Ian Evans of the Child Accident Prevention Trust highlights common choking hazards for infants and young children.
Choking is one of the leading causes of accidental death among the under-fives in England1. As we get older, eating, chewing, and swallowing become second nature, but it is easy to forget that these are among the first basic functions and life skills that have to be learnt. It is all the more important to be aware of the safe routines and behaviours which can help this phase while supporting the parents and carers who have to be ‘one step ahead’ of their developing children.
Raising awareness and tackling inequalities
The Child Accident Prevention Trust (CAPT) is the UK’s leading charity working to reduce the number of children and young people killed, disabled, or seriously injured in accidents, many of which can be prevented.
We want children to lead active, healthy lives and we understand that children need to experiment, play and take risks. However, especially in the early years, children are highly dependent on their parents, carers, and families who help to help to shape their lives, homes, and surroundings.
CAPT’s mission is to reduce injury rates through a combination of safety advice to parents, and training and engagement with front line professionals such as health visitors who work with families every day and in every community. Once parents understand the nature of the risk, they are better equipped to take preventative action.
In June every year our flagship awareness campaign, Child Safety Week, helps and inspires people from all parts of local communities to focus on the often simple steps everyone can take to reduce serous childhood injury. The theme for Child Safety Week in 2021, coming after a year or more of lockdown and multiple family pressures is, appropriately, ‘share because you care.’
CAPT is active in discussions with senior professionals, researchers and policymakers to ensure that child safety is a priority for government, public health leaders, and other key partners such as manufacturers and community-based organisations. This is important for both for more familiar injury risks, but also the new and emerging hazards such as toy magnets and button batteries.
CAPT is also concerned to reduce the serious inequalities which exist between richer and poorer children. New research from the National Child Mortality Database (NCMD)2, based on data for children who died between April 2019 and March 2020 in England, finds a clear association between the risk of child death from all causes (except malignancy) and their level of deprivation. Accidents are very much a part of this worrying picture of a steep social gradient for death in childhood.
Serious choking incidents can often be fatal. And when it comes to the main causes for emergency hospital admissions as a result of all accidents among under-fives, the figure is 38% higher for children from the most deprived backgrounds. Even with modern treatment and care, the pain, stress, and long-term consequences of a serious injury can have a profound impact on a child and their family. Even the ‘near misses’ can be upsetting and traumatic events.
Choking: an everyday risk
It is against this backdrop of awareness-raising and action that CAPT is working to get the message across about choking risks.
Children are not mini-adults. Development milestones vary for each child. We have an automatic sucking instinct from birth, but other skills have to be learned. With smaller bodies, their windpipes are narrower and still growing, and their airways can easily get blocked. When babies start to wean from around six months they are starting to practise the complex process of chewing, swallowing, and breathing which, as adults, we generally take for granted.
At any age, food and drink are among the most common causes of choking. Even very young babies, before they start weaning, can choke while they are drinking from a bottle. That is why the temptation to ‘prop feed’ a baby – propping them up unsupervised with a bottle – should be avoided. If baby starts to choke on their drink, they will not be able to push the bottle away.
As with so many aspects of child development, supervision is vital. We all know that parents can’t have ‘eyes in the backs of their heads’, and parenting under pressure from other stresses and situations in life can be very difficult. But babies and young children depend entirely on a watchful eye and for a parent to stay one step ahead of possible hazards. For example, it is a common misconception that a choking baby or child will cough and splutter. Like drowning, that is not necessarily the case. It is likely that a choking child will be completely silent with no sound to warn that something is wrong.
As weaning progresses, new foods are gradually introduced into a baby’s diet and there is good health advice on how to approach this important stage3. But it is important to remember that babies and young children can choke on food that you might think is quite soft and small, like a whole grape or a piece of sausage or hot dog. Even for softer food, teeth are still developing and the ability to chew thoroughly is limited. More obviously, hard food, bones and any small round items can easily become caught in the throat. Even raw jelly cubes can get stuck.
Good safety habits
As with all safety practices, the best advice is to get into good habits with feeding and food preparation right from the outset. To begin with, baby needs to be properly secured in a highchair, and sitting safely in an upright position. They should never be left unattended. Finger food and feeding is important as it helps to develop co-ordination and the biting, chewing and swallowing functions. It is vital to choose and prepare food properly, but there is not always enough awareness of the risks of certain types of food.
Round food should be avoided, and items like grapes and cherry tomatoes should be cut in half lengthways and ideally in quarters. Stones and pips should be removed. When the child is old enough, other solid food like vegetables, sausages or hot dogs should also be cut in half lengthways and kept narrow. Really hard items and snacks such as nuts, popcorn, boiled sweets, and ice cubes should be avoided and kept until the child is an older, more competent eater.
Children should be encouraged to chew what they have in their mouths before putting more in – little by little. This is a temptation when they are finger feeding themselves, and another reason why supervision is needed. However, this can also be a great time for a baby and parent to interact and enjoy each other’s company! Older siblings often love to help with baby too, but at mealtimes they should be discouraged from sharing their own food.
While food and drink are major causes of choking incidents, very young children have a natural tendency to explore the world by touching things and putting accessible and eye-catching objects in their mouth. This can lead to other forms of serious choking risk, when coins, buttons, beads, balloons, small ‘button’ batteries, toy magnets and other small parts could end up in the mouth.
Even if these can be swallowed without choking, there are real dangers of poisoning and internal harm. As ever, vigilance is essential, but this can be made easier by getting into the habit of keeping small objects such as these out of reach. A home safety check will help in spotting and making safe these and other everyday home hazards.
As they get older, as toddlers and beyond, children love to run around. So whatever their age, it is important to avoid the risk of choking on food, sweets and snacks while they are on the go.
Stay in touch
For any family, a child’s development is a special and precious time. But sometimes it can also be challenging. The Child Accident Prevention Trust (CAPT) is here to support parents and professionals and it is easy to stay in touch with us for information, news, and safety alerts. This can make it possible to stay one step ahead and to avoid the pain and distress caused by the most common and serious accidental injuries. These include choking, but also suffocation and strangulation, falls, burns and scalds, poisoning, and drowning.
To sign up for more information and download free educational resources, visit www.capt.org.uk/Pages/Category/child-safety-week.
1 Preventing unintentional injuries: a guide for all staff working with children under five years. Public Health England and Child Accident Prevention Trust, February 2017: www.gov.uk/government/publications/unintentional-injuries-prevention-in-children-under-5-years
2 Child Mortality and Social Deprivation. National Child Mortality Database Programme Thematic Report, NCMD/HQIP, May 2021: www.ncmd.info/2021/05/13/dep-report-2021
3 Start4life – weaning: www.nhs.uk/start4life/weaning
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