CHOKING IN CHILDHOOD: FOOD AND OTHERWISE

The Federal Hazardous Safety Act and the Child Safety Protection Act ban any toys that are intended for toddlers less than 3 years of age if the toy could cause choking, (a great idea since those under 3 or 4 are at the greatest risk for choking--with children under 2 making up over half of those seen in emergency rooms for choking). 

A recent study,* however, points out that it's not just toddlers and it's not just toys that should cause concern and caution. The data on 2953 cases from 66 hospitals participating in the National Electronic Injury Surveillance System-All Injury Program were used to estimate the national incidence of nonfatal choking. And they were striking numbers. An average of 12,435 choking events yearly. Forty percent of those were under a  year of age, with the estimated number dropping for each year until 7 years of age, when they leveled off. Said another way, children 4 and under were almost 3 times as likely to have incidents as those from 5-9 years old.

Hard candy caused 15.5% of the choking episodes with other candies causing another 12.8 percent, totaling over a quarter of all the incidents. Meat and hot dogs caused 14.8%, with bone causing 12 percent. These varied by age with bone-related choking usually at an average of 7.6 years old, while infants choked on breastmilk or formula (at an average of 4 months of age) and on raw fruits and vegetables when they were introduced.

The reasons too vary by age. Molars which grind food don't erupt until 2 years of age, and until 3-4 years of age, children are still learning to chew and swallow effectively. As children grow up, they can become distracted and their high activity levels may interfere with the attention needed to avoid choking

BOTTOM LINE AND RECOMMENDATIONS:

·         Children of all ages choke, with those at younger ages at higher risk.  

·         Cut raw fruits and vegetables into small pieces

·         Avoid hard candy  for those under 5 years (as the AAP recommends)

·         Don't let your child play, run or lie down while eating -- and vice versa (as my mother and yours recommended). Instead sit down with them and enjoy the time together while you supervise their eating behaviors

*MM Chapin et al. Pediatrics 132:275-281, 2013