CHOKING IN CHILDHOOD
Choking is one of the few true emergencies of childhood in which minutes may determine life or death. A swallowed object is the most common and serious cause of choking. Choking is caused by the obstruction of the airway resulting in an inability to breathe. It is easily identified by two key signs: the child frantically tries to breathe, and the child is not able to cry out or to speak.
If choking continues, the child quickly becomes blue, convulsive, limp, and unconscious. If the object completely blocks the air passage, you have only a few minutes to reestablish an airway before brain damage or death can occur.
The objects that choke children are usually of a shape and size to plug the opening into the throat like a cork. Frequent and especially dangerous causes of choking are peanuts, tablets, glass eyes of toy animals, hard or hard-coated sweets, beads, popcorn, and tiny toys or small parts from toys. Solid particles of food from the stomach may choke a child who breathes in during vomiting. A vomiting baby is safest from choking when lying on his or her stomach.
Choking may also occur in a child who has croup. But choking caused by croup is slightly different and is treated differently. A child choking from croup frantically tries to breathe, but the child is still able to speak or cry. See the article on Croup for treatment of that form of choking.
Signs and symptoms
Choking on an object is easily identified by the two major symptoms. There are frantic, unsuccessful efforts to breathe. The child cannot talk or cry.
Home care
Seconds count! Scream for help. A second adult on the scene should phone the police or paramedic squad for help. (Police are usually more quickly available in most communities than an ambulance, the fire department, or a doctor.)
First, give your child one minute to clear the obstruction by his or her own efforts. If this doesn’t work, place your child’s head down over a chair, table, or your lap and pound hard on his back four times. Broken ribs heal; death does not. Support the child’s head and neck before pounding to avoid fracturing the neck.
Only if safer measures fail should you consider reaching into the child’s mouth with a hooked finger or tweezer in an effort to remove or dislodge the foreign body: there’s a good chance of pushing the object more tightly into the windpipe in your desperation to remove it. If your child is not breathing after the object is removed, give mouth-to-mouth resuscitation until trained help arrives.
Precautions
• Never give mouth-to-mouth resuscitation until the obstructing object is removed; to do so may force the object further down the throat.
• Prevention of choking is most important. Examine all toys for loose eyes or other small parts. Keep tablets under lock and key. Do not give peanuts, popcorn, or hard sweets to toddlers. (Clean up after adult parties before children can wander unattended into a room.)
Medical treatment
When the object completely blocks the air passage, the child seldom reaches a doctor in time. However, the object may only partially block the airway, even though you may not think so. Your doctor will operate, on the spot, to open the windpipe through the neck (tracheotomy). Then oxygen, artificial respiration, and intravenous fluids will be given.
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