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Hard candy sends most kids to the emergency room for choking

A new study reveals that four common foods make up more than half of kids' non-fatal emergency room visits due to choking.

The study published in Pediatrics on July 29 showed that between 2001 and 2009, about 12,435 kids aged 14 and under on average went to the emergency room for choking on food each year. Thatnumber averages out to about 34 kids a day.

Kids 4 and under made up 62 percent of all non-fatal food choking incidents, and children under the age of 1 accounted for 38 percent. Fifty-five percent of the visits involved boys.

More than 60 percent of the choking visits involved children 5 and younger. The number of choking cases dropped each subsequent year until the age of 7. After that, choking-realted visits remained around the same number for all the age groups.

The most common food items that children choked on were:

  • Hard candy (15.5 percent of cases)
  • Other candies including gum (12.8 percent)
  • Meat not including hot dogs (12.2 percent)
  • Bones (12 percent)

These four items alone accounted for 52.5 percent of all food-related choking emergency room visits for kids under 14 years old.

Other common culprits included fruits and vegetables, infant formula, milk and breast milk, seeds, nuts and shells, chips, pretzels and popcorn and biscuits, cookies and crackers.

While formula, milk and breast milk only made up 6.7 percent of all food-related choking cases, it accounted for 36.3 percent of choking episodes for children less than on year old. Children 0 to 4 years old were more likely to choke on vegetables and fruit than those 5 and older.

However, certain foods were more likely to lead to extended hospital stays. For example, hot dogs only made up 2.6 percent of food-related choking incidents, but these kids were more likely to get hospitalized after their episode than kids who choked on any other type of food.

"Other high-risk foods, such as hot dogs, seeds and nuts, were more likely to require hospitalizations," author Dr. Gary Smith, director of the Center for Injury Research and Policy, said in a press release. "These foods have high-risk characteristics that make them more likely to block a child's airway or make them more difficult to chew, which can lead to more serious choking events."

Dr. David Walner, a pediatric ear, nose and throat specialist at Rush University Medical Center in Chicago, added that these larger food items can lead to the worst outcomes because they block out air for longer periods, leading to possible brain damage. If doctors can remove the item, the outcome can be good, but in a lot of cases the children don't get to the emergency room in time.

"The main thing with these cases is that they are almost always preventable," Walner, who was not involved in the study, said to USA Today. "Some things we can't prevent in medicine, and they're sad stories. But these are the saddest because they are almost always preventable by using common sense."

Dr. Robert Glatter, emergency physician on staff at Lenox Hill Hospital in New York, added to that he often sees kids with popcorn kernels, nuts, pieces of hot dogs and vegetable matter stuck in their upper airways. People mistakenly believe that the food item was swallowed or coughed up, but it ends up stuck in the small airway passages of the lungs.

Over the course of a week or so, these children develop coughing or wheezing episodes, and parents may not know why. Glatter said that's why it's important to get a thorough history from parents of what a child ate.

"This signifies that the object may have become lodged in the lungs, setting up an inflammatory response, possibly leading to pneumonia," he said. "A bronchoscopy (procedure) may be essential to remove the object at this point."

Nationwide Children's Hospital, which helped fund the study, said that children under the age of 4 should not be given round, firm foods unless they are cut into small pieces. Kids should not be allowed to run, walk, play or lie down with food in their mouths.

In addition, kids should be watched with caution when they are around latex balloons, coins, marbles or ball-shaped objects, toys with small parts or toys that can fit in a child's mouth, pen caps and small and button batteries.

Parents should also check the minimum age requirements for toys before giving them to children. Many toy stores have tube testing devices that allow parents to see if a toy is too small for a young child. Beware that older kids may give younger children toys that they can choke on.

In case of an emergency, parents should know first-aid for choking and CPR. Glatter said if a child looks like they are having problems, first check their mouth to see if there are any obvious objects that are causing the choking. Do not sweep your finger inside the mouth, because you can inadvertently push the object further.

"Start by delivering five rapid back blows between the child's shoulder blades with the heel of your hand," he instructed. "Then do five abdominal thrusts (Heimlich maneuver). Keep alternating back blows and abdominal thrusts until the object comes out and the child can talk, breathe and cough."

If the child loses consciousness, immediately begin CPR and get someone to call 911, he added.

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