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Avoiding Choking Hazards
According to the California Department of Public Health, choking is one of the primary causes of accidental injury and death in children. To help parents be proactive and ward off potential perils, Stanford Medicine Children’s Health pediatrician Joelle McConlogue, MD, offers some expert tips for dealing with choking threats throughout the year.
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Learn more about Joelle McConlogue, MD
Joelle McConlogue, MD
Joelle McConlogue, MD, received her bachelor of science from Brigham Young University and then attended medical school at Columbia University College of Physicians and Surgeons. She completed her residency in pediatrics at The Children’s Hospital of Philadelphia and spent an extra year as chief resident. Dr. McConlogue spent many years practicing on the East Coast, worked in an inner-city clinic, was involved in academic medicine teaching medical students and residents, and later joined a large suburban private practice. She joined Bayside Medical Group in 2016 after moving to California with her family. Having spent much of her childhood living overseas, she enjoys traveling, reading and spending time with her husband and four children.Learn more about Joelle McConlogue, MD
Transcription:
Scott Webb: It's not easy being a parent. And one of the top things on our worry list as parents is choking hazards and how we can prevent our kids from choking and help them when, let's just say, prevention didn't work out as we'd planned. And joining me today to help all parents with choking concerns is Dr. Joelle McConlogue. She's a pediatrician with Stanford Medicine Children's Health.
This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Doctor, thanks so much for your time today. We were just kind of talking off the air that once a parent, always a parent. So, I worried about my kids when they were little about choking. And then, my son lives by himself today and I worry about him now, you know, eating too fast and all that. So, always on our mind, sort of omnipresent when it comes to parenting, no matter how old the kids are. But let's focus today more on the younger ones, the little ones, and talk about some of the most common choking hazards, whether that's food, toys, whatever it might be.
Dr. Joelle McConlogue: Yes. And thank you for bringing light to this important topic. I know it's one that parents always worry about at all ages.
Scott Webb: Yeah.
Dr. Joelle McConlogue: So, there are several common choking hazards throughout childhood and food accounts for probably more than half of the choking episodes that we see. Particular foods that are at high risk are any type of nuts or peanuts and seeds, but also other foods such as hot dogs, chunks of hard foods, so chunks of hard vegetables or fruit or meat, whole grapes. Popcorn can be a choking hazard or some sticky candies and then also chewing gum. So, those are the main risky foods, although any food can cause a risk.
But then, there's also household objects and toys that can be choking hazards as well. So, toys or any small type of object, so plain necklaces or beads, small balls or marbles, some balloons, but then things lying around the house such as coins or buttons, little small batteries or refrigerator magnets or pen or marker caps. All those little small objects around the house can be worrisome as well.
Scott Webb: Yeah. And for those of us parents who have been through this, I just remember, you know, my kids were about four and a half years apart. So you know, my son, who was four and a half years older than his sister, he had all the toys with all the little things. And of course, the little ones, they come along and they think, "Well, that should probably go in my mouth," you know, not that they give it much thought, but it does seem that that's what kids do. They find little things and they think, "Well, it goes in the mouth, obviously." So, I remember always sort of patrolling my house looking for choking hazards. And so, I know the age range that I had when I worried, but what's the age range for kids that have the greatest risk of choking and why?
Dr. Joelle McConlogue: Choking can occur at any age, but there is a higher risk of choking in our young children, so probably from about six months of age up to age four is really the target age where it does happen the most often. And there's a couple of reasons for this. First of all, babies and young toddlers that age are very oral. They explore their world by putting everything in their mouth and parents know, as they're developing, they're constantly grabbing things and right into the mouth it goes. And that's a normal developmental stage, but it also puts them in a higher risk.
The other reason that children this age are at higher risk is that they don't have a full complement of teeth. They don't have those back molars, they aren't able to chew foods. And they're still developing the oral motor skills that they need to chew and to swallow. And so, those foods that we talked about a little bit earlier can really be a high risk because they don't have the ability to process that in a safe way.
Scott Webb: Yeah. Right. And of course, we as parents can't apply logic and reason to little ones. You know, it's like, "Don't they know they don't have teeth? Don't they know they can't chew that?" Well, no, of course they don't. And you say like it's an important developmental stage, but also a scary one for parents, of course. And let's talk a little bit about older kids, what are some of the hazards they and we need to be on the lookout for?
Dr. Joelle McConlogue: Older kids can certainly be at risk too. And a lot of that is due to eating habits in older kids. Lots of older kids like to stuff as many marshmallows in their mouth as they can, or they like to throw foods up in the air and catch them with their mouth. And these are not necessarily good eating habits and does put them at risk for choking. And then, also just, you know, walking around, eating while walking, eating while running, eating while piling around with your friends and kind of pushing each other around, or even just laying down eating. You know, eating popcorn while you're laying down on the couch, watching a movie can be at risk too. So, you have to watch those eating behaviors and environments for older kids as well.
Scott Webb: Yeah, you do. When I was in third grade, right before I walked out the door, my grandma said, "If you're going to take a piece of candy, don't run." So of course, I put the candy in my mouth and I immediately sprinted to school because I'd gone home for lunch. And I started choking on that candy, and I wish I could thank this woman to this day, the crossing guard that was standing there, she saved my life. She gave me the Heimlich and popped that candy out of my mouth and saved my life because the traffic was so bad I wouldn't have been able to get across to the school. And I wish I could thank her. And I always remind my kids of that story, you know, that yes, parents say lots of things and kids tend to tune us out, but when they say don't run with candy in your mouth, we really do mean it. There's really good reasons for these things. And what are some of the other safety measures besides just telling our kids, "Don't run with candy in your mouth"? What are some other things that we can do, families can do, to help children not, you know, choke on things?
Dr. Joelle McConlogue: I think I'd like to address this in two different viewpoints. One, the things that we should do with food and then also the things that we should do with toys or other small parts because I think both of those are important and they're a little bit different.
So when we talk about foods, you know, prevention is the most important in trying to prevent choking episodes. And I think for kids who are under four, I would avoid those high risk foods that we talked about. So, just make sure that those foods that are at higher risk for choking, that they're out of the diet until they're around four years of age and really can chew them.
I think when feeding babies and small children, really make sure that you're cutting up the foods into small pieces. And what I usually use is my nail on my pinky finger. And I say, you know, if you look at the size of your nail on your pinky finger, that's about the size to cut it, when you're cutting it for your toddler. So, kind of use that as a guide so that parents can cut things up into small pieces. And then, always supervise mealtimes when you're feeding your baby or your toddler. Be right there. Don't set them down and walk away. Just kind of be there present. I think for older kids, we talked about just encourage them to be sitting at meals, to eat at the table, not to be walking around, not to be playing games with their food, and just making sure that they're taking their time to chew.
And then, I would also say for foods, just be especially careful during parties. When you're in other people's homes, they often have bowls of nuts or candies or other foods that you may not have at home but your toddler or a small child might be interested in. So, just be aware and be vigilant of those things that are out on the tables or at arm's reach of those kids or anything that may have fallen on the floor. That would be my advice for food.
I'll kind of pivot and we can talk about toys and small objects. And specifically with toys, the toys are designed for specific age ranges, and these ranges take into account any choking hazards. So when parents are buying toys or items for their child, I would strongly encourage them to follow these and not buy toys or things which are designated for children who are older because they may have those small parts or those joking hazards.
And if you have older children, I would be careful of the older children's toys that do have small pieces. Make sure that when they play with them, they're really good about cleaning them up or even have a separate area where the kids can play with those toys where the baby or the small child is not around when they're doing the Legos or the bead sets or other things as well.
Scott Webb: You know, it's funny you mentioned Legos. I've kind of gotten back into that as an older person in my 50s. I've enjoyed putting Lego cars and things together again, like I did when I was a kid. And it occurred to me the other day when I had all these little pieces on the table, I never could have done this when my kids were little. So, the timing worked out good. I don't think my 15-year-old's going to come along and start putting Legos in her mouth, at least I hope not. And I mentioned the Heimlich and how grateful I am that someone did that for me when I was choking when I was a kid. Is that really our only recourse, you know, if we realize that our child is choking on something? Is Heimlich the best thing? Is that the go-to thing or are there some other things we can do as well?
Dr. Joelle McConlogue: So, I would say that if your child is choking, but they are having just some difficulty, they're able to speak, they have a strong cough, they're coughing on their own, then at that point I wouldn't step in to do anything right away. The child's own cough and their own maneuvers are often stronger than anything that another person can do. So if they're coughing and able to speak, then let them try to clear their airway on their own first.
But if the child doesn't seem like they're breathing at all, if they're appearing pale or they have a very weak cough that doesn't seem very effective, then this is a medical emergency and this needs immediate attention right away. So, the first thing that I would do if that's happens is first call 911 or direct someone to call 911 right away. And then if the child is older than a year of age, then go ahead and perform the Heimlich maneuver, which is an abdominal thrust, which is designed to try to dislodge that occluding object.
And then Scott, for children less than a year, what I would recommend doing first is just to have the parents just look in the mouth. If there's something they can see easily and is easily accessible, do a sweep of the mouth and try to remove that object. And if they are not able to do that and the child is still choking, then for kids under a year, we recommend doing five back blows followed by five chest thrusts, and alternating those back and forth until the object is dislodged.
Scott Webb: Yeah. And I'm sure, you know, a lot of parents, things that I had to make sure I knew how to do when I became a parent, which was, you know, perform the Heimlich if necessary, though I never needed to, learn how to do CPR properly and now try to keep up with the latest guidelines for CPR, all those things. So, a lot of responsibilities and a lot of good, bad and, you know, everything in between being a parent. And, you know, I was just thinking about emergency departments and emergency room doctors and thinking about all the things that they experience, especially when it comes to kids, whether that's putting things in their ears and noses and perhaps other places they shouldn't. So when we think about that, just what kids generally do with things, toys and otherwise, and when we should take our children to see the doctor or to urgent care. Maybe you can just, as we wrap up here, give us some guidance on these things.
Dr. Joelle McConlogue: Kids are wonderfully imaginative and they love to explore. And so often, objects do go where they shouldn't. We talk about those small pieces and the small toys where they are choking hazards, but they are also risks for, you know, even if a child's not putting it in their mouth, they may take a small bead or something and put it in a place where it doesn't usually go. If that's the case, I would seek medical attention. If there's something up the nose or in the ear, go into the emergency room or into the urgent care and have them take a look. And often, they have specialized tools or abilities to kind of pull those small objects out.
The one warning that I do want to give is that button batteries are extremely worrisome. So if a child ingests a button battery or if they take a button battery and put it into any place where it should be, a nose, an ear, that is an emergency also, and you should seek medical attention right away to have that removed and evaluated.
Scott Webb: Definitely. Well, you know, great advice from an expert today. As I said, my kids are older, but they give me other worries now, of course, 15 and 19. And so for all of us parents out there, once a parent, always a parent. And as you say, the risk of choking isn't just isolated to little ones. They could be older kids or even adults. So, great information today, doctor. Thanks so much. You stay well.
Dr. Joelle McConlogue: Thank you for having me.
Scott Webb: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: It's not easy being a parent. And one of the top things on our worry list as parents is choking hazards and how we can prevent our kids from choking and help them when, let's just say, prevention didn't work out as we'd planned. And joining me today to help all parents with choking concerns is Dr. Joelle McConlogue. She's a pediatrician with Stanford Medicine Children's Health.
This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Doctor, thanks so much for your time today. We were just kind of talking off the air that once a parent, always a parent. So, I worried about my kids when they were little about choking. And then, my son lives by himself today and I worry about him now, you know, eating too fast and all that. So, always on our mind, sort of omnipresent when it comes to parenting, no matter how old the kids are. But let's focus today more on the younger ones, the little ones, and talk about some of the most common choking hazards, whether that's food, toys, whatever it might be.
Dr. Joelle McConlogue: Yes. And thank you for bringing light to this important topic. I know it's one that parents always worry about at all ages.
Scott Webb: Yeah.
Dr. Joelle McConlogue: So, there are several common choking hazards throughout childhood and food accounts for probably more than half of the choking episodes that we see. Particular foods that are at high risk are any type of nuts or peanuts and seeds, but also other foods such as hot dogs, chunks of hard foods, so chunks of hard vegetables or fruit or meat, whole grapes. Popcorn can be a choking hazard or some sticky candies and then also chewing gum. So, those are the main risky foods, although any food can cause a risk.
But then, there's also household objects and toys that can be choking hazards as well. So, toys or any small type of object, so plain necklaces or beads, small balls or marbles, some balloons, but then things lying around the house such as coins or buttons, little small batteries or refrigerator magnets or pen or marker caps. All those little small objects around the house can be worrisome as well.
Scott Webb: Yeah. And for those of us parents who have been through this, I just remember, you know, my kids were about four and a half years apart. So you know, my son, who was four and a half years older than his sister, he had all the toys with all the little things. And of course, the little ones, they come along and they think, "Well, that should probably go in my mouth," you know, not that they give it much thought, but it does seem that that's what kids do. They find little things and they think, "Well, it goes in the mouth, obviously." So, I remember always sort of patrolling my house looking for choking hazards. And so, I know the age range that I had when I worried, but what's the age range for kids that have the greatest risk of choking and why?
Dr. Joelle McConlogue: Choking can occur at any age, but there is a higher risk of choking in our young children, so probably from about six months of age up to age four is really the target age where it does happen the most often. And there's a couple of reasons for this. First of all, babies and young toddlers that age are very oral. They explore their world by putting everything in their mouth and parents know, as they're developing, they're constantly grabbing things and right into the mouth it goes. And that's a normal developmental stage, but it also puts them in a higher risk.
The other reason that children this age are at higher risk is that they don't have a full complement of teeth. They don't have those back molars, they aren't able to chew foods. And they're still developing the oral motor skills that they need to chew and to swallow. And so, those foods that we talked about a little bit earlier can really be a high risk because they don't have the ability to process that in a safe way.
Scott Webb: Yeah. Right. And of course, we as parents can't apply logic and reason to little ones. You know, it's like, "Don't they know they don't have teeth? Don't they know they can't chew that?" Well, no, of course they don't. And you say like it's an important developmental stage, but also a scary one for parents, of course. And let's talk a little bit about older kids, what are some of the hazards they and we need to be on the lookout for?
Dr. Joelle McConlogue: Older kids can certainly be at risk too. And a lot of that is due to eating habits in older kids. Lots of older kids like to stuff as many marshmallows in their mouth as they can, or they like to throw foods up in the air and catch them with their mouth. And these are not necessarily good eating habits and does put them at risk for choking. And then, also just, you know, walking around, eating while walking, eating while running, eating while piling around with your friends and kind of pushing each other around, or even just laying down eating. You know, eating popcorn while you're laying down on the couch, watching a movie can be at risk too. So, you have to watch those eating behaviors and environments for older kids as well.
Scott Webb: Yeah, you do. When I was in third grade, right before I walked out the door, my grandma said, "If you're going to take a piece of candy, don't run." So of course, I put the candy in my mouth and I immediately sprinted to school because I'd gone home for lunch. And I started choking on that candy, and I wish I could thank this woman to this day, the crossing guard that was standing there, she saved my life. She gave me the Heimlich and popped that candy out of my mouth and saved my life because the traffic was so bad I wouldn't have been able to get across to the school. And I wish I could thank her. And I always remind my kids of that story, you know, that yes, parents say lots of things and kids tend to tune us out, but when they say don't run with candy in your mouth, we really do mean it. There's really good reasons for these things. And what are some of the other safety measures besides just telling our kids, "Don't run with candy in your mouth"? What are some other things that we can do, families can do, to help children not, you know, choke on things?
Dr. Joelle McConlogue: I think I'd like to address this in two different viewpoints. One, the things that we should do with food and then also the things that we should do with toys or other small parts because I think both of those are important and they're a little bit different.
So when we talk about foods, you know, prevention is the most important in trying to prevent choking episodes. And I think for kids who are under four, I would avoid those high risk foods that we talked about. So, just make sure that those foods that are at higher risk for choking, that they're out of the diet until they're around four years of age and really can chew them.
I think when feeding babies and small children, really make sure that you're cutting up the foods into small pieces. And what I usually use is my nail on my pinky finger. And I say, you know, if you look at the size of your nail on your pinky finger, that's about the size to cut it, when you're cutting it for your toddler. So, kind of use that as a guide so that parents can cut things up into small pieces. And then, always supervise mealtimes when you're feeding your baby or your toddler. Be right there. Don't set them down and walk away. Just kind of be there present. I think for older kids, we talked about just encourage them to be sitting at meals, to eat at the table, not to be walking around, not to be playing games with their food, and just making sure that they're taking their time to chew.
And then, I would also say for foods, just be especially careful during parties. When you're in other people's homes, they often have bowls of nuts or candies or other foods that you may not have at home but your toddler or a small child might be interested in. So, just be aware and be vigilant of those things that are out on the tables or at arm's reach of those kids or anything that may have fallen on the floor. That would be my advice for food.
I'll kind of pivot and we can talk about toys and small objects. And specifically with toys, the toys are designed for specific age ranges, and these ranges take into account any choking hazards. So when parents are buying toys or items for their child, I would strongly encourage them to follow these and not buy toys or things which are designated for children who are older because they may have those small parts or those joking hazards.
And if you have older children, I would be careful of the older children's toys that do have small pieces. Make sure that when they play with them, they're really good about cleaning them up or even have a separate area where the kids can play with those toys where the baby or the small child is not around when they're doing the Legos or the bead sets or other things as well.
Scott Webb: You know, it's funny you mentioned Legos. I've kind of gotten back into that as an older person in my 50s. I've enjoyed putting Lego cars and things together again, like I did when I was a kid. And it occurred to me the other day when I had all these little pieces on the table, I never could have done this when my kids were little. So, the timing worked out good. I don't think my 15-year-old's going to come along and start putting Legos in her mouth, at least I hope not. And I mentioned the Heimlich and how grateful I am that someone did that for me when I was choking when I was a kid. Is that really our only recourse, you know, if we realize that our child is choking on something? Is Heimlich the best thing? Is that the go-to thing or are there some other things we can do as well?
Dr. Joelle McConlogue: So, I would say that if your child is choking, but they are having just some difficulty, they're able to speak, they have a strong cough, they're coughing on their own, then at that point I wouldn't step in to do anything right away. The child's own cough and their own maneuvers are often stronger than anything that another person can do. So if they're coughing and able to speak, then let them try to clear their airway on their own first.
But if the child doesn't seem like they're breathing at all, if they're appearing pale or they have a very weak cough that doesn't seem very effective, then this is a medical emergency and this needs immediate attention right away. So, the first thing that I would do if that's happens is first call 911 or direct someone to call 911 right away. And then if the child is older than a year of age, then go ahead and perform the Heimlich maneuver, which is an abdominal thrust, which is designed to try to dislodge that occluding object.
And then Scott, for children less than a year, what I would recommend doing first is just to have the parents just look in the mouth. If there's something they can see easily and is easily accessible, do a sweep of the mouth and try to remove that object. And if they are not able to do that and the child is still choking, then for kids under a year, we recommend doing five back blows followed by five chest thrusts, and alternating those back and forth until the object is dislodged.
Scott Webb: Yeah. And I'm sure, you know, a lot of parents, things that I had to make sure I knew how to do when I became a parent, which was, you know, perform the Heimlich if necessary, though I never needed to, learn how to do CPR properly and now try to keep up with the latest guidelines for CPR, all those things. So, a lot of responsibilities and a lot of good, bad and, you know, everything in between being a parent. And, you know, I was just thinking about emergency departments and emergency room doctors and thinking about all the things that they experience, especially when it comes to kids, whether that's putting things in their ears and noses and perhaps other places they shouldn't. So when we think about that, just what kids generally do with things, toys and otherwise, and when we should take our children to see the doctor or to urgent care. Maybe you can just, as we wrap up here, give us some guidance on these things.
Dr. Joelle McConlogue: Kids are wonderfully imaginative and they love to explore. And so often, objects do go where they shouldn't. We talk about those small pieces and the small toys where they are choking hazards, but they are also risks for, you know, even if a child's not putting it in their mouth, they may take a small bead or something and put it in a place where it doesn't usually go. If that's the case, I would seek medical attention. If there's something up the nose or in the ear, go into the emergency room or into the urgent care and have them take a look. And often, they have specialized tools or abilities to kind of pull those small objects out.
The one warning that I do want to give is that button batteries are extremely worrisome. So if a child ingests a button battery or if they take a button battery and put it into any place where it should be, a nose, an ear, that is an emergency also, and you should seek medical attention right away to have that removed and evaluated.
Scott Webb: Definitely. Well, you know, great advice from an expert today. As I said, my kids are older, but they give me other worries now, of course, 15 and 19. And so for all of us parents out there, once a parent, always a parent. And as you say, the risk of choking isn't just isolated to little ones. They could be older kids or even adults. So, great information today, doctor. Thanks so much. You stay well.
Dr. Joelle McConlogue: Thank you for having me.
Scott Webb: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.