Choking hazards and how to reduce the risks
In my time working as an advanced life support Paramedic, I quickly learned that choking is a massive fear amongst many parents, and rightfully so. It's more common than we think; it's silent and, unless we act fast, can be deadly. But please do not panic, we can all do things to reduce the risks and if the unthinkable is to happen and our child chokes, we can initiate life-saving treatment that is highly effective. So take a deep breath and let me help you become less fearful and more empowered!
So let's start with the basics; what is choking?
Choking is when there is an object caught in a child's airway that blocks the airway, which makes it difficult or impossible to breathe. It either partially blocks the airway or completely blocks the airway. This is different to gagging. Gagging is a natural mechanism designed to protect bub from choking. Gagging can be triggered by bub putting things in their mouth, like spoons, food, toys or even the breast or bottle at a young age, but nothing is lodged in the airway, unlike choking. Gagging requires a big, calm smile from you, observation only and lots of reassurance. This reflex is designed to stop objects going to the back of the airway and causing a choking episode, so while scary, it's an excellent, protective reflex that bub has. It will start to disappear around six months of age.
Round, firm, slippery = choking hazard
Really anything that goes in your little one's mouth can be a choking hazard, but we know the most common hazards are round, firm or slippery; think grapes, cherry tomatoes, blueberries, nuts, raw carrot, apple, popcorn chewing gums, coins, marbles, batteries and the list goes on. The greater the roundness, firmness or slipperiness of an object, the greater the choking risk.
Here are my top tips to reduce the risk of choking
Modify your child's food
It's important to know the foods that cause the greatest choking risks and alter these foods to ensure they are less likely to cause a choking incident. In simple terms, make food that is firm, less firm. Make foods that are round, less round and foods that are slippery, less slippery. For example, you can make food less round by cutting it; you should cut grapes in quarters, lengthways. You can roll slippery food like avocado in fine breadcrumbs and cook carrot to make it less firm!
The squish test is a great test to perform to make sure your babies finger food is safe. Simply pinch the food between your pointer fingers and thumb. This mimics the pressure of a toothless little ones' gums. If the food squishes easily, it means it's safe, and bub will be able to chew. If it doesn't squish easily, you should cook, grate or mash it, so it becomes soft enough to pass the test.
Size of an airway
This little trick is one you'll find me constantly doing at home! I grab my pointer finger and touch it to the knuckle of my thumb to make a small circle. This is the indicative size of an airway of a three-year-old child. Anything that can drop through here could block the airway of your child. Use this hack when buying toys or thinking about what is safe for your baby to play with.
Safe eating environment
Creating a safe and calm environment for your child to eat is so important, but often overlooked. Your child should be seated and secured in a highchair, you should be within arms reach of your child at all times and have your eyes on your child while eating. Choking is silent and it only takes a few minutes to cause brain damage.
My child is choking what do I do?
Now, onto the most important part of this post; treatment.
The management of choking is dependent if bub has a partial or complete obstruction.
Partial choking obstruction
We determine this by assessing whether they have an effective cough or not. If your child can cough, it means the airway is only partially blocked. You need to encourage your child to cough in an attempt to clear their own airway. Stay vigilant as the object may move and completely block the airway. If coughing does not dislodge the item, call 000. Stay with bub, continue reassessing the situation, and remember that you can always cancel an ambulance if it's no longer needed.
Complete choking obstruction
If your bub has a complete obstruction, no air will be moving in or out. The child will be silent, red and turning blue and look petrified. It's time to act fast.
Start by performing that life assessment [DRSABCD], and call 000 immediately with the phone on speaker so you can speak to them while performing first aid. If bub is unconscious and not breathing normally, continue with CPR as part of your DRSABCD management steps. If bub is conscious, you need to give back blows and chest thrusts. For a bub aged 0-1, lay them across your lap on their tummy with their legs higher than their head. In the centre of the back, between their shoulder blades, give five sharp back blows with the heel of your hand, gradually increasing the strength of each one as you go. Make sure to quickly check bubs mouth between each one to see if you've dislodged the object, and if you have, roll them to the side and sweep the object out of their mouth with one finger for an infant, two for a child.
For a child aged 1-8, the management is exactly the same, except instead of laying them across your lap, sit them on the edge of a seat and lean them forward.
If back blows don't dislodge the object, you need to move onto chest thrusts for both an infant [0-1] and a child [1-8]. For an infant, roll them onto their side from the back blow position so their tummy is facing outward and their back is against your tummy. Using two fingers, press down firmly at the same point you would provide CPR [centre of the chest, in between the nipples] five times, checking bub's mouth to see if the object dislodges between chest thrusts. If, after five chest thrusts, the object is not cleared, go back into back blows.
Again, the management for a child [1-8] is the same, except instead of laying them on their tummy, lean them back from their leaning forward position and support their neck with your other hand. Also, use an open hand instead of two fingers for chest thrusts.
If the object becomes dislodged after back blows or chest thrusts, put your infant or child in the recovery position and sweep the object out of their mouth using one finger for an infant and two for a child.
But if at any point, your infant or child goes unconscious and is not breathing normally, you need to start CPR immediately.
Remember, silent and blue they need help from you!
Former Advanced Life Support Paramedic
Cofounder of Tiny Hearts Education