Preventing choking and suffocation in children

Question 1

What percentage of unintentional injuries in infants under the age of one in Canada are due to choking and suffocation?

Answer 1

40%

Question 2

What is the definition of choking?

Answer 2

The interruption of respiration by an internal obstruction of the airway, usu. a food item or small object

Question 3

What is the definition of aspiration?

Answer 3

Occurs when this object is inhaled into the respiratory system

Question 4

What is the definition of suffocation?

Answer 4

Obstruction of the airway by an external object that blocks the nose and mouth, such as a plastic bag, bedding, or mattress.

Question 5

What is the definition of strangulation?

Answer 5

External constriction of the neck that interferes with respiration, and may be caused by a curtain cord or clothing drawstring.

Question 6

What is the definition of entrapment?

Answer 6

Mechanical interference with respiration when the head and neck are caught in a constricting place or position, such as a gap in play equipment, a bunk bed barrier, between balcony rails, or in a car window.

Question 7

What is the definition of traumatic (crush) asphyxia?

Answer 7

Mechanical fixation of the chest, by fallen furniture, for example, or closing garage door, or by burial in soil, grain or other materials. Entrapment can `result in suffocation, strangulation or asphyxia.

Question 8

What is the most common nonfood item cause of choking deaths in children?

Answer 8

Latex balloons

29%

Question 9

What small objects are choking hazards in the home?

Answer 9

Round, smooth objects <4cm in diameter are particularly hazardous, as well as conformable items such as balloons

Question 10

What cords are strangulation hazards in the home?

Answer 10

Pull cords >20cm or any dangling or loose cords that is attached to a fixed object

Question 11

What are suffocation hazards in the home?

Answer 11

Household items that might cover the nose and mouth and obstruct breathing esp. soft toys and bedding, bumper pads, plastic bags

Question 12

What are entrapment hazards in the home?

Answer 12

Places with poor air supply, a heavy lid, or a self-latching door or spaces measuring between 9-22.9cm rungs or rails e.g. old refrigerators, freezers, ice boxes, washes, dryers, etc.

Question 13

What foods should be avoided for children under 4yo?

Answer 13

Hard candies
Cough drops
Gum
Gummy candies
Chewable vitamins
Peanuts
Sunflower seeds
Fish with bones
Snacks on toothpicks or skewers

Question 14

What foods require special preparation in infants and toddlers?

Answer 14

Grapes - slice lengthwise
Hot dogs, sausages - slice lengthwise
Raw carrots, apples - chop, grate

Question 15

What percentage of unintentional asphyxial deaths in children <15yo are related to the child’s own bed or bed accessories, to an inappropriate sleep location, or having hazardous objects in the sleep environment?

Answer 15

40%

Question 16

What is the most common cause of fatal asphyxial injury in older children?

Answer 16

Strangulation

Question 17

What are recommendations regarding research and surveillance?

Answer 17

Detailed data including narrative descriptions of events and products involved should be collected for all fatal and near miss choking and suffocation incidents

Question 18

What are the CPS recommendations for legislation and standards?

Answer 18

1. National: revise the Hazardous Products Act to include known hazards which are not currently regulated but are associated with fatal and near-fatal incidents, such as bunk beds, toddler bed guardrails, children’s clothing with drawstrings, and window covering cords.
2. Provincial: day care regulators integrate safety guidelines, including measures that prevent choking, suffocation and strangulation.
3. Municipal: communities and school boards mandate the use of the (now voluntary) Canadian Standards Association guidelines for play spaces and playground equipment.

Question 19

What are the CPS recommendations regarding product design/manufacture?

Answer 19

1. Manufacturers and designers of baby and children’s products and children’s facilities should use guidance documents such as the ISO Guide 50 to design and produce
2. Reduce and eliminate the use of plastic wrap, plastic bags, and other choking hazards in the packaging of products for young children
3. Labeling of children’s toys and products should clearly identify a specific risk, rather than simply making an age recommendation

Question 20

What are the anticipatory guidance for newborn to 2mo infants to prevent choking and suffocation?

Answer 20

1. A crib that meets current government standards is the safest place for infants to sleep. Cribs made before 1986, or that do not having a permanent label with the manufacturer’s name, the model number or name, date of manufacture, instructions for assembly, and a warning statement about mattress size and proper crib use, are not safe to use.
2. Check the crib regularly for loose parts and hardware, and especially after it has been moved.
3. Avoid soft bedding, bumper pads or stuffed toys. The crib mattress should be firm and tight-fitting.
4. Place infants to sleep on their back.
5. Do not sleep with an infant on an adult bed, sofa, reclining chair or air mattress, and do not use these as sleeping surfaces for infants.
6. Avoid toys with strings or pull-cord longer 20 cm (8 in), stringed bibs, and baby necklaces.
7. Avoid any toy that is breakable, that can fit through an empty toilet roll, has small or detachable parts.
8. Use one-piece pacifiers and replace them at least every two months rather than waiting for signs of damage. Never tie a pacifier around a baby’s neck. Use clips with short ribbons attached to them instead.
9. Fasten harness straps properly when an infant is in a car seat, carrier, bouncy chair or swing, and always use the crotch strap. A car seat or carrier is not a safe place for a baby to sleep.

Question 21

What are the anticipatory guidance for 4-6mo infants to prevent choking and suffocation?

Answer 21

1. Continue taking all the preventative measures recommended for 0-2mo
2. Be on constant lookout for choking hazards in the home. Vacuum or sweep floors often, and be especially attentive when there are visitors and older children present.
3. Remove suspended crib toys and mobiles as soon as a baby is four months old or can push up with hands and knees.
4. Make sure the crib is placed away from window blinds or cords.
5. Cut, tie up or tie down window blind and curtain cords so they are always inaccessible.

Question 22

What are the anticipatory guidance for 6-12mo infants to prevent choking and suffocation?

Answer 22

1. Continue taking all the preventative measures recommended for 0-6mo
2. Stay within arm’s reach at mealtimes.
3. Discourage older siblings from feeding their baby brother or sister.
4. Consider switching to a teething ring if the baby starts to chew on a pacifier.
5. Check floors, under furniture and between couch or chair cushions frequently for choking hazards, especially after a party or gathering.
6. Store older children’s toys in a separate place, so that a younger child cannot get at them.
7. Check for and adhere to all toy label age and safety recommendations.
8. Avoid clothing with drawstrings at the neck or waist. For winter wear, use a neck warmer instead of a scarf and mitten clips instead of strings.
9. Keep pet food off the floor between feedings.
10. Tie plastic bags in a knot before storing them out of reach and out of sight.

Question 23

What are the anticipatory guidance for pre-schoolers (1-4yo) to prevent choking and suffocation?

Answer 23

1. Continue taking all the preventative measures recommended for 0-12mo
2. Avoid magnetic toys.
3. Make sure toys batteries are properly installed and not accessible to the child.
4. Do not use latex balloons. Choose mylar or foil balloons instead.
5. Use only large beads for stringing (more than 4cm [1.5 in] across). Anything smaller is a choking hazard.
6. Make sure that your child’s toy box is safe: that it has air holes and a lightweight lid with good supporting hinges.
7. Only use a bunk bed if it meets current standards (ASTM and 16 CFR), which were developed to prevent fatal entrapment injuries to children resulting from improper guardrail spacing and other design flaws. Children can also become wedged between the wall and mattress or frame; a guardrail on the wall side of the bed can help to prevent this, for both bunks. Never allow a child under 6 years old to use the top bunk, as they are at higher risk for entrapment due to their body size. Ensure the mattress is the correct size and fits snugly, with no more than a 3 cm gap on any side. Children should never tie ropes or cords to bunk beds or other furniture or fixtures.
8. Remove a child’s bicycle helmet before allowing them on playground equipment.
9. Do not allow children to tie skipping ropes, pet leashes or other ropes and cords to trees, decks, or play equipment.
10. Encourage table manners: staying seated while eating, being calm and not speaking with food in the mouth, chewing well before swallowing, and no running around while eating.

Question 24

What are the CPS recommendations regarding first aid/CPR?

Answer 24

1. Parents and caregivers should be encouraged to take CPR and choking first aid courses
2. Pediatric health care providers should maintain their advanced pediatric resuscitation knowledge and skills (PALS)