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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Choking

Choking occurs when a child struggles to breath because of a blockage in the airway. Choking is the leading cause of unintentional death for children under the age of 5. Toys, household items and food can all pose potential choking risks to young children. The size of a young child's trachea or breathing tube is approximately the diameter of a drinking straw, and it is therefore easy for small objects to get lodged in this tiny area. The risk of choking depends on the shape, size and consistency of an item, together with the child's behavioural and developmental capabilities. The most common cause of nonfatal choking in children between the ages of 1 and 5 is food, with hotdogs posing the greatest risk. Education regarding choking risks, prevention and life saving techniques in the case of a choking emergency, are essential to eliminate choking injuries and possible deaths.
Symptoms:
  • Coughing or gasping in an attempt to draw breathe around the object or dislodge it
  • Struggling sounds or raspy squeaking whispers in an attempt to communicate distress
  • Thrashing
  • Drooling
  • Watering eyes
  • Flushing then turning blue
  • Babies in particular may remain silent while they choke
Causes:
In small children, choking is most commonly the result of a small foreign object becoming lodged in one of the major airways. This may be due to a small object that they have put into their mouths and inadvertently swallowed, or a piece of food that has not been chewed properly. Some infections, such as epiglottis or severe tonsillitis, that cause swelling of the airway or the production of excessive mucous can lead to choking.
Treatment:
Treatment involves removing the obstruction and helping the child regain normal breathing:
  • Only remove the object if you can see it clearly. Don't poke around blindly with your fingers as this may make the situation worse by pushing the object further into the trachea (windpipe) or airways.
  • If your child is coughing, do not interfere. Encourage them to continue doing so and do not leave them. Often, coughing alone is sufficient to dislodge the blockage.
  • If this is unsuccessful, give 5 backslaps. This involves giving 5 sharp back blows with the heel of one hand in the middle of the back between the shoulder blades. Place baby along your arm (in a downward position), with their head low and chin supported, or allow an older child to lean forwards. This may be easier if you sit or kneel, with the child in front of you or the baby on your lap. In some cases, gravity can help dislodge the object.
  • If this is ineffective, give 5 chest thrusts (pushes), by compressing the chest by about a third. Lay your baby on their back and place two fingers over their breastbone, in order to perform the chest thrusts. For older children, use the heel of your hand to execute a downward thrust on their breastbone.
  • If this does not work, older children may be given abdominal thrusts (the Heimlich maneuver) (1 year of age or older). Stand or kneel behind your child. Place your arms under theirs and around their upper abdomen. Clench your fist and place it between the navel and the ribs. Grasp this hand with your other hand. Perform up to 5 abdominal thrusts by pulling sharply inwards and upwards. The child can then be rolled onto their side and the back slaps can recommence.
  • If your child loses consciousness or all efforts to remove the obstruction are unsuccessful, call for an ambulance immediately.
  • If a choking child is unconscious or loses consciousness, lay them on a firm, flat surface. Call out loudly or send for help. Do not leave your child on alone at any stage. Only remove the object if it is visible and easy to grasp. Begin performing CPR until emergency medical assistance is available.
  • Even if the object has been expelled, seek medical assistance. Part of the object may have been left behind or your child may have been injured by the procedure.
Prevention:
Children between the ages of 1 and 5, often put objects inside their mouths as a means of exploring their world. Some of these objects are just the right size to get stuck in a child's airway and cause choking. The following age appropriate safety precautions are recommended to protect your child from choking, suffocating or strangulation:
  • Ensure that your infant's crib meets national safety standards and has a firm, flat mattress. Infants should sleep on their backs.
  • Avoid putting pillows, comforters or soft toys in your infant's crib.
  • Keep certain foods that are choking hazards away from children under the age of 4.
  • Do not allow your child to run, walk or play if they have food in their mouths. Children should have calm, unhurried meal and snack times.
  • Cut your young child's food into small pieces and encourage them to chew properly. Remove all seeds and pits. Cook or steam vegetables to soften their texture. Cut larger items, such as hotdogs, length and widthwise. Particular caution should be taken with all food items that can be cut into a coin shape, such as sausages. Round shaped fruit, such as grapes and cherries can be cut into quarters.
  • Supervise your child closely while they are eating.
  • Offer your child liquids in between mouthfuls of food. Never allow them to swallow solids and liquids simultaneously.
  • Pay attention to shape, size, consistency and combinations when choosing and introducing foods to your child. For example, only use a small amount of peanut butter (when it is age appropriate) because this food item can stick to the roof of your child's mouth and form a glob. Consider combining the peanut butter with jam or cream cheese and spread it on bread, rather than offering it your child on a spoon.
  • Not all children are at the same developmental level. Ensure that your child is sitting upright; they have a sufficient number of teeth, and the muscular and developmental ability to chew and swallow the chosen food. Children with special health care needs are particularly vulnerable to choking risks.
  • Other foods that should be avoided or only be given to children of the correct age under supervision include; hard or sticky candies, especially those with a round shape, whole grapes, raw vegetables, fruits with skin and seeds, raw peas, seeds, nuts and peanuts, ice cubes, cheese cubes, dried fruit, celery, carrots and cherries. Any food items that clump, are sticky, slippery, or have a hard, dry texture.
  • Keep choking hazards away from young children, such as small toys and items with small parts. A small parts tester can help you establish whether a particular item is a choking hazard or not. If a particular object can be inserted into the tester, it is a choking hazard.
  • Household items and toys that need to be kept out of reach include; latex balloons, coins, marbles, pen or marker caps, button type batteries, medicine syringes, screws, rings, earrings, stuffing from bean bag chairs, crayons, erasers, staples, small stones, holiday decorations including tinsel, ornaments and lights.
  • Follow the manufacturers guidelines and avoid giving your child any toy or object that is labeled as a choking hazard.
  • Remove drawstrings from the outerwear of young children
  • Tie up or cut all window blinds and curtain cords.
  • Parents and caregivers should learn first aid techniques for choking and CPR cardiopulmonary resuscitation.
References:
Peters M. British Medical Association Home Doctor. London: Dorling Kindersley; 2009.
Nationwide Children's Hospital. American Academy of Pediatrics Releases New Policy Statement on Choking. Newswise. Published February 22, 2010. Accessed April 21, 2012.
Dr Trisha Macnair. Choking. BBC Health. Published, December 2007. Accessed April 22, 2012.
NHS Choices. How to help a choking child. NHS Choices. Published July 29, 2011. Accessed April 22, 2012.