from children. Manufacturers often indicate the appropriate age range of a toy on the box to convey safety hazards and not the toy's level of sophistication.

"Lastly, because it is impossible to prevent all choking episodes, parents can prepare for emergencies by learning CPR and choking first aid. In addition, they may want to check with school and day care providers to see if their staff has been trained."

When Choking Can Be an Emergency

If a child is choking and coughing but can breathe and talk and the airway is not completely blocked, it's best to watch the child carefully and make sure he or she recovers completely. The child will likely be fine after a short coughing spell.

"In this case, don't reach into the mouth to grab the object or even pat the child on the back," Dr. Penix warned. "Either of these steps could push the object farther down the airway and make the situation worse. Stay with the child and remain calm until the episode passes. If your child had an episode that seemed like choking but fully recovered without assistance after a coughing spell, there is no need to seek immediate medical care."

A child may be choking and need help right away if he or she:

-is unable to breathe or is gasping or wheezing

-is unable to talk, cry, or make noise

-turns blue

-grabs at his or her throat or waves arms and appears panicked

-becomes limp or unconscious

In these cases, immediately start abdominal thrusts, known as the Heimlich maneuver, if you've been trained properly to do them. Call immediately for emergency medical help.

It is also recommended to seek emergency medical care after a choking episode for a child if:

-there is a persistent cough, drooling, gagging, wheezing, difficulty swallowing or difficulty breathing;

-the child turned blue, became limp, or was unconscious during the episode, even if he or she seemed to recover;

-you think the child has swallowed a foreign object like a toy or battery.

Laurie Penix, M.D., is a board certified pediatrician affiliated with Salem Community Hospital's medical staff. Her office is located at the Salem Pediatric Care Center, 2020 East State Street, Suite C, in Salem, 330-332-0084.



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