Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Elizabeth Flowers. She's an assistant attending pediatrician at New York Presbyterian Hospital, Weill Cornell Medical Center, and an instructor in pediatrics at Weill Cornell Medical College Cornell University. And she's here today to address choking hazards for children, what parents can do to prevent choking and what to do if your child is choking.

Dr. Flowers, thank you so much for joining us today. Choking is such a huge concern for parents. I know that I was terrified when my little guys were little. So. I'd like you to start by telling us what choking hazards are, other things that kids might put in their mouth in general. Tell us about all of it.

Dr Liz Flowers: Thanks, Melanie. First of all, I want to say thank you for having me today. I'm really excited to talk about this topic because, as a general outpatient pediatrician, it applies to all of my patients at some point in their lives. And so, choking hazards, they're items that can get stuck in a child's trachea or windpipe as it's commonly called. And the windpipe is important, because it connects your upper and lower respiratory tracts and allows air to get into your lungs and flow to the rest of your body. So when you're eating and drinking something and you feel like something went down the wrong pipe, that's often referring to the item going down your trachea instead of your esophagus, the tube that connects your mouth to your stomach.

Melanie Cole, MS: So that was good. That was a good lesson to help people understand really what it is. How often does this topic come up in your clinical practice? Do you hear about it a lot?

Dr Liz Flowers: Yeah. So, I'd say, most commonly I get asked about choking hazards when parents are first starting to think about introducing foods other than breast milk or formula, so around the four to six-month mark depending on the individual child. I also tend to bring this topic up again when I provide guidance on general baby proofing before babies develop the motor skills that allow them to move around and explore their environment.

Melanie Cole, MS: Well then, speaking of babies, are there specific groups that are more susceptible to choking incidents? You mentioned that right when they start to eat solid foods other than formula or breast milk. So, is it just the little guys we're worried about or toddlers too?

Dr Liz Flowers: So, certainly, all children under the age of four are at higher risk of serious injury or death caused by an airway obstruction from choking. So, this is really the group that we worry the most about, but it's also really important to remember there are other groups at risk. So, children with cerebral palsy, for example, who might have decreased protective airway reflexes, or children with developmental delays that might have more underdeveloped oral motor skills, which puts them at higher risk of choking.

Melanie Cole, MS: Now, tell us the most common things that you see and/or are concerned about, whether it's food or objects around the home, what are some of those most common choking hazards?

Dr Liz Flowers: I want to touch on a few food items and also a few objects that are common choking hazards, and what I'm talking about are some of the most common things, but certainly this is not an all-inclusive list. So starting with food, we know the American Academy of Pediatrics recommends that children four years and younger should not be fed any round or firm food unless it's cut up into small non-round pieces, because these hard foods can get stuck in the windpipe and cause a child to have trouble breathing. So, hot dogs and sausages, these are a high risk food, so certainly don't cut these into round slices. They should be cut into half moon or triangle shapes if you're going to feed this to your child. Whole grapes, cherry tomatoes, pieces of raw apples, popcorn. And something that's actually a little surprising to a lot of my families is when I talk about peanut butter being a choking risk or other nut butters. And this comes up when I'm talking about introducing new allergens, so around four to six months. And if parents are going to give their child peanut butter, especially in infancy, they really should water this down to thin out the texture. Other things I worry about are cubes of meat or cheese, chewing gum, hard candies and cough drops. These should be avoided until kids are at least six years of age with the hard candy and cough drops. And then, lastly, chunks of raw veggies like baby carrots if they're not cut up properly.

And so while food accounts for most of the choking-related episodes that we see, there are other objects that parents and caregivers should be vigilant about. So, button batteries or lithium coin batteries, these are the types of batteries that are found in remotes, keys, bathroom scales, thermometers. And if your child has swallowed one of these or you suspect your child has swallowed a button battery or a lithium coin battery, this is actually a medical emergency, so it would be reason to seek urgent medical attention.

Other items we worry about are things like latex balloons when they're uninflated or broken into pieces. So, these balloons actually cause more childhood deaths than any other toy. And we're worried about this until kids are up to the age of eight years of age. Water beads, loose change, marbles, pen caps, these are all common things found around the house that are choking hazards.

Melanie Cole, MS: I've always been afraid of this, even in myself, in my older relatives, and certainly in my kids. I'm still nervous and don't have hard candy, even around the house, and like baby carrots. I'm always cutting them up and my 20-year-old kids are like, "Really mom?" But those things still make me nervous. Now, prevention is certainly going to be the key and not everybody needs to be a nut job like me. But what are we supposed to do to hopefully prevent these things? We want to give our kids little carrots when they're little and make baby food and steam these things. What can make it so that they are less likely to choke on them?

Dr Liz Flowers: I think one of the most important things to remember is always having an adult supervising meal time and snack time. And being conscious about not only the type of food you're giving, but the texture, like you were touching on. So with baby carrots, steaming them or mashing them make the choking risk decrease substantially. You know, steaming things, cutting fruits and veggies into bite-sized pieces totally changes the choking risk. And children should always be sitting down at the table during meal and snack time, because the risk of choking goes up if kids are up and moving around. And something that also surprises parents sometimes when I mention is I really recommend trying to avoid screen time, like tablets or smartphones during meal and snack time, if possible, because again, when kids are distracted by other things, they're not as focused on what they're doing and we see a higher risk of choking in these situations. I also suggest avoiding feeding kids in a moving car, especially if your baby is still in a car seat because the reclined position in combination with the motion of the vehicle puts them at higher risk.

And when it comes to toys and other items that are choking hazards, it's important to pay attention to the manufacturer's instructions regarding age recommendations. And some toys are only safe for older kids, so if you're receiving a gift from family or friends, making sure that it's appropriate for your child's age, if you have multiple kids at home, ensuring the older child doesn't have a toy that the younger child might get their hands on and cause a choking risk.

Melanie Cole, MS: I remember someone gave one of my kids those metallic magnetic balls. And there's like a thousand of them in the thing, right? I threw them out the second that I opened them, I didn't even let the kids see them. I'm like, "Oh, no way. Not worth it at all." Now, what do we do? Because I think that's every parent's question and their biggest fear is if the child starts choking, how do we know that they are choking and how do we respond? What do we do?

Dr Liz Flowers: I'm so glad you asked this question, Melanie. So, you know, parents can do their best to be prepared and prevent choking episodes. We know accidents do happen no matter how prepared you are. So, some common things to be looking out for that might signal a child is choking and needs help right away would be if they're gasping or wheezing, if they're unable to talk or cry, make noise, if you're seeing that their lips or face are turning blue or they have a panicked look on their face.

So if you're ever concerned about a serious choking situation like this, my recommendation is calling 911 right away. And it can be very, very scary to see your child choking like this, but try to remember never perform a blind sweep in their mouth because sticking your fingers in their mouth to try to get the object out might actually push that object further into their windpipe and cause more issues. And so, this is why I recommend all parents and caregivers take a basic first aid course. And these are offered by a number of medical organizations and various community centers. And in these courses, you'll learn CPR as well as the proper techniques for abdominal thrusts, also known as the Heimlich maneuver. And these, specific techniques vary based on your child's age. So, that's why it's important to be properly trained by a professional.

Melanie Cole, MS: That is great advice. We should all take CPR and learn how to do those things and to know the signs. And whether it's our children or even ourselves, it's something that's really, really important to know. I'd like you to wrap up with your best advice because choking hazards are one of the bigger fears that most parents have. I mean, I know it's not just me. So, give us your best advice in ways that we can absolutely prevent choking in our children or keep a real close eye on them.

Dr Liz Flowers: I think choking hazards are, you touched on this, one of the most common things that parents are worried about, and just remembering that when kids are exploring their environment, trying new foods, these are all normal parts of childhood and development, and this is what we expect. This is how kids learn to grow and eat and explore their environment, but there are risks. So, making sure your house is baby-proofed, especially when your child is starting to become more mobile and exploring the environment, to make sure there's nothing around they could get their hands on and put in their mouth. Making sure someone is always supervising your child when they're eating during meal times and snack times. And basically, remembering that this is a really common thing parents are worried about, but by listening to this podcast, educating yourself and preparing yourself with CPR and first aid classes in case this does happen in your life, it will help you feel more prepared and more at ease if the situation ever arises. And always talk to your pediatrician if you have any specific questions.

Melanie Cole, MS: That's true. Being prepared does help you to ease your mind a little bit, and podcasts like this with experts like you are certainly the way to do it. And listeners, please share this one with your friends and your family. We're learning from the experts at Weill Cornell Medicine together. And if you share this, then we all learn about choking hazards and ways to prevent them and ways to ease our own fears as parents.

And Weill Cornell Medicine continues to see our patients in-person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. Thank you so much, Dr. Flowers, for joining us today. And that concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts and Google Podcasts. For more health tips, please visit wildcornell.org and search podcasts and don't forget to check out Back to Health. Great podcasts there as well. I'm Melanie Cole. Thanks so much for joining us today.

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