One of the things I counsel about frequently is choking risk.  Choking is the 4th leading cause of death in children and the majority of incidents occur in kids < 5 years.  This is because a child’s gag reflex does not mature until she is 4 years old.  One child chokes to death every 5 days in the US.

Common objects that are a risk are foods, toys, coins, and balloons.   There is all kinds of advise available but I can keep it relatively straightforward.  Under age 4 avoid nuts, popcorn, chicklets, lifesavers, M+M’s, jellybeans, raw vegetables.  I can simplify it further:  if you need to use molars to crush the food you are eating–no good.  If you can mash the food up between your tongue and palate and then swallow it, it’s probably ok.  So pretzel sticks are ok(the dough based pieces will dissolve quickly), popcorn no; soft piece of chicken-yes, hard piece of steak or shrimp-no.  You get the idea.   With respect to toys, I use a cardboard toilet paper center roll as a guide.  If the object in question is of a size and shape that it will slide through the roll in 2 planes–held upright and horizontally–that’s no good, It’s a choking risk.  If the object can only fit through the roll in one plane but is too bulky to fit in the other its likely safe.  In my office I demonstrate with a pen and the cap: the child can play with the pen but not the cap, which is too small.

A few ” special cases”–cut hot dogs lengthwise and then widthwise.  Cut grapes into quarters.  Keep coins away from toddlers.   Hold balloons with your younger child when she blows them up.  Endeavor to have your toddler seated and calm when he is eating.

I am excited to be joining Operation Smile this week for my 4th mission, this time to Haiti.  I’ll be away the next 2 weekends with my “team.”  With adequate wi-fi perhaps I can send along updates.  I will certainly try.  Wish me luck.  L’shana Tovah to my Jewish patients!!


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