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By Linda Bren
Peanuts and popcorn, hot dogs, candy, carrots, and sunflower seeds. Ayal Willner, M.D., has seen them all stuck in children's throats--and sometimes their lungs. The pediatric ear, nose, and throat specialist in Long Beach, Calif., spends a lot of time in emergency rooms removing food and small objects from children's air passages. "I see about 20 to 30 kids a year from all over southern California because of choking," he says.
In 2001, more than 17,000 children ages 14 years or younger were treated for choking episodes in U.S. emergency departments, according to the Centers for Disease Control and Prevention (CDC). About 60 percent of these episodes were related to food items.
"Almost all solid foods can pose some risk of choking," says Martin Stutsman, a consumer safety officer in the Food and Drug Administration's Center for Food Safety and Applied Nutrition (CFSAN). "This is particularly true of foods that are of a size and shape that can obstruct breathing if they become lodged in the airway."
The FDA takes action when a food poses an unusual risk of choking. But most foods, while posing some choking risk, do not pose an unusual risk, says Stutsman, and the agency cannot eliminate all the potential risks. "We know a lot of choking incidents occur on grapes, for example, but it's impossible to control the size of grapes."
"But there are things that people can do to reduce the risk of choking," says Stutsman. Safety experts agree that parental supervision and keeping potential choking hazards out of children's reach are key to choking prevention. "Parents need to be cognizant of where their children are playing at all times and they should withhold foods of the size that are likely to cause choking in very young children," says Stutsman.
Food or small objects can cause choking when they get caught in the throat and block the airway, preventing oxygen from getting to the lungs and the brain. According to the American Academy of Pediatrics (AAP), when the brain goes without oxygen for more than four minutes, brain damage or even death may occur.
In May 2005, two young girls in New York City died after choking on hard candy. The girls, ages 4 and 5, choked on jumbo mint balls, round peppermint candies measuring a little more than three-quarters of an inch in diameter.
Every child is at risk for choking, says the CDC. Younger children are particularly at risk because of their tendency to place objects in their mouths, poor chewing ability, and narrow airways compared with those of older children and adults.
A peanut, for example, is going to affect a child's airway more than an adult's, says Willner. Children younger than 6 years do not have all their molars, the grinding teeth at the back of the mouth. "Food can get to the back of the jaw and without being crushed by the teeth, the food is pushed to the back of the throat and the body instantly swallows it," says Willner. "If it happens quickly, it may not lead to a coordinated swallow. Or if a child laughs or takes a deep breath, the food can be inhaled."
Inhaled food is drawn into the windpipe (trachea) and travels into one of two bronchial tubes (bronchi), where it can block the flow of air into the lungs. "Depending on the size and shape of the food particle, it can go further to a point where it actually plugs up one of the smaller branches of a bronchial tube and can cause part of the lung to collapse," says Mary Purucker, M.D., Ph.D., an FDA pulmonary specialist. "Even if the particle doesn't entirely clog the airway, it has picked up bacteria from the mouth or elsewhere and can cause respiratory infection, such as pneumonia."
When food is inhaled, coughing and choking spasms occur. "But within minutes, the choking experience will stop," says Willner. "The initial reflex is tired out and you're left with a low-grade irritation. You may think everything is fine." However, pneumonia or other serious conditions may show up weeks later. "I've taken out foreign bodies that have been there for six weeks," says Willner.
The American Academy of Pediatrics recommends keeping the following foods away from children younger than 4:
Excerpt from Sept-Oct 2005 issue of the FDA Consumer magazine.
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