Airway Obstruction Injuries

Do you know what kind of sound is made by a child who is choking, strangling, or suffocating? None! By the time you realize there is an airway obstruction crisis, it could be too late.

Choking occurs when food or an object blocks the trachea (airway). Strangulation occurs when something such as a cord or string, jewelry, railings and crib slats, or an accordion-style gate wraps around or compresses the child's neck. Suffocation occurs because materials such as plastic bags, fluffy pillows, or cushions, block or cover the child's nose and mouth.

Why are there so many injuries related to airway obstruction? Children are curious and learn by exploration. For example, one developmentally appropriate way young children explore their world is with their mouths. Parents and caregivers should anticipate that anything the child finds can go straight into his or her mouth.

Here are some suggestions to uncover hazards indoors and out as well as some prevention strategies. Tips to prevent choking

• Choose toys with the youngest possible users in mind. Balloons, one of the leading causes of death in children under age five, do not belong in a childcare setting. Many toys designed for older children have small pieces that present a choking hazard to younger ones. Marbles, buttons, beans, beads, coins, small pieces of toy food, and tiny toy figures are all choking hazards for young children. It makes sense to separate toys by children's ages, remembering that parts of toys for older children can break off and become an unintended hazard for younger ones. Damaged toys should be removed immediately. The 1994 Child Safety Protection Act requires warnings on toys intended for children three-five years of age that contain small parts. An inexpensive "no choke testing tube" from a toy store, which is about the size of a toilet paper tube, can help identify choking potential. If the toy fits entirely inside, children under age three and any other children who still put small objects in their mouths, should not use it.
• Meals for young children must be designed to avoid foods that can choke.
• Check outdoor play areas. Children will put bits of cushioning surfaces like gravel or bark in their mouths.
• Staff and visitor purses and backpacks pose another danger because they may include tempting choking items! Provide staff with a place to lock belongings. Encourage visitors to leave their items locked in their cars.
• Refrain from using tacks or push pins on bulletin boards. Use tape to post children's artwork and also cover any staples with tape.

Tips to prevent strangulation

• Cords on window blinds or draperies Cords that hang in a loop should be cut into two separate pieces and then tied or clipped near the top of the window and out of reach. Avoid placing cribs, cots, or high chairs near these windows.
• Crib toys Toys should have no strings or cords longer than seven inches dangling into the crib. Crib gyms or mobiles should not be used in the childcare setting.
• Pacifiers and rattles Do not use attached strings or cords. Pacifiers and rattles should be large enough not to lodge in an infant's throat.
• Cords on pull toys These cords should be 12 inches or less in length and have NO beads or attachments at the end. Do not overlook the cord on a play telephone. It, too, should be 12 inches or less in length. Keep in mind that attractively packaged unsafe toys are on the market! If a toy looks unsafe, do not purchase it.
• Children's clothing All drawstrings should be removed because they can catch on protrusions on a stairway or slide. Recommend clothing for infants and toddlers that utilize snaps instead of buttons. Discourage jewelry, rings, and small pins. Young children should not wear necklaces of any type.

Tips to prevent suffocation

• Fluffy comforters, pillows, or mattresses can lead to suffocation. Young children should rest on firm surfaces without pillows and be covered with very lightweight blankets. Crib mattresses should fit snugly against the side rails. Waterbeds and featherbeds are not safe for children's naps. Couches and reclining chairs also are unsafe as children can become entrapped in the footrests of recliners and between the cushions and backs of couches.
• Beanbag chairs can pose both an inhalation and suffocation hazard. Children have been known to crawl inside the cover and suffocate from inhaling the styrofoam "beans." Also, their soft surfaces can obstruct breathing for young children.
• There should be no stuffed toys in cribs. Crib slats should be no more than 2 3/8 inches (60 mm) apart. Crib corner posts should be no higher than 1/16 inch to prevent entanglement of babies' clothing. Do not use a crib with decorative cutouts on the headboard or footboard that could allow a baby's head to become trapped.
• Dispose of all plastic bags safely, especially those from dry cleaners.
• Freezers, refrigerators, and other closed containers such as toy chests can trap and suffocate a child. Secure these items carefully.

Even with all the safeguards listed here in place, airway obstruction might happen. It is crucial to recognize choking or suffocation immediately and take quick steps to help the child. In a breathing emergency, most adults and children will reach for their neck. This is considered the universal sign of choking. The victim might also flail his arms. In the unfortunate situation where the choking continues long enough to restrict air flow, the child may become lifeless and still.

There is very little time to act in an airway obstruction crisis. In as little as four minutes, permanent brain damage can begin, and death can occur in as little as six minutes. There may not be time for emergency help to arrive. If the victim is coughing, allow him to attempt to clear the obstruction by himself. DO NOT hit or pat the child on the back or try to remove an object with your fingers. This may drive the object further into the airway.

Childcare staff should be trained in the Heimlich maneuver and in rescue breathing for children, and there should be at least one staff member available at all times who is certified in infant/child CPR (cardiopulmonary Resuscitation). All victims who have suffered a choking incident should be examined by a medical authority, even though they appear to be doing fine. Contact parents and insist that the child be seen by his pediatrician immediately.

Janie Sailors, RN, NCSN, Health Specialist, Training and Technical Assistance Services, Western Kentucky University

Kidsource, www.kidsource.com/safety/prevent.choke.html

Massachusetts Dept. Of Early Education & Care, www.eec.state.ma.us/docs/TABrochureChoking.pdf

National Center for Injury Prevention & Control, www.cdc.gov/ncipc/duip/spotlite/choking.htm

National Fire Protection Association, www.nfpa.org/RiskWatch/parent_choking.html

U.S. Food & Drug Administration, www.fda.gov/fdac/features/2005/505_choking.html