Choking on food and small parts remains one of the most devastating events that can occur to infants and young children. These accidents are a leading cause of morbidity and mortality in children. The majority of these events occur in children ages 10 to 36 months. Approximately 10,000 children are seen in emergency departments each year for choking accidents. Many require surgery to remove the object, followed by hospital stays. Some do not survive: one child dies every five days in this country alone from choking on food or other objects.
The Consumer Product Safety Commission requires that all toys manufactured for young children have safety labels, indicating whether or not the toy is safe for children under age three years. Any toy with "small parts" needs to be labeled as such. There is also a requirement that any toy with a battery has to have the battery secured with child-proof latches or screws, as accidental battery ingestions, especially small disc batteries, are on the rise. These can also be deadly.
There are no such labels on most foods, as the FDA does not require safety labeling regarding food choking as they do regarding allergen risks. In addition, while most every parent does all they can to keep their child safe from dangers seeming to lurk at every corner of our world, tragic accidents occur, despite one's best efforts. The important thing is to know how to react, and act, in the face of a sudden tragic event. Parents and caregivers of infants and young children are encouraged to learn CPR, which is offered in many hospitals, schools, and through the American Red Cross. It is also recommended that those caring for infants and children learn how to assess and treat a choking incident. If a caregiver notices a child has choked and is not breathing, they or someone nearby should immediately call 911, and, for children ages one to eight years, they should stand behind the child, wrap arms around the child's waist, and grasp one hand around the fist. Then inward and upward abdominal thrusts should begin. For infants under one year, the infant should be placed face down on the adult's knee, and back blows should be attempted, followed by having the infant on the back, giving abdominal thrusts.
But sometimes, despite best efforts, these maneuvers don't work. At UCLA, we recently performed a review of cadaveric studies and performed a simulation study of a portable, non-powered suction-generating device to treat life-threatening blockages due to choking on foreign objects. We found that the amount of pressure generated by such devices were more than double that of the pressure generated by previously well-established maneuvers such as back blows and abdominal thrusts. A mom in Northern California had a terrifying experience of her child choking on an object, and was able to successfully use such a device.
Crystal, who requested her last name not be used, is a mom of an 11-month-old and two older children. When her oldest was a toddler, she had a choking incident, as Crystal told me in our telephone conversation. Thankfully, all turned out fine, but ever since then, Crystal has been acutely aware of potential choking risks. When she was pregnant with her youngest, she was shopping around for safety items and came across a device made by the company LifeVac, a non-powered handheld suction device to remove foreign objects from the airway of a choking victim. The mechanics of the device are pretty straightforward: there are three mask sizes (adult, child, infant/toddler), the mask is placed directly over the face of the choking victim, the plunger is pressed down, and then pulled up, creating a suction effect to remove the object.
"I never thought I'd use it," Crystal recalls. "I threw it in the closet and forgot about it." An extended family trip over Memorial Day weekend somehow prompted Crystal to toss the LifeVac in her suitcase. As there would be children of all ages on the trip, she wanted to pack it, just in case. Thankfully, the trip went smoothly without a hitch. And as she predicted, she didn't need it. The next day, she was busy around the house, and didn't have time to unpack. While she was in the kitchen, her 11-month-old was playing in the next room-- a room Crystal had routinely cleaned meticulously, removing any toys with small parts, sharp objects, or anything on the floor or low tables that could be a risk to her child.
Suddenly she heard a strange gurgling noise from that room, and her worst fear had come true. "She was choking. I ran over to her, and I thought I saw something sharp in her throat, and since I saw it, I tried to grab it." But then the baby gasped and the object was gone-- out of view, and now completely blocking the airway. "I tried back blows, but it was stuck." Her older daughter called 911 right away. Crystal kept trying back blows, abdominal thrusts, but "her lips were turning blue. Nothing was working." She then remembered that the device she dug out from her closet for the family trip was still in her suitcase. She ran to grab it, and used it on her baby. It took two tries, then "out popped a plastic piece [from a thick plastic bag clasp]." The baby's lips turned pink, she started to cry, and soon after, was puzzled why her mother looked so distressed. The paramedics arrived, checked the baby, and deemed she was well-- her breathing was normal, her lungs were clear, and she was running around as if her mother's worst nightmare hadn't just happened.
When it comes to safety, you really never can be too sure. As Crystal has told countless friends and family, both before this event, and more so subsequently, "Don't think it won't happen to you. You just never know."
This post was edited on August 8, 2019 to include notes from my telephone conversation with Crystal, mother of the recent choking child. It also includes additional content regarding research on a non-powered suction-generating device as a possible mechanism for removing foreign objects blocking a victim's airway.
