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Don't Let Your Child Get All Choked Up

By Lisa E. Stafford
American Forces Press Service

WASHINGTON, Nov. 19, 1998 – A parent's worst nightmare is not knowing what to do if an infant or toddler starts choking and turning blue.

Parents of young children can arm themselves against this kind of unexpected trouble by enrolling in a pediatric first aid course available at many military clinics. The classes teach service members and their spouses what to do for children who need immediate medical help.

"The main choking threats to children under age 4 are improper feeding techniques, dangerous foods, toys, and access to small, swallowable household objects," said Army Dr. (Lt. Col.) Barbara Harper, chief of the Pediatric Ambulatory Clinic at Walter Reed Army Medical Center, Washington.

"Chewing and swallowing food don't come naturally to infants. They must learn to coordinate these actions and breathe, too," said Harper. "For example, a child who runs while eating and either falls or becomes distracted might accidentally inhale food and start to choke. Prevent such accidents by making mealtimes quiet and still."

According to the 1997 U.S. Consumer Product Safety Commission annual study of children under age 9, one child chokes on food and dies in the United States every five days. The majority of victims are under age 5.

Harper suggested these tips: Always watch what and how your child eats. Cut or break food into small pieces that aren't round. Encourage your child to chew slowly and thoroughly. Food that's too large or too hard can cause a child to gag or choke.

Popcorn, whole grapes, peas, peanuts (until about age 7), some hard candies, raisins and other small, roundish foods can be dangerous if children accidentally swallow them down "the wrong pipe."

"These foods are dangerous not just because they are round, but because they have smooth surfaces and can slide down into the airway very easily," said Harper. "I advise parents of children under 4 to steer clear of them." Other dangerous foods include raw vegetables such as carrots, celery and peppers; hot dogs; gum, large pieces of meat and spoonfuls of peanut butter.

On the other hand, she said, safe foods for young children include crackers and small pieces of soft fruits such as banana, orange and ripe pear. "But young children can choke on any type of food, so parents should always keep a close eye on them during meal and snack times," she said.

The Consumer Product Safety Commission reports about 110 children choked on toy balloons and died annually between 1973 and 1988; the death toll from swallowing small balls was 40 a year between 1974 and 1987.

"All balloons -- unused, inflated or broken -- should be kept out of children's reach. Balloons are a major choking hazard for young children. Other toys to keep out of reach are marbles, small balls and toys with small parts that can break off," the safety commission report stated.

Young children's favorite way to discover something new is to put it in their mouths and taste it. Parents should frequently scan the floor and low surfaces for any object an infant could easily pop into their mouths. Potential household hazards include buttons, button-shaped batteries, coins, earrings, marbles, small balls and toy parts, paper clips, rings, safety and straight pens, screws and snaps.

"Never leave anything smaller than an infant's mouth lying around," Harper said. "Be firm in teaching your child not to hold objects in his mouth, and be especially vigilant in watching what the child is playing with. Little hands are fast as lightning and very undiscriminating."

For more information concerning first aid courses, contact your local military clinic or the American Red Cross on their Web site at www.redcross.org.

When A Child Chokes

According to the American Red Cross, take the following measures when an infant up to 12 months old is choking:

  • Do not interfere if the infant can still breathe, cough or cry on its own. Do not initiate first aid until you are certain the infant is actually choking. Perform first aid if the child can't cough or cry or if the coughing and crying are very weak.
  • If others are around, get someone to call for medical help while you begin first aid. If you are alone, shout for help and then begin first aid immediately.
  • Do not search for an object if it is not visible; you might accidentally push it farther down the infant's throat.
  • If breathing has stopped, clear the child's airway before starting CPR.

- Lay the infant face down along your forearm with the infant's chest in your palm and the jaw between your thumb and index finger. Use your thigh or lap for support. Keep the infant's head lower than the body.

- Give five quick forceful blows between the infant's shoulder blades with the palm of your free hand.

- Turn over the infant onto your other arm, face up, again using your thigh or lap for support and keeping the head lower than the body.

- Place two fingers on the middle of the breastbone just below the nipples. Give five quick downward thrusts toward the throat, depressing the breast a half-inch to an inch each time. Each thrust is a separate attempt to clear the infant's airway by forcing air out through the windpipe.

- Continue this series of five back blows and five chest thrusts until the object is dislodged or the infant loses consciousness.

  • If the infant loses consciousness or stops breathing:

- Lay the child on its back on a firm, flat surface and tilt its head back.

- Seal your lips tightly around the child's open mouth and nose.

- Give two slow breaths into the child's mouth, this will get oxygen into the child's lungs. Then give two more slow breaths. If the child begins breathing, continue to monitor the child until medical help arrives.

  • If the child still doesn't breathe on its own, continue the back blows, chest thrusts and check for the object until the child coughs it up or starts to breathe. Seek medical attention even if you successfully dislodge the obstruction and the infant seems fine. Complications can arise not only from the incident itself but also from the first aid measures.

Occasionally, an object will enter the lung instead of being completely expelled. The infant may appear to improve and breathe normally, but in a few days may start wheezing, coughing persistently or showing signs of pneumonia. If this happens, seek medical attention immediately.

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Click photo for screen-resolution imageA course instructor gives students step-by-step instructions on the proper procedures for administering CPR. CPR classes are open to service members and their families at military clinics or at local American Red Cross chapters. Courtesy of the American Heart Association  
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