In October, Maja Djukic was rollerblading in Greenwich, Conn., when she heard a woman screaming for help. Djukic, an assistant professor at New York University College of Nursing, rushed to a nearby house to find 19-month-old Griffin Greene limp and blue. He had inhaled a Goldfish cracker, and his mother’s attempts to dislodge it by holding the toddler upside down and slapping his back had failed.
While the child’s father called 911, Djukic performed chest compressions, she recalled in an interview. By the time the ambulance arrived – about four minutes later – Griffin was breathing again and crying. Although he needed treatment to extract the cracker, which had become lodged in his lungs, Griffin is now fine thanks to the quick action of a passer-by.
Not every child who chokes is so lucky. Choking is the fourth-leading cause of unintentional deaths in children under 5, according to the New York City Health Department; every five days, at least one child dies after choking on food.
The trachea, or windpipe, of a young child is about the width of a drinking straw, and if food or a small object is inhaled instead of swallowed, it can block the airway. Even when something is swallowed and becomes lodged in a child’s throat or esophagus, it may compress the trachea enough to impair breathing. After just four minutes without oxygen, a child’s brain can be permanently damaged.
Even though both of Griffin’s parents were with him when this near-tragedy occurred, neither knew what to do to save him. Few parents of newborns are taught how to prevent choking and what to do if it occurs. Yet infants and toddlers routinely explore the world with their mouths, and anything they may find lying about can become a choking hazard.
Nearly every day, I see a statistic in the making among small children in my neighborhood. Under the care of a parent, grandparent or nanny, they are routinely given all manner of snacks and allowed to run back to their activities – while still chewing. It is a disaster waiting to happen.
A child should not eat in a moving vehicle, either. If the driver stops short or the vehicle is bumped from behind, the sudden lurch may cause a child to inhale food or to swallow it unchewed.
Food accounts for 60 percent of pediatric choking cases, according to the Centers for Disease Control and Prevention.
Any food can become a choking hazard. The American Academy of Pediatrics cites hot dogs, meats, sausages, fish with bones, cheese cubes, popcorn, chips, pretzel nuggets, hard candy, gum, lollipops, jellybeans, marshmallows, whole grapes, raw vegetables, cherry tomatoes, nuts, peanut butter (especially eaten from a spoon or on soft bread) and even ice cubes.
Many parents now know that grapes should be halved for a young child, but fewer realize that a hot dog should be cut lengthwise for a child until at least age 4. (Better yet, skip nutritionally questionable hot dogs altogether.) Parents should wait to introduce puréed food until after 4 months of age, when motor skills for swallowing are better developed. Always supervise meals and snacks when babies and children feed themselves.
But nearly a third of choking cases in children are caused by objects. The pediatrics society lists these among the most common offenders: coins, buttons, marbles, small balls, deflated balloons, watch batteries, jewelry, pen caps, paper clips, arts and crafts supplies, small toys and detachable toy parts.
It is critical to know what to do if a child appears to be choking. If the child can cough, speak or cry, the airway is not completely blocked. Encourage the child to cough, and if that fails to dislodge the object, call 911. Caregivers should always have a cellphone on hand.
If a choking baby can make little or no sound, ask someone to call 911 (if you are alone, attempt a rescue for two minutes before calling 911). Place the baby facedown over your arm with the head lower than the chest and support the baby’s head with your hand. Then give five quick blows between the shoulder blades with the heel of the other hand.
If no object is dislodged, turn the baby face up on a firm surface, place two fingers in the middle of the breastbone just below the nipples and give five quick thrusts. Repeat this sequence until the baby begins breathing or help arrives. If breathing is not restored within a few minutes, begin CPR.
For a child more than 1 year old who is choking, stand or kneel behind the child and wrap your arms around her. Make a fist and place it just above the navel. Grasp the fist with the other hand, and make quick upward thrusts with it. Repeat until the object is dislodged or the child begins breathing.
Any child who required a choking rescue should be examined by a physician afterward.
The American Heart Association sells kits to teach caregivers how to perform CPR. Each costs $34.95 and includes a mannequin on which users can practice. Go to heart.org. Click on “CPR & EEC” at the top of the screen and follow the links for CPR products.