Pediatricians urge food manufacturers to reduce choking hazards

In a policy statement published in the March issue of Pediatrics, the American Academy of Pediatrics (AAP) calls upon food manufacturers to reduce choking risks for children. Pediatricians want manufacturers to make foods that are known choking hazards safer by changing the size, shape, and/or texture of high risk foods. They also request labeling of such foods with a warning about the potential for choking. Foods such as hot dogs, carrot sticks, grapes, peanut butter, and many others fall into the high risk category because of the frequency of choking incidents among young children involving them.

Hot dogs can be especially dangerous for young children under the age of 3. The size and shape, along with the ability to compress easily can cause the complete blockage of a child’s airway and can be lodged in too tightly to remove, even with proper medical equipment. According to the AAP policy statement Choking on food causes the death of approximately 1 child every 5 days in the United States. Hot dogs accounted for 17% of food-related asphyxiations among children younger than 10 years of age in a 41-state study.

Whether food manufacturers heed the call to re-design high risk foods or not, parents and child care providers must take responsibility for protecting children against choking on any food. Here are some recommended tips for helping your child eat safely:

• Cut up food into small pieces, no more than 1/2 inch in diameter.
• Do not feed children under the age of 4 any hard, smooth, round or firm foods that have to be chewed with a grinding motion without cutting them up into small pieces. Peanuts, grapes, hot dogs, and carrot sticks must be cut up first.
• Do not let children eat while playing, laughing, walking, or running around.
• Teach your child to chew food thoroughly and to swallow before talking.
• Do not feed popcorn, nuts, or hard candy to children under the age of 4.
• Learn CPR and how to appropriately and safely assist someone who is choking.

Keeping Kids Safe: Common (and Not So Common) Choking Hazards

Keeping kids safe is top on the minds of most parents, but sometimes hazards are just not that obvious. Introducing foods to infants and toddlers can be great fun, but it also brings opportunities for danger. A little knowledge about how to avoid choking can go a long way in avoiding serious emergencies.

I wrote in a previous post about using pixie stix to get kids to take their medicine. I am going to co-opt this old favorite treat for our lesson about choking hazards. What does a powdered candy have to do with choking hazards, you might ask?

The text and photo from this blog demonstrates that kids can make nearly anything into a choking hazard:

“Looks like fun, right? Probably. But a tube of powdered candy of that size might as well be a loaded gun. It’s frickin dangerous. I know.

When I was thirteen and tried putting the whole mega-Pixie Stick worth of flavored sugar in my mouth, I laughed and inhaled and the moisture in my throat hardened the sugar into a moist sugar ball lodged squarely in my trachea.

One my friends knew the Heimlich maneuver and managed to dislodge the bright blue coagulation into a psychedelic pool of vibrantly scarlet regurgitated Big Red Cola. It was the [last] time I touched either Pixie Stix or Big Red.

It wasn’t my time but I think, when I’m ready, that is exactly how I want to go.”

I love this post for several reasons…

1. This photo is a pediatrician’s nightmare.
2. That someone could avoid impaling himself with the sharp plastic tube but instead manage to obstruct his trachea with powdered candy is a mark of real talent. It’s amazing that we have any children left unharmed.
3. I love the word “frickin” and will try to use it as often as possible in this blog and in my real life. Not to worry, I will avoid using it around kids.
4. Speaking of near-death-by-food, I almost poked my eye out with a loaf of bread once. That story will probably never make it into this blog, so contact me directly if you’re interested. It is as embarrassing as it sounds….
5. Though the Olympics was more than a year ago, swimming boys still make me think of Michael Phelps. I love Michael Phelps. I’m not the only one.

Seriously though, while pixie stix are not usually cited as top choking hazards, choking is a real hazard for children, and food is the number one culprit.

It’s amazing what a mostly-toothless little one can manage to eat. Starting at about 9 months of age, babies can begin to manage foods of a variety of textures and shapes. But remember, kids less than 4 years old may not chew, grind, or gum food well and are at great risk for choking. The most common choking hazards are round firm foods (hot dogs, grapes, nuts, popcorn), and sticky/gooey foods like peanut butter or sticky snacks and candies. Chunks of uncooked vegetables and fruits can also make their way down the wrong tube. Candy and gum top the list of foods that send choking children to the emergency room.

Tips for Parents:

How can you prevent choking? Here are a few tips…

• Take an infant and child CPR class: if you did not take one before your child was born, try to do so by 6 months of age, before your little one starts solids. If you have taken the class, review the course materials as a little refresher.
• To avert the need to perform these life-saving maneuvers on your child, avoid potentially hazardous food until your child is four to five years old. Cook foods well or cut firm foods into pieces less than 1/2 inch in size.
• Give your child small portions, adding to his plate as he finishes.
• Make (and enforce) a household rule that all food is eaten at the table. In a chair. And no eating while running (with scissors). Or playing. Or lying down. Or in a car (or a bus or a taxicab or hot air balloon).
• Limit distractions (tv, pets, games, clowns) at mealtime.
• Watch out for “chipmunking”: hoarding food in the cheeks of an eager eater. Kids really do this.
• Keep helpful older sibs from feeding the little one. They will not provide the same level of supervision that you will.
• And most importantly, NEVER leave a young child alone while eating.

Useful Links:

• For more ideas on avoiding choking on foods and other objects, check out this tip sheet from the AAP
• And since food is not the only thing that your kids can choke on, the Consumer Products Safety Commission gives good information about recalls on toys and tips for avoiding choking on toys.

Safe Sizer Choking Prevention Plate – Our Story and Giveaway

I’m David Zak, the inventor of the Safe Sizer™ choking prevention plate and the dad of 3 beautiful kids aged 2 to 8. Now, I don’t consider myself an overprotective parent. When my kids are playing I don’t rush to them every time they fall down. But I do worry about the big things. Those potentially fatal but very preventable “accidents” that can happen so easily if you’re not careful. Choking on food is one of those things.

When my oldest was beginning to eat solid foods, I knew I was supposed to cut it up into really small pieces to reduce his risk of choking. But I was always asking myself “How small is small?” I should also mention that I’m a former engineer, and I simply needed a little more precision than “small”.

So, I did some research. According to the Centers for Disease Control (CDC), 75 children under the age of 14 die in the US every year from choking on food and about 7,500 are treated in emergency rooms. These are senseless and preventable tragedies. Additionally, the CDC data shows children under 2 years have the highest rates of choking deaths in this group, but children up to 4 years are still particularly vulnerable because they lack a full set of teeth.

I also found a recommendation regarding food size to reduce the risk of choking. The American Academy of Pediatrics (AAP) recommends that children younger than 4 years old not be fed any round, firm food unless it is cut into pieces no larger than one-half inch in any direction.

You think you know how small one-half inch is until you start trying to cut up pieces of food to that size. It’s smaller than you think. At least, it’s smaller than we thought. And, my wife Susie and I thought, maybe this is smaller than most people would expect. If most people have even heard of this guideline…and it’s pretty important. Nobody we knew had, and we thought they should.

As I thought about how to get this information out to more people, I kept coming back to the small objects test cylinder developed by the Consumer Products Safety Commission (CPSC). The cylinder’s purpose is to show parents what objects are too small to give a child under 3 because it could block the child’s windpipe. If a toy fits in the cylinder than it fails. As a matter of fact, if a toy fails this test it is required to have a label on its packaging stating it is a potential choking hazard. So why not a test cylinder for food?

But food is a little different. You want it to be swallowed, so here smaller is better. But there is one big advantage with food that I thought would make a test cylinder idea work even better than it does for toys. Food is typically served in pretty standard ways. There’s usually either a plate or a placemat or a tray or some other type of tableware. So a food test cylinder could always be right in front of you if it was built into the tableware itself.

So I invented the Safe Sizer™ .  It is a ½ inch diameter ring that could potentially be put anywhere and on anything on which children can be served food, in order to:

1. inform those who don’t know about the one-half inch size recommendation
2. remind those who do to follow it at the exact place and time when they need the reminder
3. provide a test gauge to accurately measure bite sizes to one-half inch or less

After striking out multiple times trying to convince some large manufacturers of children’s tableware that the Safe Sizer™  was a good idea, Susie and I decided we would just do it ourselves. We formed a company and called it Midwest Monkeys® after our 3 monkeys who were all born in the Midwest. We live in Albuquerque now so it was also a way of bringing a piece of our personal history with us.

Over the next year and a half we joined the major industry group, the Juvenile Products Manufacturers Association (JPMA), met a great product designer, developed, tested, and finally produced our first product that incorporated the Safe Sizer™ feature. We designed a set of three colorful melamine plastic plates with a 3-dimensional raised ring version of the Safe Sizer™  built right into the plate. To use the 3-dimensional Safe Sizer™  feature on the plates, the parent or grandparent or babysitter or any caregiver serving a child a meal simply places a piece of cut up food inside the raised ring, turns it to ensure the piece fits in every direction without going over the sides, and then hands over the plate to the child..

While we could have put the Safe Sizer™  feature on any number of different tableware, the plastic plate made the most sense. It is probably the most commonly used serving dish for kids and plastic allowed us to mold the feature right into plate making it permanent. By using melamine plastic, we also got a very durable, dishwasher safe, and food safe plastic. Lastly, we tested at the CPSIA accredited Intertek Labs to ensure that the Safe Sizer™  plates were fully compliant with the Consumer Products Safety Improvement Act (CPSIA) of 2008). They  meet or exceed all standards for lead, phthalates, and melamine plastics.

The Safe Sizer™  choking prevention plates have been available since January 2009 and the response has been wonderful. We’ve gotten a lot of feedback from parents about how their kids don’t want to use any other plate and how they love putting food in the Safe Sizer™ to show their parents that the food is the right size! We’ve been mentioned in numerous articles, on TV, and in mom blogs. We’re particularly proud of the awards we’ve won including iParenting Media, The National Parenting Center, PTPA (Parent Tested, Parent Approved), and Creative Child Magazine. But what we’re most proud of is that maybe we’ll help prevent one of those 75 kids and their parents from suffering a senseless tragedy.

HEALTHFUL HINTS

Choking Prevention Guidelines

Here are some great guidelines on food choking prevention from the American Academy of Pediatrics. I would encourage all parents and caregivers to look at their site (Parenting Corner Q&A: Choking Prevention) for more information.

1. Always supervise your children while eating
2. Insist that kids are sitting while eating. No walking, running, playing, or lying down.
3. Avoid the foods that kids most commonly choke on: hot dogs, nuts & seeds, chunks of meat & cheese, whole grapes, hard or gooey or sticky candy, popcorn, chunks of peanut butter, raw vegetables, raisins, and chewing gum.
4. Cut food for infants and young children into pieces no larger than one-half inch, and teach them to chew their food well

***Introducing our: ”SAFE SIZER PLATES FOR FEWER CHOKING KIDS” Giveaway!***

The Prize:  

For  3 winners: you may each choose your favorite 2 plates  *PLUS*  a wildcard (1 extra winner) – see below for details

And here’s how it works:

Below you will find a PEDIATRIC SAFETY CONTEST ENTRY FORM. It includes 2 MANDATORY entries for the contest as well as the opportunity for you to enter BONUS entries…

For simplicity (and so that you can tweet multiple times) you can use this form for each entry, however you must fill out a separate form for each entry for it to count!

How to enter:

For your Mandatory Entry: You MUST do these 2 things FIRST or no other entries will count!

1. We at Midwest Monkeys need your help. We’re trying to make some improvements to our website but we’re not really sure where to start. So please go to our site, come back here and tell us on the form below what you’d suggest we do to make the site better. We’re looking for real suggestions that show us you’ve actually gone to the site….plus…we have a surprise for you…the BEST suggestion will win our “wildcard prize”…a single plate of your choice in addition to the ones we already mentioned – and we’re choosing this winner! (1 entry)
2. Tell us which 2 plates you like best so we know which ones to send when YOU WIN (1 entry)

For your Bonus entries:

1. Follow @pediatricsafety on twitter and tweet the following: “I just entered a SafeSizer Choking Prevention Plate Giveaway @PediatricSafety http://bit.ly/mcrTp 3 winners! Safer kids! Great Idea!” 

OR “Toddlers need to eat food in pieces <1/2″. SafeSizer plates make that easy! http://bit.ly/mcrTp Giveaway w/ 3+ winners RT @PediatricSafety” (you may tweet both: 1 entry for each per day)

2. Blog about our story and giveaway on your own site and link to this post http://bit.ly/mcrTp. (2 entries – please submit 2 forms)
3. Join the Pediatric Safety community using the “Join our Community” button.  (4 entries – please submit 4 forms)

**CONGRATULATIONS TO OUR 4 WINNERS **

Our 3 Main Contest Winners – Win 2 Plates Each:

1. Traci Fritz #62 – with a Bonus Entry:  joined the Pediatric Safety site
2. Stephanie Clark #77 – with a Mandatory Entry #1: website suggestion
3. Katrina Brandenburg #31 – with a Mandatory Entry #2: which 2 plates she wanted if she won

Our Wildcard Winners – Wins Their Choice of Plate for the Most Helpful Website Suggestion

• Kristen Chumley – I think the theme should be circles. Maybe you could make the navbar circles instead of a single rectangle. Show the 3 styles of plates and when you scroll over them, there could be a zoom feature for users to check out the safe sizer. Another idea would be to have a video demonstation so people could see how useful it is to get a visual guide of 1/2″.

Contest Rules:

Giveaway is open to USA and Canada readers only. Giveaway ends at noon EST Friday Sept 11, 2009. Please fill out a separate form for each entry with your name and a valid email address so we can make sure each entry gets counted. You will have 48 hours to email pediatricsafety.net if you win. 3 winners chosen using random.org for the main prizes; 1 winner chosen by Midwest Monkeys for the wildcard prize. Good Luck to all entrants!