Smaller airways, less developed swallowing skills and bad eating habits put kids in danger. STACEY CHIA reports

Children have been known to choke to death after putting some object in their mouth, so parents should be mindful of this.

A recent article in the Los Angeles Times said that choking is one of the leading causes of injury and death in children in the United States.

Those below the age of three are especially vulnerable.

This is not the case in Singapore where injury and deaths among kids are more commonly due to falls and severe burns.

However, choking is still a hazard that parents need to be aware of, said Dr Chew Su Yah, an associate consultant at the children’s emergency department at the National University Hospital (NUH).

Dr Cheng Tai Kin, a paediatrician at Kinder Clinic, said that because the airway in a child is smaller compared to an adult's, it is much more easily obstructed.

Dr Chew added that children are far more susceptible to choking because they tend to talk, laugh or run with food in their mouths.

They might, out of curiosity, also put small objects into their nose and mouth and inadvertently choke on them, she said.

She explained that choking on food is more common among infants and toddlers as their chewing and swallowing skills are less developed, while choking on non-food items occur more in older children.

Dr Chew said that children should be made to chew food well before swallowing it.

Activities such as talking, laughing and running while eating should be prevented.

One toddler, she said, had to have a bronchoscopy to remove small pieces of apple that were obstructing his airway and ventilation. He had collapsed while jumping about and chewing on an apple at the same time. He recovered after many days in the intensive care unit (ICU).

In bronchoscopy, a scope is passed into the airway so that the object can be viewed and removed by forceps connected to the scope. On the rare occasion that this does not work, surgery is conducted.

Choosing the right type of food for a child is also important.

“Food items such as fishballs, sausages, chunks of meat, seeds, hard candy, grapes and chewable medication should not be fed to children who are unable to chew well,” said Dr Chew.

Dr Benjamin Leong from the consultant emergency medicine department at NUH said that parents should be particularly careful about food items like fishballs and sausages, which are common in choking cases even among adults. This is because such food may get squeezed into the back of the throat before expanding again to obstruct the airway, he said.

One misconception is that a choking incident can be tackled by trying to force the object down the windpipe with other foods such as rice.

“An additional scoop of rice will only add to the obstruction,” said Dr Leong.
 
Dr Chew said that parents can reduce the chances of choking by choosing toys without small parts for their young children.

Some obvious and immediate signs of choking are coughing, breathlessness, noisy breathing and cyanosis (one’s face turning blue).

But there are times when choking goes unnoticed until much later.

Dr Chew said that this happened to a teenage girl who was having respiratory distress. Although the girl could not recall any choking incident, a bronchoscopy revealed that a piece of chicken had lodged in her right airway. She recovered after several days in the ICU.

Dr Cheng said: “Every family should have at least one person who is trained in first-aid as it can improve a child's chances of survival when he is choking.”