What you need to know about choking hazards

The Dangers of Choking

Food or small objects can cause choking when they get caught in the throat and block the airway, preventing oxygen from getting to the lungs and the brain. According to the American Academy of Pediatrics (AAP), when the brain goes without oxygen for more than four minutes, brain damage or even death may occur.

In May 2005, two young girls in New York City died after choking on hard candy. The girls, ages 4 and 5, choked on jumbo mint balls, round peppermint candies measuring a little more than three-quarters of an inch in diameter.

Every child is at risk for choking, says the CDC. Younger children are particularly at risk because of their tendency to place objects in their mouths, poor chewing ability, and narrow airways compared with those of older children and adults.

A peanut, for example, is going to affect a child's airway more than an adult's, says Willner. Children younger than 6 years do not have all their molars, the grinding teeth at the back of the mouth. "Food can get to the back of the jaw and without being crushed by the teeth, the food is pushed to the back of the throat and the body instantly swallows it," says Willner. "If it happens quickly, it may not lead to a coordinated swallow. Or if a child laughs or takes a deep breath, the food can be inhaled."

Inhaled food is drawn into the windpipe (trachea) and travels into one of two bronchial tubes (bronchi), where it can block the flow of air into the lungs. "Depending on the size and shape of the food particle, it can go further to a point where it actually plugs up one of the smaller branches of a bronchial tube and can cause part of the lung to collapse," says Mary Purucker, M.D., Ph.D., an FDA pulmonary specialist. "Even if the particle doesn't entirely clog the airway, it has picked up bacteria from the mouth or elsewhere and can cause respiratory infection, such as pneumonia."

When food is inhaled, coughing and choking spasms occur. "But within minutes, the choking experience will stop," says Willner. "The initial reflex is tired out and you're left with a low-grade irritation. You may think everything is fine." However, pneumonia or other serious conditions may show up weeks later. "I've taken out foreign bodies that have been there for six weeks," says Willner.

Unsafe Foods for Young Children

The American Academy of Pediatrics recommends keeping the following foods away from children younger than 4:

• hot dogs
• nuts and seeds
• chunks of meat or cheese
• whole grapes
• hard, gooey, or sticky candy
• popcorn
• chunks of peanut butter
• raw vegetables
• raisins
• chewing gum.

Dangerous Objects for Young Children

The American Academy of Pediatrics advises keeping the following items away from infants and young children to reduce the risk of choking:

• latex balloons
• coins
• marbles
• toys with small parts
• toys that can be compressed to fit entirely into a child's mouth
• small balls
• pen or marker caps
• small button-type batteries
• medicine syringes.

Actions to Relieve Choking in an Infant

1. Hold the infant face-down on your forearm. Support the infant's head and jaw with your hand. You may need to sit or kneel and rest your arm on your lap or thigh.
2. Give up to five back blows with the heel of your free hand.
3. If the object comes out and the infant begins to breathe after only a few back blows, stop the back blows.

   If the object does not come out after five back blows, turn the infant onto his or her back and give up to five chest thrusts, supporting the head and neck. Hold the infant with one hand and arm. Use two or three fingers of your free hand to push on the breastbone just as you press for chest compressions during CPR. Stop chest thrusts if the object is forced out.

4. Alternate giving five back blows and five chest thrusts until the object comes out or the infant becomes unresponsive.
5. If the choking is not relieved, the infant will become unresponsive. When the infant becomes unresponsive, shout for help and start CPR. Chest compressions may force the object out. If you are alone with the infant and these steps don't work after about one minute, phone 911.

© American Heart Association

Actions to Relieve Choking in a Child Age 1 and Older and Adults

1. Ask, "Are you choking?"
2. If the child speaks or is coughing, do nothing. Allow the child to try to cough up whatever is blocking the windpipe.
3. If the child can't speak, cough loudly, or cry, tell the child you are going to help.
4. Stand or kneel firmly behind the child and wrap your arms around the child.
5. Make a fist with one hand.
6. Put the thumb side of the fist on the child's abdomen, slightly above thenavel and well below the breastbone.
7. Grasp the fist with your other hand and give quick upward thrusts into the child's abdomen.
8. Give thrusts until the object is forced out or the child becomes unresponsive.
9. If the choking is not relieved, the child will become unresponsive. When the child becomes unresponsive, shout for help, lower the child to the ground, and start CPR. Chest compressions may force the object out. If you are alone with the child and these steps don't work after about one minute, phone 911.

© American Heart Association