Choking: Keeping little breaths flowing

New York Times Posted online: Saturday, Dec 21, 2013 at 0000 hrs
New York : In October, Maja Djukic was rollerblading in Greenwich, Connecticut, US, when she heard a woman screaming for help. 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, 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 oesophagus, it may compress the trachea enough to impair breathing. After just four minutes without oxygen, a child’s brain can be permanently damaged.

Nearly every day,I see a statistic in the making among small children in my neighbourhood. 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.

Nearly a third of choking cases in children are caused by objects. The paediatrics 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. 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 an ambulance. Caregivers should always have a cellphone on hand.

If a choking baby can make little or no sound, ask someone to call the ambulance. 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 face up 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.

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.

Jane E Brody