CHOKING RISKS THAT MAY SURPRISE YOU

We often assume that food is the #1 choking threat when it comes to infants and yet the latest data from the Centers for Disease Control & Prevention reveals that object-related choking deaths significantly outnumber food-related deaths during the first year of life.

The study reviewed mortality data from 2018-2023, comparing food and object-related death across the lifespan. They found that “food-related choking peaked at age 1, when self-feeding becomes more common, while overall rates declined through early childhood.”

The lead author of the study, Dr. Rachel Ruiz, a pediatric gastroenterologist, looked at the analysis and it made her question her long standing assumptions about choking deaths. “As a pediatrician I was always taught that choking on food is one of the leading causes of accidental death among young children and what I found out was that’s not true.”

She acknowledged that while there has been great work done in educating families regarding food textures and portion sizes, we also need to be just as vigilant about nonfood items in the home.

Choking hazards abound when little ones begin to crawl and walk. Dr. Ruiz recommends that parents & care providers “get down on the ground and make sure you are really vigilant about vacuuming.”

This is especially true during the holidays when the risks increase. Some of the most common choking hazards include small toys (anything small enough to fit inside a toilet paper roll is a huge threat;) batteries (small lithium cell batteries, in particular;) coins, marbles, and small stones; magnets (found in magnetic toys; refrigerator magnets are also a risk;) art supplies and decorations (think beads, buttons, etc.)

Save a Little Life™ encourages parents to register with the Consumer Products Safety Commission (cpsc.gov) to receive updates on the many nonfood items that have been recalled due to choking hazards.

, ,

CPR FOR DOGS AND CATS? YOU BET!

Several years ago, I had an experience with my pug after giving her one of those hard, dehydrated, chicken strips for a snack. Almost immediately, she stopped breathing. I could see that she was fully obstructed, so I stood her up on her hind legs and attempted to perform the Heimlich maneuver. The first upward thrust didn’t clear her airway, so I tried it again (a bit harder) and out it came! A close call, for sure. Needless to say, I don’t recommend this type of snack as it poses a very high risk of choking.

But what could I have done if she had lost consciousness, or was pulled lifeless from a swimming pool? Is it possible to administer CPR for a dog or cat and how effective can it be?

Dr. Jamie Burkitt is an associate professor of Clinical Small Animal Emergency and Critical Care Service at the University of California, Davis. She also co-chairs an initiative spearheaded by a team of veterinary emergency and critical care specialists called The Recover Initiative. Not only does The Recover Initiative provide up-to-date evidence-based veterinary CPR guidelines, they offer affordable online classes to pet owners and pet professionals who want to learn these skills.

 

HOW TO KNOW IF YOUR DOG OR CAT NEEDS CPR?

According to Dr. Burkitt, pets, unlike humans whose heart’s may stop suddenly and without warning, will (most of the time) give some indication that they’re ill before their heart actually stops beating.  Typically, these signs & symptoms include rapid or irregular breathing, lethargy, loss of appetite or excessive vomiting. If things continue to deteriorate and the animal becomes unresponsive you need to act.

Should this occur, do not call 9-1-1, begin CPR instead and have someone call the nearest veterinary hospital and let them know you are on your way.  If someone else is driving you can continue to perform CPR on the way.

 

WHERE DO I DO CHEST COMPRESSIONS ON A DOG?

This varies depending on the size and breed of the dog. Chest compressions are typically done with the animal on their side but with dogs who have wider chests like an English Bulldog, for instance, it is better to do compressions while they’re on their back.

Shows 2 Vector images of a small french bulldog receiving CPR compressions
Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative 2024

For round chested dogs such as retrievers, give compressions at the widest part of the chest. This should be done in the middle of their breastbone.

For medium and larger dogs, the rescuer should position themselves at the side, lock fingers together and keep your elbows locked, not bent, to achieve better quality compressions.

For smaller dogs or cats, use an overlapping, two handed compression method with your hands under their body and use your thumb(s) to provide the compressions.

Shows 3 vector images of a cat receiving CPR compressions
Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative 2024

Similar to human CPR the compression to rescue breathing ratio is 30 compressions: 2 breaths.  Again, following the human format, the number of compressions per minute should be between 100-120 per minute.  When delivering the rescue breaths encircle the nostrils of the animal with your lips to make a tight seal and blow hard enough to see or feel the chest rise.

Dr. Burkitt noted that there is little risk in administering CPR to a cat or dog and that the potential risk(s) are small compared to the need for life saving support.

Download a copy of the latest edition (2024) RECOVER CPR Guidelines here.

Information on The Recover Initiative Animal CPR and First Aid Course for Pet Owners and Pet Professionals is available here.

More information on CPR for Pets is available through The American Red Cross.

, ,

INTRODUCING SOLID FOODS TO YOUR INFANT – When, What, How

When to initiate semi-solid and then solid food for your baby is one of the most commonly asked questions during our Pediatric CPR & Family Safety classes. These concerns are clearly associated with the risk of choking. We fully understand these anxieties and do our best to help families be prepared to deal with them.

Our friends at Beverly Hills Pediatrics have provided a very helpful set of guidelines to make the process easier and less stressful.

Answers to the following questions will help you get started.

WHEN CAN YOUR BABY EAT SOLID FOODS?

They are typically ready between 4 and 6 months of age. By this time, they have improved their head, tongue, and mouth coordination.

It is advisable to start with pureed foods that an infant can manage more easily. These foods should not necessarily replace breast or formula feeding but are an addition to those other valuable nutrients.

An infant is ready to begin this process when they display certain signs of readiness, in particular, the ability to sit upright with minimal or no support from a parent or care provider.

Close focus and attention to the infant is always essential for safety.

4-8 MONTHS

New research shows that introducing a wide variety of foods as early as possible is important for developing adventurous eaters and may be important in reducing the risk of food allergies.

At 6 months you can start introducing water via a “sippy cup” or straw.

Shows a baby boy in a high chair drinking from a yellow sippy cup

During infancy the only food you should avoid is honey as it is not tolerated well and could cause botulism.

WHAT ABOUT FOOD ALLERGIES? WHAT, IF ANYTHING SHOULD WE AVOID?

The introduction of more allergenic foods (peanuts, tree nuts, eggs, dairy and fish) early and frequently helps reduce rates of allergies. Our experts suggest including small amounts of these foods in your child’s diet 2-3 times per week. However, if your little one has a history of severe eczema or a family history of severe allergies please consult with your pediatrician before starting these foods.

It is advised to avoid processed foods while aiming for whole ingredients. You can start with spooning small amounts of food(s) and observe the natural process that we all possess at this young age.

Remember, babies love the taste of food just as we do so if you want to puree your entire dinner and offer it in small amounts to your baby, go for it!

8-12 MONTHS

At this age you should feel safe offering them finger foods. At this point, please make sure that the size of the food is small enough so pieces can dissolve more easily. Start with pea-sized bites and advance slowly. Some larger foods that might seem too big such as bananas or whole cooked carrots and sweet potatoes are good, healthy examples.

Shows a baby girl eating a piece of apple while sittiing on a counter wearing chef whites with a pink scarf and a pink skirt.

Encourage them to try a variety of mild spices and flavors yet try to avoid over salting their foods as excess sodium isn’t good for any of us.

By this time many clinicians suggest decreasing breast feeding to 3-5 times per day and formula intake from 29-32 oz. per day to 16-24 oz. per day.

FOODS TO AVOID

Some foods are just too risky and can increase the risk of choking. These include popcorn, whole nuts, whole grapes or any hard foods until at least the age of three.

Beyond this age parents and care providers need to continue to observe them while eating in case of an unexpected choking event.

BE PREPARED, JUST IN CASE!

Parents, family members, and care providers need to be prepared in case of a true choking event. All adults who care for little ones must take a CPR course to learn how to resolve this emergency. Remember, paramedics will never be there in time to assist in a severe choking episode.

CHOKING PROTOCOLS – Are Anti-Choking Devices the Best Option?

Choking is a very real threat and scary issue when it comes to infants, toddlers, and small children so it’s a rare occurrence if I don’t get questions in a CPR class regarding the use and benefits of anti-choking devices.

In a previous article, De-Choking Devices – Friend or Foe? we looked at some of the possible dangers and misinformation surrounding these devices. However, if you believe the promotions for the so-called Doctor Endorsed “Dechoker” or “LifeVac” anti-choking devices, you’re still likely to feel compelled to run out and get one immediately.

A closer look at the research and official recommendations for a choking baby or child, however, might have you come away with a different opinion.

First of all, it’s worth noting that the FDA’s recommendations do not include any of the above-mentioned devices. That holds true for the American Heart Association and the American Red Cross. Instead, they recommend that the first line of defense be the skills learned in an infant or child pediatric CPR class.

Why?

Responding to an actual complete airway obstruction requires quick action by a family member or trained care provider/nanny. Anyone responsible for the care of your baby or child must be prepared to act immediately and be well-versed in how to do so. Even a paramedic response may not be of any help because time is of the essence.

So, why not rely on an anti-choking device? They look simple enough to use.

In this video, the first in an excellent 4-part series, Dr. Darria Long Gillespie, an ER doctor and mom talks about the issues:

If you are a previous client of Save a Little Life™ you have learned the necessary skills in class. A reminder, the standard protocol is either back blows and chest pushes for an infant or a measured Heimlich Maneuver for toddlers or older children. If you were to discuss this with your pediatrician, she/he would tell you that those skills are the most important responses for complete obstruction.

If those methods do not work, then as a last resort you might consider the use of an anti-choking product.

In every class we preach the following prevention methods which should be part of your daily choking prevention routine, including:

  • Do not leave the self-feeder alone during mealtimes
  • Once able to crawl or walk do not give them any food or snacks and only do so when in a proper highchair
  • Do not provide food or snacks in the car until they are much older
  • Try to avoid overreacting to gagging episode(s) but if you feel the need to go into a small mouth, always go in along the cheek line and then sweep across. This will avoid an accidental episode of pushing food into their airway

Again, anyone with care responsibilities for a baby or child must know the proper skills…without exception.

For an in-depth comparison and investigation of the most popular anti-choking devices be sure to view the Dr. Darria’s complete series on this topic: Part 1 | Part 2 | Part 3 | Part 4

 

If you’re interested in refreshing your CPR skills or are a first-time parent wanting to learn, please contact us for more information

VISIT OUR CALENDAR FOR UPCOMING CLASSES

,

TOYS, CANDY, AND HIDDEN DANGERS

Sometimes a product, be it candy, a toy or even a purely functional item can present a hidden danger that no one is aware of until it actually causes harm or worse.

Children are both creative and curious and that will often lead them to explore play things in ways that we may not anticipate. For that reason, no matter what toys or games your little one plays with, it is always important to watch and observe how they interact with them, especially where infants & toddlers are concerned. The same holds true for food, candy in particular, which plays a big role in the holiday season or any on special occasion.

Of course, the bad news is, accidents happen. On the plus side, when accidents do occur and a product is reported to be unsafe, the ensuing investigation may result in a recall of that particular product. Unlike automobile recalls, however, product recalls don’t always make the headlines. So how do we know what we should be on the lookout for or when a recall has taken place?

Well, the good news is, the U.S government keeps close tabs on products that are unsafe and have been formally recalled by the Consumer Product Safety Commission, otherwise known as the CPSC.

Save a Little Life™ strongly encourages all parents to visit the CPSC website at https://www.cpsc.gov/ where you can find a complete and up-to-date list of products that have been recalled.

You also have the option to receive email alerts by subscribing to their newsletter.

DE-CHOKING DEVICES – FRIEND OR FOE?

Children’s hospital staff warns parents about anti-choking devices

No substitute for critical CPR training

 

BOISE

The experts at St. Luke’s Children’s Hospital have a warning for parents of young children after learning some families are relying on anti-choking devices instead of taking critical CPR training.

Several versions of the hand-held anti-choking devices are sold online and often marketed on various social media platforms. They claim to clear a person’s airways by using air pressure to suck out the item stuck inside a person’s throat while they are choking.

St. Luke’s Children’s providers say they’re hearing more and more that these devices are becoming a popular baby shower gift even though the products say they should not be used on children under 12 months or 22 pounds. They worry parents may feel a false sense of security with these devices and skip learning how to do the Heimlich maneuver and other life-saving CPR techniques.

The safety of the anti-choking devices is also a concern for medical providers. They say there have been no human clinical peer-reviewed trials or studies on anyone alive, only cadavers. Also, providers say the toddler version of one device has a tube inside the mask intended to enter the mouth and reach the back of the throat, which could cause damage. Another device could potentially push the item further down the throat rather than pull it out, if not used properly.

While choking is dangerous for children, it’s not the leading cause of death in kids as the products claim.

The CDC says for babies under 12 months old, SIDS or suffocation is the leading cause of death, for kids 1-4 years old, it’s drowning, and for those over five it’s motor vehicle accidents.

“Nothing can replace essential CPR Training, which is a key skill parents, grandparents and caregivers should have,” said Dr. Allison Gauthier, St. Luke’s Children’s Pediatric Emergency Department Director. “The Heimlich maneuver is the best way to save someone who is choking. It can be done without a device, just someone’s hands. Research shows it works about three-quarters of the time.”

The original article can be viewed online here.

8 WAYS TO REDUCE A CHILD’S RISK OF CHOKING

In the 20 years that I have been teaching for Save A Little Life™  I have heard countless stories from parents regarding choking or near-choking events with their infants and/or children. These reports stick with me and I try to learn something from each parent who experiences them.

In our CPR and First-aid classes we always discuss the realistic chances of an infant or child choking. It remains one of the top causes of accidental death and the risks vary depending on the age of the infant or child. What has become clear, however, are the circumstances and conditions that either increase or decrease these incidents.

Human beings are born with good reflexes (gagging, coughing, vomiting) that most often reject items that threaten the airway. Parents will readily tell me about these episodes and most have learned how to prevent a choking episode.

Prior to eating semi-solids and solid foods infants thrive on breast milk and other fluids. Parents observe gagging episodes and almost always find ways to reduce (or at least panic less) these. Once we begin more solid foods there is a palpable increase in parental concern. This is understandable and we never minimize those concerns.

So, what can any parent, family member or care provider do to lessen the choking risk? Here are the most effective measures you can take to lessen the risk:

  • Infants & children need to be seated in an appropriate highchair or booster seat when eating. No exceptions
  • A responsible adult needs to be present during all feeding times
  • Try and avoid doing other activities during feeding because a choking person makes no sound!
  • Once an infant or child is able to crawl or walk they should have no food in their mouths or hand(s). The risk of choking elevates when these activities coincide.
  • During family activities, vacations and/or parties (birthday’s, etc.) there should be no letdown of your focus.
  • Pay close attention to toddlers who, when self-feeding, attempt to put too much food in their mouths at once. You have control of this!
  • Never allow infants or children to eat in the vehicle…especially during the first 2 years when they are seated facing rear.
  • Make sure that any family members, care providers or friends who assist during feeding understand these risks and observe the same precautions

There is always the possibility that, even when safe eating practices are used, some little ones will choke. Most people have about 30 seconds of consciousness once their airway is completely blocked. There is no reason to (initially) call 9-1-1 for a choking person since effective removal of an obstruction is done by those present. Paramedics are anywhere from 4-10 minutes away.

During the Save A Little Life™ class we prepare all in attendance to be able to identify a blocked airway and to remove it by safe and established emergency guidelines.

Prevention is the key to reducing risk for all health emergencies. It is woven into the fabric of our daily lives. We are always living with risk but with the proper understanding and consistent practice these risks can be lowered.

AVOID POTENTIAL CHOKING RISKS

Every so often the national media is alive with stories about one medical issue or another. More often than not, it is presented as a  crisis – requiring immediate attention and renewed national focus. For those of us in the field of emergency pediatric care the risk of choking has always been on the front burner and is a significant part of our prevention and emergency response strategy.

The principal culprit in this instance was the risk of choking, associated with hot dogs. Given the specific focus on hot dogs, the American Academy of Pediatrics (AAP) recently repeated a warning to parents that hot dogs can be a significant risk for fatal and near-fatal airway obstruction (in 1-3 year olds.)

Choking deaths in this age group have been and remain a leading cause of fatalities. It has always been a priority for the AAP and related organizations requiring parents, family members & care providers to remain vigilant at all times.

This renewed policy statement should send a clear message that primary prevention of choking is the key to minimizing the risk for these fatal accidents. In addition, the U.S. Consumer Products Safety Commission (cpsc.gov) plays an important role in the educational process…again, with a strong emphasis on prevention and emergency training.

Clearly, there are other items (edible and otherwise) that pose a significant risk for fatal choking events in the 1-3 year age group. These include, but are not limited to:

  • Foods of a certain size and shape
  • Coins
  • Small toys or parts that are easily removed
  • Small batteries
  • Stones
  • Buttons
  • Pills

The characteristics (size, shape & consistency) of these products continue to demand that all individuals caring for this age group be keenly aware of the risks involved. This also includes the knowledge and ability to respond in the event of an airway crisis.

At Save A Little Life ™ we continue to focus on these risks
with particular attention to family education

The cardinal rules of choking prevention include:

  • Provide only appropriate sized/shaped foods, emphasizing the cutting of these into small(er) pieces as well as cutting lengthwise for smaller mouths and airways
  • Be present and focused on all infants, toddlers and small children when they are eating any food or snacks
  • Require that toddlers remain seated and observed while eating
  • Avoid feeding infants, toddlers and children while in a moving vehicle
  • Observe older children when they are near babies as they may offer a dangerous item without your knowledge
  • Involve EVERYONE who has solo time with babies, toddlers and children in prevention education related to this topic

    All responsible family members and care providers

    need to remain current in basic CPR skills

    If your family employs a primary Spanish speaker (even if you think their English is pretty good,) have them take the course in their native language as it increases their comprehension, so outcomes will be improved.
    Ultimately, this effort is about enhanced risk reduction. We cannot prevent all cases of choking but we can minimize the risks and, certainly, be ready if your best efforts at prevention fail.


  • ANOTHER CHILD SAVED

    Richard, I thought I’d share this story. Our son choked on a strawberry on the very day of his fourth birthday. It was a classic case, I think – he ran around like crazy, sat down to eat his birthday cake and was so excited and eating so fast that he didn’t pay attention.

    He wanted to swallow a piece of strawberry without chewing it properly and it got stuck in his throat. He went completely silent and started flapping his arms. We were all around him so we acted very quickly. I remembered most of the techniques from taking your class but all I had to do is the Heimlich and, luckily enough, the fruit came out after my first attempt. I was really shocked by the speed it shot out of his mouth with.

    Later in the evening, he complained about abdomen pain but at least he was alive!

    Thank you for all your work and effort to educate the communities around you.

PREVENT CHOKING IN INFANTS AND CHILDREN

This is an area of concern that ranks among the highest when I speak with parents and care providers. It is always valuable to review the recommendations to lower risk in the home and elsewhere. The following set of recommendations are endorsed by The American Academy of Pediatrics, American Red Cross, and the Center for Disease Control for the reduction of choking in infants and children.

At mealtime:

  • Insist that your children eat at the table, or at least sitting down.
  • Watch young children as they eat, encouraging them to eat slowly and chew food well.
  • Cut up foods that are firm and round and can get stuck in your child’s airway, such as:
    • Hot-dogs (cut length-wise) and then into small pieces
    • Grapes should be quartered
    • Raw vegetables cut into small strips or pieces (not round)

Additional foods that can cause a choking hazard include:

  • Hard or sticky candy
  • Popcorn
  • Peanuts
  • Spoonfuls of peanut butter (or any nut butter)

PLAYTIME PRECAUTIONS

Read toy packages for information on choking hazards. Any toy that is small enough to fit through a 1 1⁄4 inch circle or is smaller than 2 1⁄4 inches long is unsafe for children under 4 yrs.
Don’t allow young children to play with toys designed for older children. Teach older children to put their toys away as soon as they are finished so younger ones can’t get them.
Check often under furniture and between cushions for items that can pose a danger of choking such as:
•    coins
•    marbles
•    watch batteries (that look like buttons)
•    pen or marker caps
•    toys with small, easy to remove parts
•    small balls or foam balls that could fit into a child’s mouth.
Remember, never let your child play with or chew on deflated or broken balloons. Many choking deaths have been caused by this material.
Also, don’t let your child play on bean bag chairs made with tiny foam pellets. These could tear and expose your child to a serious hazard.

Let the facts speak for themselves:

The majority of choking deaths among children occur from household toys and items. One study found that 70% of choking deaths among 3 year olds and younger were caused by items made for children.
The most common cause of non-fatal choking incidents is food. An additional study found that 70% of the choking cases that came to the emergency room were from foods such as hot dogs, nuts, vegetables and pieces of fruit.

CHOKING PREVENTION

Choking is a leading cause of injury and death among children, especially children 3 years of age or younger. Food, toys and coins account for most of the choking-related events in young children, who put objects in their mouths as they explore new environments.
The American Academy of Pediatrics (AAP) policy statement, Prevention of Choking Among Children contains recommendations for government agencies, manufacturers, parents, teachers, child care workers and health care professionals to help prevent choking among children.
Because the size, shape and consistency of certain toys and food increase the possibility of being a choking hazard, and because many of the prevention strategies currently in place to prevent choking on toys have not yet been implemented to prevent choking on food, the AAP recommends:

  • Warning labels on foods that pose a high choking risk
  • A recall of food products that pose a significant choking hazard
  • The establishment of a nationwide food-related choking-incident surveillance and reporting system
  • 
Food manufacturers should design new food and redesign existing food to minimize choking risk
  • CPR and choking first aid should be taught to parents, teachers and child care providers

Pediatricians should continue to provide guidance to parents on safe and appropriate food and toy choices, as recommended by the AAP.

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

For more information, visit www.aap.org