So far in this past year no less than three expatriate children have choked on small objects or food. Tragically one is no longer with us, and I cannot imagine the grief and despair that the parents of this child are feeling. My heart goes out this family. The other two children came very close indeed to tragedy. One child choked on a piece of fruit. Thank heavens that the child’s mother noticed what was happening with this young one and was able to perform first aid on her child right there and then; hats off to this Mum who was composed enough to handle the situation. Fear and panic can easily paralyze even highly qualified people when their own children are involved. Another child’s father called me early one morning last week. “Help! My baby is spluttering and there is blood in his mouth.” These are classic signs of a partial airway obstruction, and after a rushed visit to Prima Medika emergency room, sure enough the object was found. Choking in infants and young children happens all too frequently. The best solution of course is to try to avoid the situation in the first place.
Choking Hazards Toys
In the developed countries there are Child Safety Protection laws in order to protect children from choking on toys. Under these laws, warning labels must appear on packaging for small balls, balloons, and marbles as well as games or toys with small parts that are intended for use by children ages 3 to 6. Small toys that may pose a choking, aspiration, or ingestion hazard are banned if they are for use by children younger than 3. HOWEVER, in developing countries (yes, you are sitting in one!) these laws are not enforced and cheaply produced toys are marketed freely. (Check out the guy on the pushbike peddling very cheap wares). Kids can also choke on small toys such as balls, marbles, and game pieces. Give your older kids a safe storage area for their toys, and make sure they keep their belongings stowed away from younger siblings. Always follow the recommended age on a toy label if it has one. These ages do not reflect whether a child is developmentally advanced enough to use it but whether it poses a safety hazard to younger children. Don’t give kids under age 3 dolls or stuffed toys with eyes, noses, or ribbons that might come off. Also, check toys regularly to make sure they are still in good condition. Sometimes parts break off. Repair or discard any toys that are broken. Be sure to discard the packaging, including gift wrap, or ribbons—especially plastic wrap—on a new toy you give your child. Plastic labels or decals on toys and juvenile products are a choking hazard, too. Peel them off. Don’t remove permanent paper warning labels, however.
Watch the Balloons
Balloons are one of the leading causes of asphyxiation in children. Part of the trouble is that these toys are designed to be put in the mouth, at least when they’re being inflated. It’s understandable, then, that a small child might put one in his mouth, swallow or breathe in, and get it caught in his windpipe. In some countries packages of balloons are required by law to carry a warning label saying that they are hazardous to children under age 8. The risk is twice as great for kids 3 and under. If your child is given a balloon that’s already blown up, there’s a chance that it will burst, and the pieces will end up in his—or a younger sibling’s—mouth. Don’t leave a young child alone to play with a balloon, and pick up the pieces right away if the balloon bursts or deflates. The string attached to a balloon is a safety risk, too. If it’s tied to a stroller or playpen, for example, a toddler could get the string around her neck and strangle. Cut it so it’s no longer than seven inches.
Rattles and Teethers
Reputable baby product manufacturers (e.g Avent, Summer, Pigeon, Chicco, Fisher Price, Baby Einstien etc) use strict guidelines for babies rattles and teethers. They also have to be sturdily made so they won’t break into pieces that can be inhaled or swallowed. Sometimes these items are recalled because they pose a hazard, but not always. Don’t take chances: Inspect them regularly. Take rattles, teethers, and squeeze toys out of the crib or playpen when your baby is sleeping. I often see some of my younger patients wearing amber bead necklaces as a traditional remedy for teething problems, and some babies wear bracelets and bangles as part of there culture. Personally, while I love to see parents using traditional remedies, amber bead necklaces (or any beads for that matter) present a clear risk for choking if they break, or if the necklace twists or becomes hooked onto another object. Gold or silver bracelets are fine but get the kind that do not have little bells or charms that could come loose.
Household Items
There are countless things a baby or small child could choke on in your house, and a baby will put anything in his mouth. That’s why keeping small objects out of reach is so important. Among the major choking hazards are coins, paper clips, buttons, beads, pen caps, little toys, sequins and small, disc-shaped batteries. But the most common cause of choking is the one thing children are supposed to put in their mouths – food.
Watch What They Eat
Imagine eating only with your gums. That’s all the equipment babies have. It takes a long time for toddlers’ teeth to emerge, and the molars, so important for grinding, are the last to make an appearance. Too often, kids swallow foods whole rather than chew them up, even when they have some teeth. The foods you give them have to be soft and cut up in small pieces. If your baby tends to stuff too much in her mouth at once, give her only a little bit of food at a time until she learns to go slow. Use a food processor or blender is a useful appliance for chopping up food for babies and toddlers.
The top choking hazards among foods are:
Nuts
Hot dogs
Grapes
Hard candy
Popcorn
Raisins
Raw carrots
Spoonfuls of peanut butter
Chunks of meat
Pediatricians recommend that children younger than 4 years should not be given these foods or any other food that is firm and round unless it is completely chopped up. Fruits should be peeled and seeds carefully removed. Seeds can be inhaled and may lead to lung infections. Don’t give kids less than 5 sunflower or pumpkin seeds to eat.
Be careful what your kids eat in the car. Even older kids who normally can eat hard candy safely could choke if the car bounces on a pothole, forcing the candy into the throat. If you don’t want to risk having to stop your car on the interstate and administer first aid, let your kids eat only soft foods while travelling in the car. Lollipops pose multiple threats. First, they are hard candy and should therefore be reserved for older children. Second, even an older child can be injured by a lollipop’s rigid stick if he falls with one in his mouth. A safer alternative is the kind of pop that has a pliable loop in place of a stick. Peanuts cause choking injuries among children more often than any other food. (Peanuts can also be life threatening for the growing number of children who are allergic to them.) Grapes and hotdogs pose serious hazards because their skins can easily cover a small child’s windpipe. Don’t give them to children under 4, and cut them up in small pieces for older ones. Never let any child (or adult for that matter) eat peanut butter by the spoonful. Even adults have died from a glob of peanut butter that stuck on their windpipe. Instead, it should be spread in a thin layer on a cracker or small piece of bread that can be easily swallowed. Pieces of crusty bread or bagels can turn gummy in the mouth and get stuck over the trachea. These should be not be given to babies. You need to be cautious about how your child eats as well as what she eats. Keep her in her highchair during meals. Don’t let her run around and play while she’s eating. Discourage laughing or horse-play while her mouth is full, because she could inhale a piece of food. Remember that kids can choke on any food. Always supervise yours when she’s eating.
Next edition: Choking Part II – What to do?
Kim Patra is a qualified registered nurse and midwife who has been living and working in Bali for almost 20 years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com or Hp. 081 2366 0000.
