In October, Maja Djukic was rollerblading in Greenwich, Conn., when she heard a woman screaming for help. Ms. Djukic, an assistant professor at New York University College of Nursing, rushed to a nearby house to find 19-month-old Griffin Greene limp and blue. He had inhaled a Goldfish cracker, and his mother’s attempts to dislodge it by holding the toddler upside down and slapping his back had failed.
While the child’s father called 911, Ms. Djukic performed chest compressions, she recalled in an interview. By the time the ambulance arrived — about four minutes later — Griffin was breathing again and crying. Although he needed treatment to extract the cracker, which had become lodged in his lungs, Griffin is now fine thanks to the quick action of a passer-by.
Not every child who chokes is so lucky. Choking is the fourth-leading cause of unintentional deaths in children under age 5; every five days, at least one child dies after choking on food.
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.
Even though both of Griffin’s parents were with him when this near-tragedy occurred, neither knew what to do to save him. Few parents of newborns are taught how to prevent choking and what to do if it occurs. Yet infants and toddlers routinely explore the world with their mouths, and anything they may find lying about can become a choking hazard.
Nearly every day, I see a statistic in the making among small children in my neighborhood. Under the care of a parent, grandparent or nanny, they are routinely given all manner of snacks and allowed to run back to their activities — while still chewing. 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.
A child should not eat in a moving vehicle, either. If the driver stops short or the vehicle is bumped from behind, the sudden lurch may cause a child to inhale food or to swallow it unchewed. Food accounts for 60 percent of pediatric choking cases, according to the Centers for Disease Control and Prevention. Any food can become a choking hazard. The American Academy of Pediatrics cites hot dogs, meats, sausages, fish with bones, cheese cubes, popcorn, chips, pretzel nuggets, hard candy, gum, lollipops, jelly beans, marshmallows, whole grapes, raw vegetables, cherry tomatoes, nuts, peanut butter (especially eaten from a spoon or on soft bread) and even ice cubes.
Many parents now know that grapes should be halved for a young child, but fewer realize that a hot dog should be cut lengthwise for a child until at least age 4. (Better yet, skip nutritionally questionable hot dogs altogether.) Parents should wait to introduce puréed food until after 4 months of age, when motor skills for swallowing are better developed. Always supervise meals and snacks when babies and children feed themselves.
But nearly a third of choking cases in children are caused by objects. The pediatrics society lists these among the most common offenders: coins, buttons, marbles, small balls, deflated balloons, watch batteries, jewelry, pen caps, paper clips, arts and crafts supplies, small toys and detachable toy parts.
Toys and games that are safe for an older sibling may not be for a younger brother or sister. Always check packaging for age recommendations, and keep toys meant for older children away from younger ones. And while it may be hard to believe, some infants have choked on pacifiers.
It is critical to know 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.
Tips for CPR on the Very Young
A baby or child who cannot breathe and loses consciousness — because of choking, an accident or any other reason — will need CPR modified for the young. If you are alone, perform CPR for two minutes before stopping to call 911.
- Place an infant face up on a firm surface. Place two or three fingers at the center of the baby’s chest, just below the level of the nipples. Give 30 gentle chest compressions at the rate of at least 100 a minute. Each should depress the chest about an inch and a half.
- Then tilt the baby’s head by lifting the chin; cover the baby’s nose and mouth with your mouth and give two gentle breaths, each for one second. Look to see that the chest rises with each breath.
- Repeat this sequence until the baby starts breathing or help arrives.
- For an unconscious older child, place the heel of one hand on the breastbone, just below the level of the nipples. Administer 30 fast and hard chest compressions, depressing the chest about two inches each time
- Then lift the chin with one hand, place the other hand on the forehead to tilt the head back, pinch the nose and put your mouth tightly over the child’s mouth. Give two breaths, each for one second, to make the chest rise.
- Repeat this sequence until the child resumes breathing or help arrives.
The American Heart Association sells kits to teach caregivers how to perform CPR on infants and children, as well as on adults. Each costs $34.95 and includes a mannequin on which users can practice. Go to heart.org. Click on “CPR & EEC” at the top of the screen and follow the links for CPR products.
This is the first of two columns on CPR.
A brief article outlining CPR instructions, which accompanied the Personal Health column Dec. 17, about CPR and children, referred incompletely to steps in administering CPR on older children. For children older than 1, you should also pinch the child’s nose while administering rescue breaths, not just put your mouth tightly over the child’s mouth.