Preventing Choking

7/30/2019 Preventing Choking

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Preventing Choking

in Children

Presented by:

Caitlin Kaeppler and Matt Schmieder


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Epidemiology

29.9 episodes of non-fatal choking per 100,000children, aged 14 and younger

140.4 per 100,000 of infants (1/3 of incidents)

77.1% of episodes occurred in children < 3 yr

59.5% non-fatal choking episodes related to food

19% related to candy or gum


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Epidemiology

Choking on food results in death of 1 child every5 days in US

66 77 children under ten die of food-relatedchoking events, per year, in US

>10,000 ED visits annually for children < 14 yrs

Hot dogs represent the cause of 17% of food-related asphyxiations (children


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Contributing Factors

Mastication development and coordination lagsbehind dentition and swallowing ability

Smaller diameter hypopharynx = greater risk forblockage

Mucus/secretions collect around blockage

forming a seal Forced expiration and cough less powerful, less

effective in children


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Contributing Factors

Children < 4 years

Underlying chewing/swallowing dysfunction

Impaired food grinding during phase betweenincisor eruption and molar eruption

Distractibility

Extraneous activity, while eating; running,talking, laughing, etc.

High risk behaviors throwing food up andcatching it in mouth


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High Risk Food Characteristics

Cylindrical or round or ovoid

Airway-sized

Compressible

Capable of forming a pliable seal, such as peanutbutter


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High Risk Foods Hot dogs Nuts and seeds

Meat and cheese chunks Whole grapes Hard or sticky candy Popcorn

Peanut butter Raw vegetables Chewing gum Marshmallows


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Prevention Policies AAP Recommendations from Policy Statement:

Surveillance

Extension of NEISS-AIP to food-related choking events Food and Drug Administration in cooperation with CPSCfor oversight

Cautionary food labeling Mandatory system for application of appropriate

warnings Sweden as a model of age-based labeling of food products

Recalls, as needed Gel candy containing Konjac

Public education: Food-related choking-preventioncampaign


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Anticipatory Guidance

Always supervise young children while eating

Do not allow children < 3 years to eat small,round, hard, or high-risk foods

Cut foods into small pieces, (< 0.5 inches)

Provide foods that do not need to be chewed,

until appropriate dentition for chewing develops No eating/sucking candy while playing or lying

down; sit at table or high chair


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Choking on non-food objects


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Epidemiology

In 2001, 17,537 children ages 14 years oryounger were treated in U.S. EDs for choking

60% associated with food item

31% associated with nonfood objects

9% were not recorded

From 1972-1992: 449 deaths from aspiratednonfood foreign bodies in children 14 andyounger


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Common objects

Coins

Balloons- especially deflated or broken pieces

Marbles

Button batteries

Pen or marker caps

Small jewelry Magnets


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Child Safety Protection Act

Requires choking-hazard warning labels onpackaging for small balls, balloons, marbles, and

other toys

Defines age groups for toys

Bans any toy intended for children 3 and

younger which may pose a risk Small-parts test fixture

Since 2008, choking-hazard warnings arerequired on ads, websites, catalogs, etc.


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How small is too small?


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Gaps in prevention

Studies showing that the criteria for toys shouldbe stricter

CPSC does not conduct premarket testing

Poor consumer response to product recalls


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Prevention strategies

Educating parents, child care providers, andpreschool teachers

Caregiver vigilance

Cpsc.gov

Clear product labeling describing hazards

Basic CPR and choking resuscitation training


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References David Walner and Julie Wei. Preventing choking in children: Many factors

increase risk of mechanical airway obstruction due to inhalation oringestion of foreign bodies.AAP News 2011;32;16

David Ma. Reduce deadly choking risks in children.AAP News 2010;31;26 Policy Statement-Prevention of Choking Among Children. Committee on

injury, violence, and poison prevention.Pediatrics; originally publishedonline February 22, 2010Prevention of Choking Among Children.Committee on Injury, Violence, and Poison Prevention. Pediatrics. Vol.125 No. 3 March 1, 2010. pp. 601-607.

Choking Prevention. HealthyChildren.org.http://www.healthychildren.org/English/health-issues/injuries-emergencies/pages/Choking-Prevention.aspx

Choking Prevention Tips. Safe Kids USA. http://www.safekids.org/safety-basics/safety-resources-by-risk-area/choking-suffocation-and-strangulation/choking-prevention-safety.html

Airway Foreign Bodies in Children. UpToDate.com. Jan 21, 2013.
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Preventing Choking

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