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Children's Health

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Hot Dogs, Marshmallows, Candy Choking Kids

Pediatricians Urge Warning Labels on Foods Risky to Kids
WebMD Health News
Reviewed by Louise Chang, MD

Feb. 22, 2010 -- Every five days, a child in the United States chokes to death while eating. Even more children die after swallowing items like balloons and small toys.

Things have to change, says the American Academy of Pediatrics (AAP), perhaps starting with labels on hot dogs, marshmallows, and round or cylindrical hard candies, which pose a high choking risk to children.

In a policy statement released today, the group is also asking the FDA to establish a nationwide food related choking-incidence surveillance and reporting system “to warn the public of existing and emerging hazards.”

“This is a call to action,” pediatric emergency medicine specialist Gary A. Smith, MD, tells WebMD. “Choking is preventable; and government, industry, and consumer protection groups need to work together to protect children.”

Hot Dogs, Balloons Most Deadly

Very young children who are just beginning to eat solid foods have the highest choking risk, but older children are at risk too.

In a 2001 CDC review of choking injuries, about one-third of choking episodes occurred in infants and three-fourths occurred in children under the age of 3.

According to one analysis, each year in the U.S., between 66 and 77 children under the age of 10 die after choking on foods, and more than 10,000 children under age 15 are treated in emergency departments.

Hot dogs are the biggest culprits, Smith says, because they are cylindrical, compressible, and about the size of a young child’s airway.

Whole grapes, popcorn, peanuts, other nuts and seeds; round, hard candies; meat, marshmallows, carrots, apples, chewing gum, and chunks of peanut butter also pose a choking risk.

“Many of these foods ... share the same high-risk physical characteristics that create effective plugs for the pediatric airway,” the AAP report states. “Similar to latex balloons, peanut butter can conform to the airways and form a tenacious seal that is difficult to dislodge or extract.”

For every choking-related death, there are 100 ER visits every year, according to the CDC.

And choking is a leading cause of brain injury in young children. When food or other small objects get caught in the throat and block the airways, oxygen cannot get to the brain. Even a few minutes without oxygen can result in brain damage.

In one analysis of about 450 choking fatalities among children over two decades, the inhalation of latex balloons was responsible for 29% of deaths and 17% of deaths were caused by hot dogs.

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