Prevention of Choking Among Children

A 4-year old girl was brought by her parents because of concern about her breathing. Two days ago, she was drinking out of a Styrofoam cup, while chewing at the rim, when all of a sudden she came to her dad saying she “swallowed” something. She did not cough, but seemed intermittently as if to be gasping for air. Her voice was not hoarse. She was able to swallow without difficulty. She was brought to the Emergency Department, where she was treated with inhaled bronchodilators and steroids and was discharged, but came back with similar symptoms. Physical examination revealed a quiet girl, not in distress while at rest, but sounding stridorous on deep inhalation. She had slight suprasternal retraction, but her breaths were not labored. Her oxygen saturations were 96% on room air. Auscultation revealed a coarse breath sound on inspiration, heard throughout both lung fields. Air entry was equal bilaterally. Chest X-Ray in both inspiratory and expiratory phases was unremarkable. Bronchoscopy revealed two fragments from the Styrofoam cup lodged in the upper trachea. Those were retrieved and she recovered uneventfully.

Foreign body aspiration is commonly encountered in pediatric emergency medicine. Styrofoam, however, represents a particular concern. Because of its light weight, inhalation into the air passages may be more likely to occur. Given the widespread use of such cups, aspiration is probably a more frequent occurrence than recognised, with many cases going undetected. The initial incident might be forgotten, only to present later with recurrent breathing troubles for which no obvious cause is found. Once every decade or two, a letter appears in the pediatric literature reporting a similar event (1,2). This report once again aims to draw attention to this preventable respiratory risk, highlighting the hazard posed to infants and small children by Styrofoam cups. Similar to small toys and other objects, it is suggested that Styrofoam cups carry a warning “choking hazard –keep out of reach of small children”

References: 1-Sessa E: Styrofoam aspiration (Letter) Pediatrics 1980;65:1055. 2-Reiman R: Danger of Styrofoam cups (Letter)Pediatrics 1975;55:746.

Dr Ayman Habiba, FAAP Pediatrician, Cape Breton Regional Hospital Sydney, NS Canada B1P 1P3 902 563 4059

Conflict of Interest:

None declared

Dear Dr. Halaburka, thank you on behalf of COIVPP for your eLetter. The Academy agrees that an important role for pediatricians is providing anticipatory guidance regarding injury prevention to their patients and patients' families. COIVPP and the Academy provide guidance to pediatricians regarding this role through the TIPP and Connected Kids materials. You are correct in pointing out that children should be seated while eating, and should not eat while walking or playing. Education of caregivers and children about this and other risky behaviors is clearly one component of a comprehensive approach to prevention of choking among children.

Sincerely, Gary Smith, MD, DrPH, FAAP Immediate Past Chairperson, Committee on Injury, Violence, and Poison Prevention and lead author of the policy statement

Conflict of Interest:

None declared

Normally I am not one to put pen to paper or rather fingers to keyboard but I am amazed and disapointed that no one ever talks about our role giving parents anticipatory guidance about the biggest risk of choking that I even get to witness in my office. If we could teach parents never to let their children walk with food I believe that we could cut down significantly on choking. When these little ones trip which they do so often they inhale and anything in the mouth will be given a free ride into the airways...let's have a campaign to free our children of walking around with a mouthful of chokable food items all of which could cause choking!

Conflict of Interest:

None declared

Pam, thank you on behalf of COIVPP for your eLetter. The Academy has been engaged with this issue since the early 1980's. We have learned much over the years regarding the prevention of choking on toys by young children. We now wish to apply that knowledge to the prevention of choking on food. Thanks again for your eLetter.

Sincerely, Gary Smith, MD, DrPH, FAAP Immediate Past Chairperson, Committee on Injury, Violence and Poison Prevention and lead author of policy statement

Conflict of Interest:

None declared