Preventing Choking in Children

Presented by:
Caitlin Kaeppler and Matt Schmieder

Epidemiology
29.9 episodes of non-fatal choking per 100,000 children, aged 14 and younger 140.4 per 100,000 of infants (1/3 of incidents) 77.1% of episodes occurred in children < 3 yr 59.5% non-fatal choking episodes related to food 19% related to candy or gum

Epidemiology
Choking on food results in death of 1 child every 5 days in US 66 77 children under ten die of food-related choking events, per year, in US >10,000 ED visits annually for children < 14 yrs Hot dogs represent the cause of 17% of foodrelated asphyxiations (children <10 years)

Contributing Factors
Mastication development and coordination lags behind dentition and swallowing ability Smaller diameter hypopharynx = greater risk for blockage Mucus/secretions collect around blockage forming a seal Forced expiration and cough less powerful, less effective in children

Contributing Factors
Children < 4 years Underlying chewing/swallowing dysfunction Impaired food grinding during phase between incisor eruption and molar eruption Distractibility Extraneous activity, while eating; running, talking, laughing, etc. High risk behaviors throwing food up and catching it in mouth

High Risk Food Characteristics

Cylindrical or round or ovoid Airway-sized Compressible Capable of forming a pliable seal, such as peanut butter

High Risk Foods

Hot dogs Nuts and seeds Meat and cheese chunks Whole grapes Hard or sticky candy Popcorn Peanut butter Raw vegetables Chewing gum Marshmallows

Prevention Policies
AAP Recommendations from Policy Statement:
Surveillance
Extension of NEISS-AIP to food-related choking events Food and Drug Administration in cooperation with CPSC for oversight Mandatory system for application of appropriate warnings Sweden as a model of age-based labeling of food products Gel candy containing Konjac

Cautionary food labeling

Recalls, as needed

Public education: Food-related choking-prevention campaign

Anticipatory Guidance
Always supervise young children while eating Do not allow children < 3 years to eat small, round, hard, or high-risk foods Cut foods into small pieces, (< 0.5 inches) Provide foods that do not need to be chewed, until appropriate dentition for chewing develops No eating/sucking candy while playing or lying down; sit at table or high chair

Choking on non-food objects

Epidemiology
In 2001, 17,537 children ages 14 years or younger were treated in U.S. EDs for choking
60% associated with food item 31% associated with nonfood objects 9% were not recorded

From 1972-1992: 449 deaths from aspirated nonfood foreign bodies in children 14 and younger

Common objects
Coins Balloons- especially deflated or broken pieces Marbles Button batteries Pen or marker caps Small jewelry Magnets

Child Safety Protection Act

Requires choking-hazard warning labels on packaging for small balls, balloons, marbles, and other toys Defines age groups for toys Bans any toy intended for children 3 and younger which may pose a risk Small-parts test fixture Since 2008, choking-hazard warnings are required on ads, websites, catalogs, etc.

How small is too small?

Gaps in prevention
Studies showing that the criteria for toys should be stricter CPSC does not conduct premarket testing Poor consumer response to product recalls

Prevention strategies
Educating parents, child care providers, and preschool teachers Caregiver vigilance Cpsc.gov Clear product labeling describing hazards Basic CPR and choking resuscitation training

References
David Walner and Julie Wei. Preventing choking in children: Many factors increase risk of mechanical airway obstruction due to inhalation or ingestion of foreign bodies. AAP News 2011;32;16 David Ma. Reduce deadly choking risks in children. AAP News 2010;31;26 Policy Statement-Prevention of Choking Among Children. Committee on injury, violence, and poison prevention. Pediatrics; originally published online February 22, 2010Prevention of Choking Among Children. Committee on Injury, Violence, and Poison Prevention. Pediatrics. Vol. 125 No. 3 March 1, 2010. pp. 601-607. Choking Prevention. HealthyChildren.org. http://www.healthychildren.org/English/health-issues/injuriesemergencies/pages/Choking-Prevention.aspx Choking Prevention Tips. Safe Kids USA. http://www.safekids.org/safetybasics/safety-resources-by-risk-area/choking-suffocation-andstrangulation/choking-prevention-safety.html Airway Foreign Bodies in Children. UpToDate.com. Jan 21, 2013.