Keeping Little Breaths Flowing
December 16, 2013 9:38 AM   Subscribe

The trachea, or windpipe, of a young child is about the width of a drinking straw, and if food or a small object is inhaled instead of swallowed, it can block the airway. Even when something is swallowed and becomes lodged in a child’s throat or esophagus, it may compress the trachea enough to impair breathing. After just four minutes without oxygen, a child’s brain can be permanently damaged. - A NYTimes piece gives useful advice on preventing and responding to a young child's choking
posted by beisny (31 comments total) 25 users marked this as a favorite

Reading about this kind of care for really little kids sets my pulse pounding even while I know that I need to learn & remember it.
posted by wenestvedt at 10:03 AM on December 16, 2013 [4 favorites]

When my daughters were in preschool, one of their classmates choked to death on a children's vitamin. The tragedy of that little boy's death haunts me to this day. I hope these links will save lives.
posted by Gelatin at 10:04 AM on December 16, 2013 [3 favorites]

(Better yet, skip nutritionally questionable hot dogs altogether.)

Flagged for editorializing. (What is childhood without hot dogs?)

(Not flagging the article, which is obviously worthy & important, just this line.)
posted by chavenet at 10:11 AM on December 16, 2013 [3 favorites]

If you want your children to avoid hot dogs, just boil them in a pot of water with cabbage the way my mom did.
posted by The Card Cheat at 10:15 AM on December 16, 2013 [5 favorites]

I never realized how terrifying this stuff could be until I had a child. Now it ranks somewhere above nuclear war and slightly below SIDS.
posted by blue_beetle at 10:16 AM on December 16, 2013 [7 favorites]

If you want your children to avoid hot dogs, just boil them in a pot of water with cabbage the way my mom did.

I'll agree that this will solve the hot dog problem, but now you have a dead boiled child problem instead!
posted by Mister_A at 10:24 AM on December 16, 2013 [40 favorites]

It's pretty amazing how quickly the infant-choke technique comes back to you when you need it. Also how quickly a tot recovers from the whole ordeal. Adults need a little longer.
posted by jquinby at 10:26 AM on December 16, 2013

That initial link takes eleven paragraphs before it actually gets to ...

what to do if a child appears to be choking. If the child can cough, speak or cry, the airway is not completely blocked. Encourage the child to cough, and if that fails to dislodge the object, call 911. Caregivers should always have a cellphone on hand.

If a choking baby can make little or no sound, ask someone to call 911 (if you are alone, attempt a rescue for two minutes before calling 911). Place the baby face down over your arm with the head lower than the chest and support the baby’s head with your hand. Then give five quick blows between the shoulder blades with the heel of the other hand. If no object is dislodged, turn the baby faceup on a firm surface, place two fingers in the middle of the breastbone just below the nipples and give five quick thrusts. Repeat this sequence until the baby begins breathing or help arrives. If breathing is not restored within a few minutes, begin CPR (see box).

For a child over 1 who is choking, stand or kneel behind the child and wrap your arms around her. Make a fist and place it just above the navel. Grasp the fist with the other hand, and make quick upward thrusts with it. Repeat until the object is dislodged or the child begins breathing.

Any child who required a choking rescue should be examined by a physician afterward.

posted by philip-random at 10:28 AM on December 16, 2013 [5 favorites]

When my daughter was about 1.5 we were at a restaurant & while we were distracted, she grabbed a tortilla chip off the table & got a bit of it lodged in her throat. The ex-wife very nimbly yanked her out of that highchair, turned her upside down walloped her on the back, and plop, the chip came right out, but yeah I realize looking back that that was a more close call than I thought at the time.
posted by Devils Rancher at 10:35 AM on December 16, 2013 [3 favorites]

...a hot dog should be cut lengthwise for a child until at least age 4.
Another option was the Octodog, which appears to be discontinued now.

Much of my job revolves around the pediatric airway and I am glad to see this information out there. By the time they get to me in the OR they have pretty much proven that they will survive, but that doesn't mean there can't be scary moments.

Things I have seen fished out of childrens' airways not mentioned in the article: artificial nails, toilet bolt caps, safety pins (both open and shut).

Marshmallows are bad because they quickly become a gooey mes that can't be easily plucked out, thus my fear of the Chubby Bunny game. Watch batteries are bad because they can leak and erode through the wall of the trachea (or esophagus if they go down that way) in a matter of hours, leading to serious problems.

Very worthwhile post; thanks!
posted by TedW at 10:44 AM on December 16, 2013 [6 favorites]

Whenever I'm being led through these steps during yearly re-certification, I can't help but imagine the surreal horror of having to ask someone to surrender their infant to you, turning it upside-down, and beating on its back... and it not working.
Never had to do it. Would probably be pretty good at the obtaining consent part. Might not do so well after handing off a brain-damaged, almost certainly deceased child to EMS, tho.

TedW, I have no idea how you do that.
posted by tigrrrlily at 10:54 AM on December 16, 2013 [2 favorites]

Yikes. When my no. 1 was a baby, a child in my mother's group choked on something. I grabbed him and did the upside down and beat on back thing to screams from all mothers, and it worked, so I wasn't sued. I had the impression the mother had talked with her doctor about the whole thing next time we met.
But it does seem rather extreme if you are completely unaware of both the danger and the procedure.
posted by mumimor at 11:13 AM on December 16, 2013 [4 favorites]

I'm sitting here reading this because Mrs Stumpskin needs sleep so I'm watching our 2-week-old, checking the breathing every ten minutes. I'm really glad to get this info. It's still going to give me nightmares, especially the word "unintentional".
posted by Wrinkled Stumpskin at 11:14 AM on December 16, 2013

My firstborn was in the back seat of our Dodge Neon, in his car seat; he was maybe 6 months old. Fortunately, we were parked waiting for Mrs. A. I noticed the babble in the back had stopped. Turned around and there he was, obviously choking. No air at all. In the car seat. In the back of a Neon.

Well I knew I was supposed to do, by the book, but I didn't know how long he'd been without air, and I was not in a proper state to fuss with the harness. I leapt into the back seat and looked into his mouth, and saw a bit of mushed-up teething biscuit. I was able to sweep the stuff out cleanly with a finger, and he started breathing again. Didn't even cry! I did though.
posted by Mister_A at 11:25 AM on December 16, 2013 [5 favorites]

Just fished a glass pear ornament out of my toddler's mouth yesterday. When she is out of sight for more than 15 seconds I just assume there is a choking hazard in her mouth, works pretty well.
posted by selfnoise at 11:28 AM on December 16, 2013 [3 favorites]

I choked on a boiled sweet at daycare aged 3 and had the full upside-down whacking treatment. Probably the most traumatic event of my entire life. Sensing this, the other children teased me mercilessly forever after for being the upside-down choking spluttering guy. To this day I still wake up from a nightmare panicking that I'm choking, usually a couple of times a year or so. Chew your food *very* carefully, people!
posted by colie at 11:30 AM on December 16, 2013

Very useful article, and the Red Cross reference from the first comment is a must read (and see).
PS if you want your children to avoid hot dogs, just tell them how and of what the sausages are made.
posted by hat_eater at 11:30 AM on December 16, 2013 [1 favorite]

When she is out of sight for more than 15 seconds I just assume there is a choking hazard in her mouth, works pretty well.

It got to where I would just hold a hand out in front of her mouth & she knew that meant she was to disgorge the contents. She was especially fond of the kitty crunchies. Baby-proofing any house is hard damn work. Those babies are real connivers! My daughter learned to climb up & out of her crib/bed pretty much as soon as she could walk -- 11 months or so. The first time she appeared at our bedside at 1 in the morning, it scared the crap out of us, but she never fell. We had to move her to a regular bed a lot earlier than we wanted to, & just padded the floor by it with blanket & pillows because we figured falling out of that would be less bad than falling at the top of her climb, or hooking a leg on the railing & breaking it.

My son wasn't a mouth-stuffer, but he grabbed at shiny objects, which cost him some stitches one christmas, as he lunged from three feet away & grabbed the blade of my wife's new mini-swiss army knife exactly 1/10th of a second after she opened the blade. OH HEY 8-YEAR-OLD-GIRLS, RUNNING IN CIRCLES AND SCREAMING AT THE SIGHT OF YOUR BROTHER'S BLOOD REALLY HELPS MOM AND DAD FOCUS ON THE SITUATION AT HAND!

Remind me why I'm a parent? Oh yeah.
posted by Devils Rancher at 11:48 AM on December 16, 2013 [5 favorites]

Well, now I'm paranoid for the rest of the day while my child is in daycare.

This is beyond scary...but good that now I have a PDF.
posted by stormpooper at 11:54 AM on December 16, 2013

tigrrrlily: "Whenever I'm being led through these steps during yearly re-certification, I can't help but imagine the surreal horror of having to ask someone to surrender their infant to you, turning it upside-down, and beating on its back... and it not working."

Having been the parent in this situation (my 18-month-old stopped breathing not from choking but from rage -- he would hold his breath until he passed out, then start again. This particular time, he didn't start again), I have never been so grateful to anyone in my entire life as the First Aid/CPR trained park employees who took him from me as I came running in the building screaming, "MY BABY ISN'T BREATHING!" and began working on him immediately. (They got him breathing right away, before EMS even arrived, and EMS had him conscious within a few minutes. We had a trip to the hospital but he is fine, we still don't know what caused him to NOT re-start breathing when he fainted, and he seems to have mostly outgrown rage-fainting -- fingers crossed, anyway.)

I was and am so profoundly grateful that someone trained was there to take over until EMS got there 90 seconds later that I went right out and did the very next Red Cross training offered, so that if I ever see someone else's child in distress, I can be the person who knows what to do. I truly feel like these people who were there with their CPR training were this incredible, amazing gift in my life and there is no possible way to express my gratitude for them except to try to pay it forward by learning the same thing. It's hard to explain, but sometimes when we're at the same park facility and I see the blond-haired woman who resuscitated my son that day, I get teary with gratitude that she was there and knew what to do.

Anyway, thanks for recertifying yearly, so that if you do ever, God forbid, witness something like that, you can be that person who's there.
posted by Eyebrows McGee at 12:23 PM on December 16, 2013 [8 favorites]

"That initial link takes eleven paragraphs before it actually gets to ..."

"Hold on a sec, I bookmarked instructions on this the other day..."

posted by rhizome at 12:36 PM on December 16, 2013 [2 favorites]

Just in case this FPP didn't make your holiday season more festive enough there's this from the FAA*.

*Not Really
posted by The 10th Regiment of Foot at 12:38 PM on December 16, 2013

I threw my niece on a bed while rough-housing. She starting chocking on her gum and I whacked her on the back until it was dislodged. She used her second post-choking breath to inform me that I was the "Bad Uncle".

Now I'm not so sure about the utility of rescuing children.
posted by srboisvert at 12:38 PM on December 16, 2013 [4 favorites]

It is a disaster waiting to happen, and sometimes I can’t resist saying aloud that the child should not get up until his food has been thoroughly chewed and his mouth is empty.

Parent your own kids, lady.
posted by 256 at 12:46 PM on December 16, 2013 [2 favorites]

Panel 5, item 1 in the PDF? Been there, done that. Cool as a cucumber in the moment, but my heart is pounding when I think back on it. Thanks, army first aid training!
posted by Harald74 at 12:52 PM on December 16, 2013

hat_eater: PS if you want your children to avoid hot dogs, just tell them how and of what the sausages are made.

May have opposite effect if your child is Calvin.
posted by history_denier at 1:17 PM on December 16, 2013 [1 favorite]

Parent your own kids, lady.

Really? How can it be bad to avoid obvious risk? After the incident described above (which happened 20 years ago), my kids have not been allowed to eat and play at the same time. Chewing gum is almost not an option. I want them alive. Obviously, I can't do much in terms of controlling them today, but it seems to have become a habit for them, to sit down when eating.
posted by mumimor at 2:50 PM on December 16, 2013

Oh man, this is probably my number one anxiety-inducer when it comes to my daughter.

For some unknown reason, I was quite a choker when I was a little kid. I still remember the feeling of terror, standing up at the dinner table scared and gesticulating wildly - my family regarded me as a bit of a drama queen I'm afraid. It's a horrible, terrifying feeling.

It's amazing how that feeling - almost exactly the same - surged when my daughter started solids (and choking with it). I have worked in childcare, held a first aid certificate for many years: Nothing can banish the paralysing fear and distress when your kid starts choking.

I will say this, however: thank god babies have an incredible gag reflex. The worst choking incident my daughter had concluded with an absolutely epic vomit before we could pick her up. It was amazing, like a pyroclastic flow. Whatever scrap of food had caused the blockage was completely overwhelmed in the tsunami of milky spew that tumbled down her front and over the floor.

I have never been happier to see buckets of spew in my life.
posted by smoke at 4:04 PM on December 16, 2013 [3 favorites]

The first time my daughter got solids, she choked. She got a chunk of pear and it just slid down her throat until it couldn't slide any more - I'd cut it wrong I think. I remember turning and she was red faced with her little mouth open and no sound coming out. I did the sweep but I have tiny hands (one of those clear panic thought "fuck my stupid fucking tiny hands") so I couldn't reach it, all while she's flailing and tears and silence. I screamed for my partner and tried to get her out of the highchair, remembering as I yanked that it was a lap belt, but that jolt, yanking her forwards, moved it enough that she started making choking noises, so another sweep and then that big whooping breath, and I gently got her out and stood, bawling, in the kitchen as my partner rounded the corner at a dead run.

He still doesn't quite get it, that terrifying clutching fear, and I still sometimes see her face, angry red and silent.

(Turns out she gags a LOT as well, just to make those first few months of solids truly fun).
posted by geek anachronism at 5:59 PM on December 16, 2013 [1 favorite]

I will relate a particularly embarrassing and harrowing experience.

When I was a young Ear, Nose, and Throat resident, I was relaxing on the patio at a friend's house. About two minutes after I'd been introduced to said friend's infant, I half-watched as it grabbed a whole, green grape and put it in its mouth. I just watched it do it.

I deal with airways every day. I fish all kinds of stuff out of airways in emergent situations. I've operated on baby tracheas and know that they are about the size of a McDonalds straw. And I just watched him eat it, attempt to swallow it, and begin choking on it before my brain screamed at me "YOU DUMBASS BABIES CAN'T EAT GRAPES!"

One back slap and everything was fine...but it just reminded me that it can happen to anyone at any time and everyone should be prepared to handle these situations.

Thanks for the post.
posted by robstercraw at 10:56 AM on December 19, 2013 [3 favorites]

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