In the blink of an eye, things can change. Three year old Billy is happy, playing next to his mother in the kitchen. His mother turns to get food out of the refrigerator and starts to chop vegetables in preparation for dinner that evening.
Suddenly, Billy starts to cough. His Mom turns around and the little guy can’t stop coughing. He has trouble catching his breath and he’s starting to turn blue… What to do?
Small children, younger than 5 years of age, have a higher incidence of accidental deaths from ingesting foreign bodies compared to other age groups. Certain foods (hot dogs, peanuts), soft or hard objects (beads, a piece of a balloon) can block the larynx, or go down the trachea or enter parts of the lung.
In a certain percentage of children, the diagnosis of choking may take several days if no one has witnessed the ingestion of the foreign object by the child.
If there is partial blockage to the airway, children still have the capacity to breathe… They may experience gagging, coughing, have hoarseness or sound as if they are wheezing — And you do not want to make a bad situation worse… See incomplete blockage below.
If the blockage is complete, total airway obstruction, the child cannot make noise or breathe. A frightening, true emergency
Choking Infants and Small Children
The opening of a young child’s larynx (voice box) and the diameter of the trachea (windpipe) is approxamately the size of a drinking straw! Imagine if a grape or a marble became lodged in one of these areas? Air cannot get into or out of the lungs.
The American Safety and Health Institue, plus medical and other oranizations, recommend the following guidelines in a choking young child, especially if there is complete obstruction of the airway.
Assess the Infant or Small Child
- Look at the infant or small child
- If the child is silent, unable to make noise or is turning blue — act quickly
- Ask a bystander to call 911
Give 5 Back Blows
- Place the infant or small child, stomach-down, over your forearm. Place your forearm against your thigh and knee with the child’s head lower than his chest.
- Support the head by holding the jaw
- Using the heel of other hand, give 5 quick back blows between the shoulder blades.
Give 5 Chest Thrusts
- Turn the child over, stomach up over your forearm. Place your forearm against your thigh and knee Support the back of the head with your hand positioning the head lower than the chest.
- Using the other hand, place two fingers just below the breastbone — just below the nipple line and give 5 chest thrusts.
Repeat back blows and chest thrusts until the small child can breathe normally. The intent of the back blows and chest thrusts is to expel the foreign body. Initiate CPR if the above measures get no response
Incomplete Airway Blockage
If the blockage to the airway is incomplete, a good cough often takes care of the problem. Careful observation of the child is crucial and often is all that is needed. No back blows, no chest thrusts and do not blindly reach into the mouth in an attempt to remove the foreign object. Such maneuvers can change a non-emergency situation into a catastrophe… What about prevention?
Precautions and Prevention
Food is responsible for most non-fatal choking incidents. More than 10,000 children are taken to a US hospital emergency room each year for food-choking episodes. And at least one child dies every five days from choking on food in America. Never leave a small child unattended while eating.
Food
Certain foods are easy to choke on. If the child is younger than 5 years of age, avoid giving the youngster foods such as hot dogs, chunks of peanut butter, grapes, nuts, popcorn, raw carrots, hard or gooey candy. Recall that the diameter of the airway passage in a young child is quite small.
Cut food into small pieces. Grandma says, “Take small bites, chew your food, don’t talk with food in your mouth, sit down and take your time while eating.”
Household Items
Kids have a tendency to crawl on the floor and put stuff into their mouths. They pick up anything from the floor and many items can cause choking, block the airway or be dangerous to swallow. Be particularly vigilant about children picking up coins, beads, small circular batteries, balloons, marbles, buttons, pills, certain toys or any small item so the youngster will not be tempted to put them in his mouth.
About Billy; his Mom had taken a CPR course and learned the Heimlich maneuver. She gave Billy several back blows and chest thrusts and out popped a piece of raw carrot. While his Mom was chopping vegetables, some raw pieces of carrots accidentally fell on the kitchen floor. In no time, he was back to his curious self, smiling and looking for stuff on the floor.
References
American Safety Health Institute; CPR Pro
National Safety Council; Choking Prevention and Rescuing Tips; 2016
Gupta, R.C. Choking; Nemours Institute, Kids Health; Sept.2004
Stephen, P. Caring For Your Baby and Young Child; AAP, 2009
New York Department of Health; Choking Prevention for Children; March, 2016
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.