Years ago I treated a 2-year-old boy who came to the hospital because he was having difficulty breathing. An x-ray showed that one of his lungs had collapsed. The ear, nose and throat doctor found a peanut completely blocking the entrance to one lung. The doctor removed the peanut, but the boy still required a stay in the intensive care unit on a breathing machine before he fully recovered. The parents had seen him choke a little while eating peanuts, but they had no idea how serious it really was.
One of my colleagues used to say that a child shouldn’t eat a peanut until he could spell peanut. Unfortunately, peanuts aren’t the only choking hazard for children under 4. Add grapes, apples, hot dogs, popcorn, raisins, kidney beans, raw carrots, hard candy, fruit chews, marbles, coins and anything else you can think of that is small and hard to that list. Pay attention to warnings that suggest a toy may be a choking hazard. Even latex balloons pose a danger if sucked into the windpipe, so don’t let young children blow up balloons or play with pieces of popped balloons.
Small children have small airways and the reason these items are especially dangerous is because they can completely cover a child’s windpipe. Babies are at high risk for choking because their swallow is not fully developed so they can lose control of food in their mouths and it can go down the windpipe instead of the esophagus. Toddlers are at risk because they often eat fast and don’t chew food well. All of us choke occasionally and usually we just cough and sputter to clear the blockage. But a child’s weaker cough often doesn’t have enough force to dislodge the item.
To reduce choking risk, cut grapes and apples into small pieces. Cut hot dogs it into quarters lengthwise, then slice them into pieces. Never give a child a whole hot dog or beef sausage to eat like a lollipop. Don’t give young children real lollipops either since they can slip off the stick and into the throat. Cook all carrots until soft, mash all round beans and avoid popcorn and hard candy altogether. Also, don’t allow your children to run with food in their mouths since it increases choking risk.
The medical term for choking is "aspiration" and every year more than 17,000 children 14 years old or younger are treated in U.S. emergency departments with that diagnosis. About 170 of them die. If a child’s airway becomes completely blocked they are going to die—fast. It only takes a few minutes of no oxygen for brain damage to occur. Learn infant and toddler CPR since a Heimlich maneuver or chest thrusts may clear the trachea and save a life.
Crawl around on the floor of your home and look for small items that could choke your child. If an item can fit through a standard toilet paper tube, a toddler can choke on it.
Before you feed your child anything, stop for a minute and think about whether it may pose a risk. Be aware of common choking hazards and avoid them because the best strategy against choking is prevention.
Dr. Lisa Thornton, a mother of three, is director of pediatric rehabilitation at Schwab Rehabilitation Hospital and LaRabida Children’s Hospital. She also is assistant professor of pediatrics at the University of Chicago. E-mail her at firstname.lastname@example.org.
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