Fatal Choking a Real Risk Among Toddlers

MONDAY April 19, 2010 -- Although the number of young children who choke after swallowing a foreign object is relatively low, the risk of death when that happens is real, the latest research indicates.

"In such cases, the mortality is about 3 percent," said study author Dr. Rahul K. Shah, a pediatric otolaryngologist with the Children's National Medical Center and George Washington University School of Medicine, both in Washington, D.C. "And that is, in fact, pretty high. And it's frustrating because it's been that way for a long time."

"So I would stress to parents that the threat to children is real," he cautioned. "I myself have two kids, and I'm obsessed with how they're fed, what they eat and what they can get their hands on. Because choking can happen to any family, anywhere."

Shah and his team report the findings in the April issue of the Archives of Otolaryngology--Head & Neck Surgery.

The current risk calculation was drawn from an analysis of U.S. hospital records concerning nearly 3 million pediatric patients who were discharged from more than 3,400 hospitals in 2003. Of these, nearly 2,800 had received medical care for airway obstruction brought on by a foreign body, which in 42 percent of the cases was a food item.

The average age of these choking patients was just over 3, although more than half of the children were under 2.

Every year, about 2.5 million American children experience a choking incident after consuming a foreign substance of some kind, the authors noted, resulting in more than 2,000 deaths, mostly among children under age 3.

"Parents should be aware of these facts and take precautions," Shah said. "What can you do to prevent this? Cut your child's food up into really small pieces. It drives my wife crazy. She'll cut the grapes into halves and quarters, and I want to cut them into eighths. It's a pain, but if you realize what the flip side is, you would want to do this."

Earlier this year, the American Academy of Pediatrics called for the physical redesign of several common food items, such as hot dogs and candy, to reduce pediatric choking risk. In addition to advocating for a change in the cylindrical shaping of such foods, the academy also suggested that new warning labels be placed on all food packaging for high risk products -- such as candy, peanuts, nuts, peanut butter, and hot dogs -- to warn parents of the choking risk among the very young with these foods.

"But there is also the question of inorganic non-food toys, which actually strikes older children," Shah added. "These need to be kept out of reach, because just because you have an older toddler you should not assume your child can't choke on this or that object."

Dr. Lee Sanders, an associate professor of pediatrics at the University of Miami Miller School of Medicine, praised the study for raising awareness of the issue.

"But I would first say that those of us in injury prevention know that there are a considerable number of children who have a choking incident that survive without ever going to the hospital," he noted. "And if you count them in -- and this study doesn't -- it lowers the percentage of children who actually die from choking. So I would be careful to keep that in mind and not overstate the percentages of those children who succumb."

"However, these findings are relatively in line with what I might expect," Sanders conceded. "And it's been known for quite some time that one of the most serious causes of injury for young children -- particularly in the first two years of life -- is choking. So, it's certainly important for parents to be aware of this."

"Starting at infancy, we recommend that no objects should be left in the crib," Sanders noted. "And then once a child gets to be a little older -- usually around 6 months -- they're able to grasp things in their hand. That's how young children explore the world, by putting things in their mouth. So, we recommend something we call the 'Toilet Paper Tube Test': If there's any object that can fit through an empty toilet paper roll, then it's too small to be left within reach of the child."

"And finally, the other thing for parents to realize is that these choking incidents can happen in an instant," he added. "You can be there with a child, and within seconds a child can put something in their mouth and choke in front of you. So, it's important to keep these objects out of their reach, not only when they're unattended but when they're attended as well."

More information

For more on pediatric choking risk, visit the KidsHealth.

Posted: April 2010


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