Toddlers and choking

Air enters the lungs via the trachea (windpipe). Choking is caused when a foreign object, like a hard lump of food, goes into the trachea instead of the oesophagus (food pipe). If the object is at the entrance to the trachea (epiglottis), a good cough will, more than likely, expel it. If the object has made its way past the epiglottis, coughing may prevent the object from descending further down the trachea. Sometimes, an inhaled object may cut off the airway completely. Toddlers are at risk from choking on food and small items, such as buttons or beads. Parents can take many precautions to reduce the risk of their child choking. The most important thing to remember is never to pat or slap your choking child on the back if they are managing to cough. Your actions may dislodge the object and allow it to be inhaled deeper into the airway.

Symptoms
If the object is sitting at the epiglottis, coughing will expel it. However, breathing may be impaired if the object is lodged further down the trachea. This is a medical emergency. Symptoms include:

• Panic
• Inability to cough
• Stridulous (high pitched, noisy) breathing
• Breathing difficulties
• No breathing at all
• The skin around the mouth turns blue because of low oxygen levels (cyanosis)
• Unconsciousness.

• Encourage your child to cough.
• Put your child in a position where their head hangs down, perhaps over your knee.
• Slap firmly four times between the shoulder blades.
• Check to see if the object has fallen out and if your child can breathe properly again.
• If not, repeat the procedure and call an ambulance.
• If your child loses consciousness, place them on the floor on their side and repeatedly compress and release their ribcage with your hands, using sharp, fast actions. This may force the remaining air in their lungs to expel the object.
• If your child is still not breathing, perform mouth-to-mouth resuscitation until the ambulance officers arrive and take over.

• Hard foods should be cooked, mashed, grated or avoided altogether.
• Cut meat into small, manageable pieces for your child, and remove tough skins from sausages and frankfurters.
• Cut food lengthwise to make it narrower.
• Supervise your child while they are eating.
• Explain to your child the importance of eating food quietly and while sitting down.
• Don't try to feed them if they are laughing or crying.

• Accept that changes in behaviour take time and effort. Be patient and calm.
• Discuss your plan of action with your partner and other carers, so that your approaches are consistent.
• Be a good role model. Don't let your child see you walking around the house while eating.
• Establish a predictable mealtime routine to help your child remember they are required to sit down. They should sit down at an appropriate table and not be distracted - for example, by television.
• Involve your child in family discussions at mealtimes, so they are less inclined to leave the table.
• Don't fight over the 'sitting down' issue at mealtime.
• Talk about it with your child in a calm and reasonable way.
• Tell your child that their meal is over when they leave the table. Take away their plate, but offer them a healthy snack later if they are hungry.
• Be consistent. Insist that snacks are also eaten while sitting down.
• Compliment your child whenever they show the desired behaviour.

• Treat any object smaller than a ping-pong ball (such as coins, buttons, marbles and beads) as a possible choking threat. Keep these small objects out of your child's reach.
• Polystyrene beads, found in beanbags and some stuffed toys, are easily inhaled.
• If you spot a potential choking hazard, deal with it immediately.
• Only buy toys from reputable manufacturers. Toys should comply with the Australian Standard AS1647.
• Warning labels on toys, such as 'Not suitable for children under three years', means that small parts may present a choking hazard. The label doesn't refer to skill level.
• Check toys regularly for signs of wear and tear. For instance, beaded stuffing inside a toy may present a choking hazard.
• Keep balloons away from small children. A bitten balloon may burst and send fragments down the child's throat.
• Older children in the household should be warned not to leave potentially dangerous items near young children.
• Peanuts are a well-known hazard.

• Your doctor
• Maternal and Child Health nurse
• Parentline Tel. 132 289
• Tweddle Child and Family Health Service Tel. (03) 9689 1577
• St John's Ambulance Australia (Victoria) - for first aid course information Tel. 131 394
• Maternal and Child Health Line, Victoria (24 hours) Tel. 132 229
• In an emergency, Tel. 000 for an ambulance.

• Choking is caused by a foreign object, such as a hard lump of food, going into the trachea instead of the oesophagus.
• Toddlers are at risk from choking on food and small items, such as buttons or beads.
• Hard foods, such as raw carrot and apple, should be cooked, mashed or grated.
• Supervise your child at all times when they are eating.
• Keep small items, such as coins, buttons and beads, out of reach of small children.

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