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.

Summer’s Lifeguard

On October 13, 2006, at just 21 months old, my daughter, Summer was diagnosed with acute myelogenous leukemia (AML). Because AML is fatal without treatment (and even with treatment the overall survivor rate is low), Summer began intensive chemotherapy within hours of the diagnosis. The treatment process lasted over six months, with the majority of the time spent in-house at Children’s Medical Center in Dallas, Texas.

As part of her treatment, Summer had a central venous catheter (CVC) surgically implanted in her chest, through which, she received her medicine and treatment. Less than a month into treatment, my husband Brad discovered that part of Summer’s CVC was twisting, which could cause the tube to break, and bring about serious complications including the need for additional surgery.

After several unsuccessful attempts by the caring pediatric oncology nurses at Children’s Medical Center Dallas, to find a remedy, Brad and I realized we needed to design our own solution. During this time, Summer’s CVC broke twice within two days. (After three breaks surgery is required to implant a new central line catheter!) I contacted a family friend, Karen, a retired nurse who is also a sewer, and together we developed Summer’s Lifeguard™, a Central Line/Port Wrap.

The primary concerns were minimizing the risk of infection (due to no immune system) and avoiding additional surgery, by ensuring Summer’s (CVC) was out of her reach. The unique design literally wrapped the lines of the CVC around her body, with padding and soft fabric that cushioned Summer to make her more comfortable and allowed for her mobility. Karen, as a nurse, added some unique features that provided easy access to the lumens for administration of medicine, and color coded tabs that matched the lumens for easy identification by hospital staff and caregivers. Four drafts later, we finally settled on a design that met all of Summer’s needs. And now we have designed a version that is universal enough to fit any child regardless of where their CVC is implanted on their chest.

Although Summer reached remission in May of 2007 and enjoyed a wonderful summer, she relapsed in November 2007. Summer completed a bone marrow transplant in January 2008. She is facing many challenges, specifically chronic graft versus host disease (GVHD), but today I am blessed to say she is a happy, active pre-schooler.

When Summer was originally diagnosed, I would tell her that she was a soldier of God, and her “armor” included her entire family and friends, her medicine, and all the doctors, nurses, and specialists treating her. Summer’s Lifeguard is an important part of this soldier’s armor in her fight against cancer.

Due to the interest by other parent’s of critically-ill children and through the encouragement of the nurses and doctors at Children’s Medical Center, Karen and I have formed a company called SIYA, Inc, located in Texas. The mission of this company is to provide medical protection with safety garments and other devices for patients, while providing peace of mind for families. After three attempts, Summer’s Lifeguard received clearance from the FDA in May of 2009 as a class I exempt medical device which means that hospitals can carry Summer’s Lifeguard and nurses can determine if a patient needs the device.

We’re thrilled to know that through our efforts, we can now give other parents of critically-ill children a little peace of mind and comfort to their child.

HEALTHFUL HINTS

If your child has a central line or portacath, here are some things to consider:

• Have your nurse use a Biopatch on the exit site of the central line or port as another precaution. (According to Ethicon 360’s website: “Catheter-Related Blood Stream Infections (CRBSI) are the 10th leading cause of death in the United States.”
• Have the dressing changed weekly around the exit site of the catheter.
• If your child develops a rash, examine what kind of tape is being used for the dressing, many children develop sensitivities to the tape.
• When using Summer’s Lifeguard:
  • Have your child lay down on their back to put on the wrap.
  • If your child is a transplant patient, you will want to put on a clean wrap daily (…therefore, it may make sense to have at least one extra wrap available).

Signs of Leukemia:

Believe it or not, it is different for everybody, and it sometimes may seem minor, like a cold that just won’t go away. To that note- if your child is experiencing symptoms of illness or a cut/scrape, or unusual and a lot of bruising, that won’t go away- have a Complete Blood Culture (CBC) done right away.

Dear Santa…Please Keep My Family Safe

Every year children all across the country and the world make lists to Santa. Wishes for new bikes and dolls and don’t forget the very latest toy. Childhood wishes and childhood dreams. Every year though children are poisoned by holiday plants; are electrocuted by holiday decorations. Parents die in drunk-driving collisions.

As a paramedic my partner and I responded one Christmas morning to an unknown medical. When we arrived we walked past a Christmas tree completely surrounded by presents as well as two young children eagerly awaiting both parents arrival so the day’s festivities could begin. The husband met us and led us to the master bedroom. Mom was dead- had died several hours earlier. The holidays are hard times for many people even people with love, and family and friends. Some people make choices during the holiday they might not make during other times of the year. There was nothing we could do and not a more helpless feeling we could feel.

What’s amazing to me is that this call was over 20 years ago. I had no other involvement that what I stated yet I still remember it- every Christmas season. The children would be grown by now. I bet that they too still remember. I bet they still feel different about Christmas than do many of their friends.

I bet if those kids could go back in time their wishes would simply be to have Mom with them for many more years to come. So please place safety at the very top of your Santa list. As adults we need to assure the health and safety of our kids and we can’t afford a break over the holiday season.

The lyrics of one of my favorite holiday songs perhaps say it best.

My Grown Up Christmas List

….”As children we believed
The grandest sight to see
Was something shiny
Wrapped beneath the tree

But heaven only knows
That packages and bows
Can never heal
A hurting human soul

No more lives torn apart
That wars would never start
And time would heal all hearts
And everyone would have a friend
And right would always win
And love would never end

Oh, This is my grown up Christmas list”

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.

Emmas Inspirations

When our daughter Emma was an infant, we moved into our new house. As parents of six children, we were very excited about getting to this new house and getting some much needed unloading done! Pulling into the driveway, we all became very excited and quickly left the car to see the house. There was so much to do – everyone went off in different directions.

I had assumed that my husband or one of the older kids had taken Emma from her car seat (as that was almost ALWAYS the case) and he thought that it was me who had brought her inside. Making the assumption that everything was okay, we went about unpacking and arranging our new home.

In a sudden moment of panic, I realized that our baby girl wasn’t even in the house. Nearly 45 minutes after we had arrived, I rushed to our car for Emma. 

The sun was hot for a spring day. I cannot tell you the thoughts and fears, and the horror that welled up inside of me as I was sure I had harmed our baby girl!  I thank God every day that my older son had opened the back window on the ride up because he felt car-sick, or Emma may not have become the vibrant six year old she is today!

From that point on we left notes in all the cars. “Where’s Emma?” was our catch phrase. We were determined to never let this happen to us again.

When my daughter and I read about the school principal who, out of routine, left her baby in the car all day, and the dad who forgot the baby was in his back seat because he didn’t ‘usually’ drop him off at child-care, we were sad and sickened by their tragedies… yet we knew how ‘routine’ oriented we all are today… and how easy it is for this tragedy to take place:

• An average of 40 children die each year in closed vehicles… and numerous others have been left alone in cars by adults who assume the car is a ‘safe place’ for their children…
• How many bus drivers do we read about who fail to “check their seats”!
• What is typically not realized is how quickly the air inside our vehicles can become saunas for our precious little ones… with temperatures escalating 20 to 30, or even 40 degrees higher INSIDE the car than the air OUTSIDE the car! According to an article in New Science Magazine (July 5, 2005) , a study done out of Stanford University re-echoes these facts: cars become ovens, even while outside temperatures are on the ‘cool’ side!
• Children’s bodies’ heat up 3 to 5 times faster than adults, and a child can be critically injured or tragically dead within minutes!
• In 2001, according to Kids N Cars, there were approx 20 child deaths due to hyperthermia. As of 6/26/2009 – approximately half-way into 2009 – we already have 15…and it is estimated that the data vastly underestimates the safety issue.

My daughter and I remembered our ‘notes’. I thought of easy ways to leave a ‘note’ affixed to car windows, in key spots, to help remind us to “check the seats before we leave”. We decided to design decals to help save lives, as well as awaken our awareness of the dangers of vehicle suffocation for small children and pets! This is how we came up with Emma’s Inspirations.

I came up with the idea of static-cling decals to adhere (but not STICK with adhesive) to the car windows. I wanted to add a couple of ‘check’ marks to the decals with a stick figure boy and girl (some with a cat and dog added as well) and add a phrase that rhymed to increase the ease of remembering the dangers of suffocation for adults… and to educate children as well. I thought the phrase would help develop a new mindset for everyone… and help educate our children about automobile safety- the same way we educate them about outlet and toaster safety.

I thought 3 decals for each car was a good idea so I put them together in packages of 6 … enough for two cars. One could be placed just above the driver’s side window door-lock, another just below the rear-view mirror, (or the left corner of the windshield), and one for the back window corner. Some moms stick one on the kitchen window as well; to remind them to keep any cars outside LOCKED from little hands or hide and seek players! Others place one on or above their house alarm to remind them to check the seats.

Gene Weingarten of the Washington Post wrote a painfully candid article on this subject on Sunday, March 8, 2009. He recounts the tragedy of three families as they endure the heartache of recognition that their children died a horrifically “modern” death; they suffocated in seats their parents never took a second glance in! These are situations no family ever would have anticipated.

Emma’s window decals are that little reminder you need when things are moving at a fast pace. By sticking these decals in the right places you will have a simple and affordable reminder to check again. A reminder so simple …yet one that could save your child’s life!

HEALTHFUL HINTS

Many parents are unaware of the dangers lurking around parked cars. According to the Kids N Cars national database, there are a number of injuries that can happen in a ‘MOMENT’ to children left unattended in or around motor vehicles. Here are just a few things to watch for:

• A child can suffocate in unattended vehicles;
• Children can get their heads and hands caught in power windows;
• They can inadvertently shift the car into gear…or fall out windows and doors;
• “Frontovers” and “Backovers” are responsible for approx 61% of non-traffic fatalities for children under the age of 15;
• We must be of a mind to NEVER LEAVE OUR CHILDREN ALONE IN OR AROUND CARS.

 The decals from Emma’s Inspirations are an accident prevention tool to remind us to DOUBLE CHECK our seats, REMOVE any passengers, and LOCK our EMPTY parked cars from curious little ones. Other areas where safety stickers can keep your children safe from harm:

• ID stickers for child safety seats – if you were ever in an accident, it would provide key information about your child to caregivers that you may be unable to communicate. You can usually get these at your local pharmacy or stationery store…
• You might want to place a decal or sticker on a house or apartment window or door to alert emergency personnel to the presence of children in the home.
• Poison Control stickers should be placed on phones themselves or next to the phone and/or on an inside cabinet door.
• Medical alert bracelets or anklets or stickers or decals on a child’s seat or diaper bag or person to warn of potentially life-threatening allergies.
• Decals and stickers are good to remind ‘no metal’ in the microwave or toaster.
• Stickers and decals are small, yet significant aids in helping us keep track of the never ending flow of “things to remember to mention” or ”do” or “watch out for”… as we manage the literal “ins” and “outs” of our days… and care for the people, who at the end of our day, we do it ALL for… our children!

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