New study finds increase in nonfatal food-related choking among children in the US

(Press-News.org) Choking is a leading cause of injury among children, especially for children 4 years of age and younger. A new study by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital and colleagues at the Centers for Disease Control and Prevention examined nonfatal food-related choking among children 14 years of age or younger from 2001through 2009. During the nine-year study period, more than 12,000 children were treated each year in U.S. emergency departments for injuries from choking on food, which equals 34 children each day.

According to the study, published in the July online issue of Pediatrics, hard candy caused the most choking episodes (15 percent), followed by other candy (13 percent), meat, other than hot dogs (12 percent), and bones (12 percent). These four food types alone accounted for more than half of all the choking episodes in the study. "Other high-risk foods, such as hot dogs, seeds and nuts, were more likely to require hospitalizations," said Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy. "These foods have high-risk characteristics that make them more likely to block a child's airway or make them more difficult to chew, which can lead to more serious choking events."

More than 60 percent of the choking episodes occurred among children 4 years of age and younger. In line with physical and neurological development, the number of choking episodes decreased with increasing age until 7 years of age, after which the number of episodes remained relatively unchanged through age 14. However, the number of choking episodes involving candy increased with increasing age, and by age 4 years, more than half of choking episodes involved candy.

"Although the Consumer Product Safety Commission has well-established surveillance systems in place, as well as legislation and regulations to protect children from nonfood-related choking, no similar monitoring systems, legislation, or regulations currently exist to address food-related choking among children," added Dr. Smith, also professor of Pediatrics in The Ohio State University College of Medicine. "Implementing improved monitoring of food-related choking incidents, placing warning labels on foods that pose a high choking risk, changing the design of foods consumed by children to reduce the risk of choking, and developing public awareness campaigns to educate parents about the danger of food-related choking among children could all help reduce the number of choking episodes in the United States."

### Child caregivers should be aware of food choking prevention recommendations and guidelines. Children younger than 5 years of age should not be given hard candies or gum, and raw fruits and vegetables should be cut into small pieces. Young children should be supervised while eating and should eat sitting down. More choking prevention tips are available at http://www.nationwidechildrens.org/cirp-choking-prevention.

This is the first study to use a nationally representative sample to examine nonfatal food-related choking among children treated in U.S. emergency departments over a multi-year period. Data for this study were obtained from the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP), which is operated by the U.S. Consumer Product Safety Commission. The NEISS-AIP provides information on consumer product-related and sports- and recreation-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children's Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials, or to learn more about CIRP, visit http://www.injurycenter.org.