Small, hard foods can be choking hazards for toddlers
The mixed nuts were tantalizingly close, and while his parents were looking the other way, the toddler acted quickly, reaching into the bowl to pop a few of the delicious, forbidden morsels into his mouth.
The little boy immediately began choking and rapidly developed respiratory distress. Mom grabbed him and instinctively performed some version of the Heimlich maneuver, promptly dislodging a cashew, and allowing her son to take a good, deep breath.
After calming him, the mother washed the toddler up and put him to bed. She noticed that her son's breathing was a bit noisy, but since he was sleeping comfortably, decided to let him rest. The 20-month-old had an uninterrupted night's sleep, but on awakening the next morning, he sounded like he was wheezing.
Mom became concerned and brought her son to the doctor's office for evaluation. After hearing about the previous night's excitement, my partner carefully examined the little boy. He noted audible wheezing, but more importantly, when listening with his stethoscope, could not hear breath sounds in the right middle and lower lung fields.
My colleague quickly concluded that his patient had aspirated, or inhaled, a foreign body - most likely one of the aforementioned nuts. He contacted the city children's hospital and arranged for the boy to be transported for emergency treatment by a pediatric otolaryngologist.
The ENT specialist did scope the child, finding a number of peanuts in the little guy's right mainstem bronchus, the most common spot for foreign bodies to lodge in the lungs. The nuts were removed, and the patient did well, though he continued to experience some residual wheezing for several weeks.
Little ones have quick hands and small airways, a potentially dangerous and even lethal combination when small, hard foods are left within reach.
Sometimes exposure is accidental. Other times, parents actually offer their kids such items, not realizing that small children often eat quickly, stuffing their cheeks and not bothering to do much chewing before swallowing the entire mouthful.
The American Academy of Pediatrics recommends that caretakers not serve children younger than 4 years old any foods that are round and firm. The AAP considers the following foods potential choking hazards: hot dogs, nuts and seeds, chunks of meat or cheese, whole grapes, hard or sticky candy, popcorn, chunks of peanut butter, raw vegetables, raisins and chewing gum.
Avoiding these foods, chopping foods into manageable pieces, requiring children to sit (not run or climb!) while eating, supervising all meals and instructing older siblings of the dangers of sharing inappropriate snacks are all practices that can help decrease a child's risk of choking on and aspirating food bits.
The AAP also advises that parents and other caretakers invest some time into formal first aid and CPR education. Classroom training can give adults the knowledge and presence of mind that can help save a child during a choking emergency.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.