Many of the foods that kids regularly eat and enjoy — from fruits and vegetables, to hot dogs and candy — have long been known to pose a choking hazard and to sometimes be fatal.
A new study shows just how common the risk is: On average, 12,435 children under age 14 are treated annually in hospital emergency departments for a non-fatal choking involving food — the equivalent of 34 children a day.
Kids younger than 4 are most often endangered, and hard candy causes the most non-fatal choking episodes (16%) among all children under age 14, followed by other types of candy (13%), meat other than hot dogs (12%), bones (12%), and fruits and vegetables (10%), says the study in the August issue of Pediatrics, published online today.
"Other high-risk foods, such as hot dogs, which can totally block the airway of a small child, or seeds and nuts, which can be difficult for them to chew, are more likely to lead to hospitalizations," says Gary Smith, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio.
Although the study focuses on choking incidents that were not fatal, "that doesn't mean they're not serious," Smith says. In 10% of these cases children had to be hospitalized and often had to go to the operating room, be put under general anesthesia, and undergo a bronchoscopy — "a serious, invasive procedure" — to have the food removed from their airway, he says.
The study, conducted in collaboration with the Centers for Disease Control and Prevention, analyzed hospital emergency department data from 2001-2009 from the federal government's National Electronic Injury Surveillance System-All Injury Program.
A previous CDC study showed that among children younger than 14, 60% of non-fatal choking cases involved food; 31% involved toys, coins, batteries or other non-food-related items. (The source of the choking was undetermined in the remaining 9% of cases.) According to the most recent CDC data, 66 children younger than 14 died from choking on food in 2010.
The total number of non-fatal food choking cases remained stable over the nine years of the new study, which also found:
• Kids under age 4 accounted for 62% of all non-fatal food-related chokings; kids under age 1 accounted for 38%.
• Boys accounted for 55% of cases.
• The top four food types alone accounted for more than half of all choking episodes.
• Seeds, nuts and shells, and hot dogs accounted for 7% and 3% of the non-fatal choking cases, respectively, but were more likely to require hospitalization than any other food category.
The physical characteristics of certain foods, such as hot dogs and grapes, present unique challenges and added risks to young children who are still developing coordination and chewing and swallowing abilities, says David Walner, a pediatric ear, nose and throat specialist at Rush University Medical Center in Chicago.
He and his colleagues have to remove the "hot dog pieces, nuts, popcorn kernels and vegetable matter that kids have choked on" and that get lodged in their airway, says Walner, who was not involved in the new study.
"Usually the bronchoscopy is a success and they survive, but the bigger chunks of hot dog or grapes are the ones where they often don't even make it to the hospital" or face other catastrophic outcomes, such as brain damage, he says.
"The main thing with these cases is that they are almost always preventable," says Walner. "Some things we can't prevent in medicine, and they're sad stories. But these are the saddest because they are almost always preventable by using common sense."
That includes making safe and appropriate food choices, cutting any foods given to children under age 4 into very small pieces, and ensuring that kids are supervised and stay seated when eating, says the American Academy of Pediatrics.
In 2010 the AAP proposed additional choking prevention recommendations, including the redesign of foods that pose a high risk, and the use of warning labels on those foods, much like the labels that now exist on toys that are a choking hazard.
"We know what works, and now we need to apply that to food," says Smith, lead author of that policy recommendation.
Janet Riley, president of the National Hot Dog & Sausage Council, says her group supports the academy's call to better educate parents and caregivers about choking prevention, adding, "Many of our member hot dog makers remind parents of the importance of these practices via labeling on many packages already. Suggesting we redesign foods seems extreme and won't address the issue of foods that naturally are cylindrical in shape, like grapes."