Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION

Choking is the coughing spasm and sputtering that happen when liquids or solids get into the airway. (This is called aspiration.) A child's cough reflex will clear the windpipe of liquid within 10 to 30 seconds. Complete blockage occurs when solid food or a foreign object becomes lodged in the voice box. (It can also occur with severe croup.) If this happens a child is unable to breathe, cry, or speak. The child will be in a state of panic, and if the obstruction isn't removed in 1 or 2 minutes, the child will pass out.

FIRST AID

1. Call the rescue squad (911) IMMEDIATELY.

   Call the rescue squad (911) immediately in all cases of choking on a solid object.

   In general, choking on liquids is temporary and harmless. Call the rescue squad if your child chokes on a liquid and turns blue, becomes limp, or passes out.

2. Encourage coughing.

   As long as your child is breathing and coughing, do nothing except encourage him to cough the material up by himself. The main purpose of your child's cough reflex is to clear the windpipe. Don't give your child anything to drink because fluids may take up space needed for the passage of air.

3. Heimlich maneuver if a child over 1 year old stops breathing

   If your child can't breathe, cough, or make a sound, proceed with high abdominal thrusts. Grasp your child from behind, just below the lower ribs but above the waist, in bear-hug fashion. Give a sudden upward jerk at a 45-degree angle to try to squeeze all the air out of the chest and pop the lodged object out of the windpipe. Quickly repeat this upward abdominal thrust 10 times in rapid succession.

   If your child is unable to stand and is too heavy for you to suspend from your arms, lay him on his back on the floor. Put your hands on both sides of the abdomen, just below the ribs, and apply sudden, strong bursts of upward pressure.

4. Back blows and chest compressions if a child under 1 year old stops breathing

   If your infant can't breathe or cough, place him face down over your knees or forearm (that is, use gravity to help propel the object out). Then deliver 5 hard blows with the heel of your hand between the shoulder blades in rapid succession. (This is not helpful in older children.)

   If the child does not start breathing again, lay your child on his back on the floor and apply 5 rapid chest compressions over the lower breast bone (sternum) using two fingers.

   (These revised first aid measures were recommended by the American Academy of Pediatrics in 1993.)

5. Resuscitation if your child passes out from choking

   The rescue squad should be on its way.

   Quickly open your child's mouth and look inside with a light to see if there is an object that can be removed with your fingers or tweezers (usually there is not). Don't put your fingers into your child's mouth unless you already see the object. Doing this blindly can wedge an object deeper into the voice box (larynx).

   If you know how, begin mouth-to-mouth resuscitation. Air can usually be forced past the foreign object. If mouth-to-mouth breathing doesn't move the chest, repeat the abdominal thrusts (if over 1 year old) or chest compressions (if under 1 year old).

PREVENTION

Choking can be life-threatening, so try to prevent it from happening again by not giving young children foods or small objects that are most likely to cause choking.

Foods that are most likely to cause choking are nuts of any kind, sunflower seeds, orange seeds, cherry pits, watermelon seeds, gum, hard candies, popcorn, raw carrots, raw peas, raw celery, and tough meats. Do not give these hard foods to children who are less than 4 years old. They do not have enough molar teeth to chew them well and they may not understand that some seeds should be spat out rather than swallowed.

The soft foods that most often cause fatal choking are hot dogs, sausages, and grapes. These foods must be chopped up before serving. Warn baby-sitters and older siblings not to share these foods.

Choking on a rubber balloon is the leading cause of deaths resulting from choking on objects other than foods. Most incidents occur when children suddenly inhale a deflated balloon they have been chewing. Warn your child never to chew or suck on pieces of rubber balloons. Even teenagers have died from this freak accident. Chewing on an inflated balloon is also dangerous because it could burst. Mylar helium balloons are safer, but rubber balloons are fine if they are used with supervision.