Tag Archive for: choking

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PEDIATRIC CPR GUIDELINES UPDATE

A coordinated effort between the American Academy of Pediatrics and the American Heart Association has produced new CPR and airway obstruction guidelines which went into effect towards the end of 2025. This is an important update and one all families should be aware of.

CHANGES FOR INFANT CPR

The use of two or three fingers on the chest for compressions is no longer in effect. It is now recommended that the rescuer use the palm of their hand between the nipples (as before), 

or alternatively, the two-thumb encircling hands technique.

We still need to move the infant chest at least 1/3 of its depth or about 1.5 inches. The ratio of pumps to breaths remains 30 pumps and 2 rescue breaths.

This change reflects the fact that most rescuers were not pumping deep enough.

The recommendation for foreign body obstruction (choking) is unchanged. Repeated upper back hits (up to 5) followed by up to 5 chest thrusts is still the method of choice until the baby is over one year old.

CHANGES FOR CHILD CPR

CPR technique for a child now includes the use of two hands to ensure adequate depth of compression (at least 1/3 of the chest wall depth).

 

Please remember that if a child is no longer conscious due to airway blockage it is imperative that CPR begin immediately.

The new recommendation for a choking child now includes 5 upper back hits followed by up to 5 abdominal thrusts (inward and upward), alternating until the object is cleared.

  • For best effect, position yourself to the side and slightly behind the choking child. For a small child, you may need to kneel behind them rather than stand. This should be done while the child is bent over. Previously we suggested back hits while the child was standing upright.
  • Give 5 back blows using the heel of the hand to strike between the shoulder blades. If no improvement, then have the child stand up straight.
  • Next, move behind the child; bend your knees slightly for balance and support, and give 5 abdominal thrusts, pulling inward and upward each time.
  • Continue alternating 5 back blows and 5 abdominal thrusts until the child can cough, cry or speak.
  • If they become unresponsive, begin CPR (starting with compressions)

 

CORRECT RESPONSE TO CHOKING 

As always, we continue to encourage parents and care providers to follow the basics of prevention of airway obstruction by adhering to the following principles:

  • Never leave an infant or small child unattended during mealtimes
  • Once they are crawling/walking keep all food and other objects away from them
  • Do not provide food or snacks in the car as it is difficult or impossible to recognize an airway obstruction before it is too late
  • Be extra careful if you enter a small mouth to try and remove an object. If you must, do so by going along the cheek then swipe across the mouth

When someone is choking immediate response is crucial. You can’t rely on Paramedics to save the day as they won’t be able to arrive in time. That is why we cannot stress enough how important it is for ALL family members and care providers to know how to save a choking infant or child. 

 

BE PREPARED. BE SAFE.

 

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CONSUMER WATCH! RECALL ALERT

There’s a lot to think about when you’re having a baby, so many needs to consider – cribs, strollers, clothing, diapers, baby bottles, bassinets, and more. Needless to say, choosing the best and safest products for your infant, toddler, or young child can be a dizzying process, especially when you’re bombarded with so many product choices.

But how to know if you’re buying something that poses a serious risk? An easy way to stay informed is to register with the Consumer Product Safety Commission (cpsc.gov) so you can receive email alerts that identify dangerous products and provide information about their risks. They also have an app you can download to your phone. You can find that here. This is a must-have resource. Adult-related products are included as well.

We went over all the alerts that were issued this year up to the writing of this article and identified a number of product categories that seem to continually pose a health and safety risk where infants and toddlers are concerned. And the list of products grows every day.

Here’s a sample of our findings…

  • Several baby bathing seats that are unsafe and present an increased risk of drowning
  • Bassinets which are unsafe for infants, increasing the risk of suffocation or entrapment

  • One or more baby gates that do not meet safety standards
  • More than a few chests of drawers that are top heavy and are easy to tip over by a small child causing serious injury

  • Numerous toys, games and other items powered by small batteries that, if placed in
    the mouth, increase both a choking risk as well as a risk for toxic ingestion

  • Several safety helmets for those starting to ride a bike or skateboard that are not
    adequate for protection of the head
  • Several “self-feeding” pillows with attachments for a small bottle that pose a
    choking risk

  • Any number of medications and/or supplements that violate child resistant
    packaging and can lead to serious or lethal toxic ingestion
  • Infant & toddler bedtime clothing that do not meet flammability standards

There are also a significant number of items that adults use regularly including:

  • Power strips for multiple electrical inputs that pose a fire risk
  • Steam cleaners due to risk of serious burns
  • A number of pool or hot tub drain covers which increase the risk of entrapment and
    drowning
  • Several adult portable side rails that increase the risk of serious falls

 

Save a Little Life™ strongly encourages all parents to register with the CPSC. Here’s a direct link to subscribe to their mailing list.

 

BE PREPARED. BE SAFE.

 

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.

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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.

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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

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.

NANNIES NEED A CPR AND FIRST-AID CLASS

Why Does My Nanny Need CPR and First Aid Training?

The question posed above is a good one. The answer I usually provide anyone who asks why their caregiver needs a life-saving course is: “Do we really have control over when bad events occur at home or anywhere else?” That answer suggests that parents stop and think about this issue. Their answer is usually self-evident. Of course we don’t.
Emergencies in the home have little or no warning as to when they will occur. This is why we emphasize the importance of two main areas: Prevention and, if and when needed, action.

The program offered by Save A Little Life ™ addresses and re-focuses on these two critical areas. The responsibilities we give our nannies/care-providers are awesome. They are not only your eyes and ears when parents are away from home, they really need the exact same understanding of how we prevent and, importantly when and how we act.

Simply and accurately put, they perform the most important job you will ever hire for. The vast majority of your home based help are smart, interested and utterly committed to your infant, toddler and child’s well-being. It is the parent’s job to make sure you are leaving your little ones in prepared hands.

First Aid and little ones

The first-aid component of the course is far more likely to be required. Cuts, bumps, splinters, head bonks and the like are quite common. Our experienced instructors review the most common of these incidents so that your nanny will be able to be decisive in their action. These actions may include:

* Responding to the more minor incidents noted above.
* Be able to understand when an injury, for example, needs the parent’s attention right away.
* Should be confident in explaining a situation that has occurred and do so succinctly and in a timely way.
* The competent use of first-aid supplies provided by the parent at home or elsewhere.
* Do their best to identify injuries or accidents that may require a visit to the E.R.
* Quickly identify higher risk concerns in or near your home where quick action may be needed to safeguard your small ones.

What we do

Save A Little Life ™ specializes in Pediatric CPR and First Aid for families and caregivers. Ask us about family discounts for those who have taken our class recently and need to have a caregiver trained too. Don’t wait!

Our next two certification courses are as follows:

Westside Nannies (En Espanol)
July 15, 2017
(Ask about our Special for this class, now through June 13, 2017!)
Westside Nannies (English)
July 22, 2017
Parents are welcome too, of course!

Have a safe and prosperous summer
Richard Pass, RN ,BS
Founder and Owner of Save A Little Life, inc.

BASIC FIRST AID: A MUST FOR ALL

Having been very involved in both of my daughters’ extracurricular activities, I found that basic first aid is more than helpful, it’s a must!

In our case, my kids played soccer and softball, rode bikes, zoomed on skateboards and much more. On occasion, one or the other took a tumble from that bike or skateboard, bonked heads with another kid on the soccer field, got stung by a bee or got an accidental poke in the eye.

 Since we know that minor injuries occur with regularity for children of all ages, the question is: Are we ready with adequate first-aid supplies and do we know how to use them?

 Save A Little Life not only offers the highest quality in CPR training, but we are specialists in first-aid response and have an excellent basic first-aid class just for you.

Those who attend our first-aid course will learn the following skills:

•    How to control bleeding
•    How to manage a burn
•    How to stabilize a bad sprain or fractured bone
•    How to safely irrigate a wound or eye
•    The basics of bandaging wounds
•    Dealing with insect or animal bites
•    Response to poisonings
•    How to assist a victim of a seizure
•    How best to evaluate a head injury victim

Our First Aid course is a hands-on program where all participants work with real First Aid materials under the supervision of a trained critical care or emergency department R.N.

 Knowing how to respond to urgent care problems requires the ability to remain as calm and self-assured as possible. The goal of our program is to help you gain confidence in managing many of the minor to moderate injuries when and where they occur.

These classes are a must for all parents, family members and care providers.

Check our Calendar for upcoming classes, or contact us at (818) 344-1442.

And be sure to check out our Family First Aid Kits.

Regards,

Richard Pass, RN,BS

Director, Save A Little Life, Inc.