Choking In Children: Signs, What To Do And Prevention

Choking in children occurs when food or a foreign object gets stuck in a their airway. If the windpipe is partially blocked, the body usually clears the airway by inducing coughing. However, if the airway is completely blocked, immediate medical attention is needed to remove the stuck item. Choking can also occur if the foreign object gets stuck in the voice box, vocal cords, lungs, or esophagus (1).

According to the New York State Department of Health, choking is the fourth leading cause of unintentional death in children under five years. And in the US, at least one child dies every week due to food-related choking, and about 12,000 children are rushed to emergency rooms for choking each year (2).

Learn more about the causes, signs, risks and complications, treatment options, and prevention for choking in children in this post.

Is Choking An Emergency?

Yes, choking is a medical emergency and needs immediate attention as it may lead to severe complications and even death.

A foreign object lodged in the airway can prevent oxygen from reaching the lungs and the rest of the body. If the brain does not receive oxygen for four minutes or longer, it may lead to permanent brain damage or death (3).

Causes Of Choking In Children

According to the American Academy of Pediatrics, children under four years are at the highest risk of choking on food and small objects. However, youngsters in their middle age can also choke (3).

Younger children are at a higher risk of choking due to the following reasons (1).

• They do not have enough practice at controlling food in their mouths.
• They do not break food into small pieces.
• They have smaller airways as compared to older children or adults·
• They explore objects by putting them in their mouths

The following are the common culprits that may lead to choking in children (1) (2).

Food products

• Hotdogs, sausages, and meat chunks
• Grapes, celery, marshmallows
• Fruit poppers, hard candies, or gel candies
• Peanuts and other nuts
• Apples
• Popcorn
• Sunflower or watermelon seeds
• Fishbones and small chicken bones
• Dried raisins
• Chunks of peanut butter
• Ice cubes
• Cheese cubes
• Chips and pretzel nuggets
• Coughdrops
• Raw peas, raw vegetables, etc.
• Raw fruit like cherries

Objects

• Coins, marbles, and small balls
• Toys with small parts
• Latex balloons
• Caps of pen and markers
• Button cells or disc batteries
• Screws
• Beans of a bean chair
• Rings, earrings, and other small pieces of jewelry
• Crayons and erasers
• Staples and safety pins
• Small stones and tiny figurines
• Small magnets and metal hardware
• Fishing tackles
• Toys and objects that come labeled as a choking hazard
• All small and round household items

The diameter of a young child’s trachea (windpipe) is equal to the diameter of a straw. Thus, any food that gets lodged in its diameter can be a choking hazard. The shape, texture, and size of an object determine how hazardous an object can be. Hard, sticky, and round objects may easily lead to choking.

Signs And Symptoms Of Choking

Choking among children can be due to either a partial airway obstruction or a total airway obstruction. Choking can present itself as one or more of the following depending upon the type of obstruction (4) (5).

Symptoms of partial choking

• Noisy, labored, or gasping breaths
• Little air escaping from the mouth
• Coughing
• Stridor or a crow-like noise
• Extreme anxiety or agitation

Symptoms of complete choking

• Inability to breathe, cry, or speak.
• Cyanosis (bluish discoloration of skin, mouth, or lips)
• Pale skin
• Clutching of the throat (a universal sign of choking)
• Effort to breath with in-drawing of spaces between ribs and above the collarbones

What Should You Do If A Child Chokes?

Ask the child if they are choking. If they are unable to answer or make a noise, consider it to be a total airway obstruction.

The actions you should take depend on the condition of the child. Read the following points to understand the different scenarios that may arise when a child chokes on something (4).

If the child has difficulty breathing but can cough well and also talk,

• Maintain your calm and reassure the child.
• Encourage them to cough until they expel the substance they are choking on.
• Have someone call 911. If there is no one around, call 911 yourself.
• Do not put your fingers in their mouth to pull the foreign body out, as it might worsen the situation by pushing the stuck object deeper.
• Do not give back blows as it might further move the object deeper into the windpipe (5).
• Keep a close eye on any worsening symptoms.

Take the child to the hospital even if the child is able to expel the foreign body, as a part of it may still be in the lung. Only the doctor can confirm if the object has been fully removed.

If the child has trouble breathing and is conscious but can’t make a sound or talk,

• Do not put your fingers in their mouth to remove the object as it might worsen the situation.
• Call 911.
• Do the Heimlich maneuver (read instructions below) until the object gets out of the child’s mouth.
• Stop doing the Heimlich maneuver if the child becomes unconscious or stops breathing.

If the child is not breathing and is unconscious,

• Inform 911.
• Lay the child on their back on a flat, hard surface.
• Try to open the child’s mouth and observe if anything is stuck in the throat.
• If you do not see anything, and the child is not breathing yet, put your mouth over the child’s mouth.
• Pinch the nose of the child shut and puff two breaths into the child’s mouth.
• Do the Heimlich maneuver with the child lying on the back. Continue until the object comes out or medical help arrives.
• If there is no pulse, it means the heart is not beating. In this scenario, perform CPR (Read instruction below). Continue CPR until emergency medical help arrives or until the child resumes breathing.

Heimlich maneuver

Heimlich maneuver can help get the stuck food or object out. Read on to learn the step-by-step description of doing the Heimlich maneuver (4) (6).

• Stand or kneel behind the child and wrap them around their waist with one hand. If they are unconscious, lay them on a flat surface.
• You may place your leg between the legs of your child if they are standing so that you can support the child if the child faints.
• Give five back blows between the shoulder blades with the heel of your hand.
• If the foreign body does not get dislodged, make a fist with one hand and place the fist on the child’s belly so that the thumb faces the belly.
• The fist should be just above the belly button and well under the breastbone.
• Grasp this fist with the other hand and give five quick upward thrusts. Keep alternating these back blows and thrusts until the object pops out, the child faints, or help arrives.

Cardiopulmonary resuscitation (CPR)

Accurately performing CPR might help you save a life. Here’s a step-by-step guide on how to perform CPR on children (7).

• Tap the child’s shoulder and shout, “Are you okay?” to ensure if they need treatment.
• If you have someone around you, ask them to call 911 and provide the child with two minutes of care. If you are alone, provide two minutes of care and then inform 911.
• Lay the child on their back, tilt their head, and slightly lift the chin. This will open their airway.
• Listen carefully for ten seconds. Check for the sounds of breathing.
• If the child isn’t breathing, deliver two rescue breaths by pinching the child’s nose shut and making a tight seal by placing your mouth over the child’s mouth.
• If the rescue breaths do not work, and the child does not show any signs of breathing, start CPR.
• For CPR, place the heel of one hand on the center of the child’s chest and then place the heel of the other hand on the top of the first hand.
• Intertwine the fingers of both hands. Deliver 30 quick compressions that are about two inches deep.
• Give two rescue breaths.
• Continue until the child resumes breathing or emergency medical care arrives.
• Shout and ask for help so that someone can take over if you are exhausted.

What Are The Risks And Complications Of Choking?

Children with medical issues that affect chewing or swallowing, such as dysphagia and gastroesophageal reflux disease (GERD), and children with special needs are at an increased risk for choking (8).

Choking can cause throat irritation, unconsciousness, permanent brain damage, and even death (3) (9).

Choking Prevention For Children

You may take the following precautions to prevent your children from choking (1) (2) (4).

• Do not leave the children unattended when they are eating.
• Choose the child’s food depending on the number of teeth the child has and their muscular and developmental ability.
• Sit your children upright when eating.
• Explain to children that they should eat their meals without hurry.
• Discourage them from eating when they are walking, running, playing, or riding in a car.
• Remove seeds and pits in the food.
• Cook and steam the vegetables. Cut them into small-sized pieces.
• Cut the hotdogs lengthwise and widthwise.
• Offer water or liquid between or after solids. Do not give solids and liquid together.
• Do not give large chunks of peanut butter as it might pose a risk to children because it may stick to the child’s palate and form a glob. Always use it with cream cheese or jelly on whole-grain bread.
• Educate and prevent elder siblings from giving any dangerous toy or food to a young child.
• Educate babysitters or other child caregivers about choking hazards.
• Pay attention while buying toys, products, and food substances with a labeled warning of choking hazards.
• The Consumer Product Safety Commission’s website, www.cpsc.gov updates toys that are identified as choking hazards. Keep checking the published list.
• Instruct your child not to put toys in the mouth.
• Keep checking the toys’ condition and replace or dispose of anything with broken or loose pieces.
• Buy age-appropriate toys that meet all safety standards for children.
• Safety proof your home and keep potential hazards out of a child’s reach.
• Keep printed guidelines of how to perform the Heimlich maneuver and CPR in your car, medical kit, desk, kitchen counter, and keep reading them to keep yourself well equipped.

References

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Dr. Dur Afshar AghaMS

   

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha