Efforts to reduce choking deaths among young children seem to have paid off: A new report finds the number of kids dying from choking on household objects has plummeted 75 percent since 1968.
Regulations, more education about choking hazards and guidelines from organizations such as the American Academy of Pediatrics have likely all played a role in the downward trend, said study author Dr. John Cramer.
Cramer said that regulations may have played the most significant role in reducing child deaths from choking on small objects.
"Some of the regulations from the last 50 years have forced people to do the right thing. When you buy toys or cribs now, products are designed so that they can't be choked on. If you're a parent and you go buy a crib, you don't have to think about buying a crib with small parts; it's already regulated," Cramer said. He's an assistant professor of otolaryngology -- head and neck surgery at Wayne State University in Detroit.
One example cited by the study authors is a 1979 law regarding products designed for young children. Products made for young children can no longer contain parts small enough to fit into a test cylinder that is approximately the size of the airway of a child younger than 3.
For the study, the researchers reviewed national data from 1968 through 2017. In 1968, there were 719 deaths in children from choking on an object. By 2017, that number was down to 184.
Children under 3 are most at risk from choking, and they've also had the most significant drops in choking death rates over time, the study authors noted.
"Choking hazard warnings for toys used in children under age 3 have probably had the biggest benefit over time. This is a developmental stage where kids are oral and exploratory, often putting things in their mouths," Cramer said.
The database used by the researchers didn't have specific information about the types of objects that kids choke on, but Cramer said that small, round objects may be just the right size to block the airway.
Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, has previously published research on choking in children. He said that latex balloons are a particularly high-risk object for choking.
"A fragment of a balloon or an uninflated balloon can drape over the opening of the child's larynx and it's like shrink wrap. Even with the best equipment, it's really tough to dislodge," Smith said.
Marbles and small balls, like those used to play the child's game "Jacks," are also a big hazard, he said.
"Anything round or cylindrical that's the size of the airway can act as a plug for the airway," Smith explained.
In addition to small household objects, Smith pointed out that food can also be a big hazard.
"Hot dogs are a perfectly designed airway plug," Smith noted. He said toy hot dogs also are a risk for young kids who might put them in their mouths. Grapes, carrots, gumballs, jawbreakers and round hard candies are all foods that pose a choking hazard to young children.
Hot dogs and grapes should be quartered before given to small children. Hot dogs are such a choking hazard, Smith said, that they're a risk even to age 10. He suggested shredding carrots for small children.
Smith added that kids with special needs often have a greater choking risk until they're older. And, he mentioned that older adults often develop chewing or swallowing issues and need to take precautions so that they don't choke either.
Cramer said, "Although you can't completely sterilize a child's environment, parents sometimes have a lack of appreciation for some of the risks their child can face. For parents, awareness and education about choking hazards is important. There are a lot of things in a child's environment that kids can get a hold of. Be careful what you give kids to play with, like coins or keys."
Smith agreed that "you can't watch a child 100 percent of the time. They're quick and inquisitive and it doesn't take much for something to happen. Take steps to protect them pre-emptively."
The study was published as a research letter in the Nov. 26 issue of the Journal of the American Medical Association.
More information
Nationwide Children's Hospital has more on preventing choking in children.
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