How to avoid choking hazards with children? With Dr Ali Strocker, pediatric ENT

Welcome to Episode 61 of Ask Dr Jessica! This week, our guest is pediatric ENT Dr Ali Strocker and we discuss choking hazards.  We talk about the most common foods that lead to choking, and what parents need to know to help keep their children safe.  We also hear Dr Strocker's take on baby led weaning, on practice this method in a safe way.  Thank you to Dr Strocker for coming back on the podcast!  (she also did a previous episode on Swimmer's ear!)

Dr Stroker is an ENT, specializing in children of all ages with ear, nose and throat problems. Dr Strocker received her medical doctorate with high honors from the UCLA School of Medicine in 2001 and was inducted into the Alpha Omega Alpha honor society .  She completed a residency in Otolaryngology-Head and Neck Surgery at UCLA.  Dr. Strocker was an assistant clinical professor of Otolaryngology-Head and Neck Surgery at USC-Keck School of Medicine and has been an attending surgeon at Children’s Hospital Los Angeles. 

She is currently works in private practice in Tarzana, California.  For more information or to schedule a visit with Dr Strocker, more information can be found on her website:

Link for online CPR course

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children.  Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. 

Do you have a future topic you'd like Dr Jessica Hochman to discuss?  Email your suggestion to: askdrjessicamd@gmail.com. 

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The information presented in Ask Dr Jessica is for general educational purposes only.  She does not diagnose medical conditions or formulate treatment plans for specific individuals.  If you have a concern about your child's health, be sure to call your child's health care provider.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

Follow her on Instagram: @AskDrJessica
Subscribe to her YouTube channel! Ask Dr Jessica
Subscribe to this podcast: Ask Dr Jessica
Subscribe to her mailing list: www.askdrjessicamd.com

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hello hello welcome to ask Dr. Jessica the podcast where my goal is to give you useful practical information to help you along your parenting journey. I'm your host and paediatrician Dr. Jessica Hochman. Today's episode covers a really important topic choking hazards and children. I feel lucky because here with me today is the fantastic Dr. Ali Stroker. Dr. Striker is an ear, nose and throat doctor and she sees firsthand what commonly causes choking episodes in children. In this episode, she gives really useful advice to parents on what we can do to prevent choking altogether. Thank you for listening. Welcome back ally striker to the podcast. How are you? I'm good. Thank you. It's good to be back. So for those of you who are listening, Alli did an episode not that long ago all about protecting our ears over the summer. So if you haven't checked it out, I highly recommend you go back and take a listen. Today, I'm really excited because we're gonna have a conversation about what a lot of parents fear, and that is choking children and choking. And we're going to talk about what choking hazards are and how to prevent them. And I think this will be a really helpful episode. So So first, Dr. Stryker Tell me Tell me, do you have a lot of experience around choking? Yeah, so actually, I reached out to you because I thought this was actually a really important thing. And I had two patients in the last two months who had a choking incident. And it's not the typical Trumpian zone we'll be we'll touch on those two, but where the child couldn't breathe, these are kids who are eating otherwise you find a little gagging and choking, and then we're fine, and then subsequently ended up having wheezing and coughing. And what happens is they actually aspirate it. So there's choking were blocked airway. And there's things where they actually get sucked in, and they breathe into the lungs. And so they're actually sitting in the bronchi the tubes that go into the lungs. So yes, as a paediatric anti, we see this. Unfortunately, we see this pretty frequently. So first, starting with the blocking of the airway. Can you tell us what are the typical foods that might cause blocking of the airway so that parents are aware? Yeah, so these are the things that we probably have heard about were hot dogs, right? You know, when you don't want to cut hot dogs into those perfect little rounds, because that's the perfect size to completely block the top of the trachea, that big air pipe. Same thing with grapes, a whole grape, it a little kid who says a two years, three years old, will sit perfectly there and block and they won't be able to breathe. This is when your child is going to actually like totally their throat, they're choking, they can't breathe, they can't talk, you're gonna have to try and get that evacuated by a Heimlich. So those are those those kinds of foods. Hotdogs, great, maybe a carrot also put in a ring. And it's a lot of this is because kids don't have the ability to control the food in the mouth like we do. So they're chewing, maybe they get distracted, they laugh, something happens. And they kind of inhale that moment and those foods will lodge and they will block the whole airway. I usually tell parents who to think about foods that can't get that aren't dissolvable by saliva. And those are always foods to keep in mind. So like a hard candy. You know, like a big chunk of a meat. As you mentioned raw vegetables, hotdogs, grapes, absolutely. Yeah, that's That's exactly it. And those foods can be given you just have to cut them so that they're not the shape of the airway. So you don't want that perfect circle that perfect ring. So when you cut your grapes, you want to cut them lengthwise, even when they're really little, maybe even two spears or half and half again. So a quarter of a grape hotdog same thing. You don't want it to be a little round this way you want to be around you want it to be into like almost like cut that into half again. So there's they're going strips, so if God forbid they choke, more likely to go down the oesophagus so it won't get blocking the whole airway. Okay, so any food that is not dissolvable that might perfectly block the airway, really imperative that we cut those foods into pieces before serving. That makes sense, right? Yeah, like spears, spears are a lot better because they're like long pieces. And then kids have a better chance of holding that breaking of what they can eat and chewing and I get a big piece. It's gonna lodge in their way. So now to mention aspiration what you brought up earlier, what kind of foods should parents be concerned with when it comes to aspiration? And do you have any advice on how to avoid this happening? Yeah, so these are the things that we see a lot in the paediatric EMT world. So these are things typically like nuts, and seeds. Now, as a paediatrician, I'm sure you advise your patients that it is important for kids to be exposed to nuts because of allergy risk. The safe way to do that is creamy, creamy, creamy nut butters almond butter, peanut butter. So when you try to have an allergy things, those are great, they're smooth, they're not going to choke on them. But it's the solid pieces of that so I wouldn't even on a little kid give them a chunky peanut butter because there's no pizza that's in there. I've had a patient eat a Snickers bar again, small piece of nut in there. And even though this camera and everything else that not somehow it will find its way down the airway. So we recommend not having solid nuts to believe it or not five years old. And the reason is at that age, they're better able to control their chewing, their swallowing is less likely to get trapped. In slipped down to the airframe. What happens with knots in particular, and same with seeds, there's that that oily coating on the outside, that's what makes how we get all the different oils that we use. Those oils make the net the perfect thing to slip into the air. So the child's eating, maybe chokes, maybe inhales laughs. And then instead of going down to the oesophagus, that little bit of nut goes lips down into the, into the airway into the trachea, down the bronchus, and that will block the lungs. So I think this is so important to bring this up, because you're right, we are getting sort of two almost contradictory pieces of medical advice, because we're telling a lot of parents to make sure they introduce, you know, peanut products from a very early age. Now it's recommended between four and six months of age. But you're right, I think it's so important that we distinguish what kind of peanut butter or peanut product we're offering. Definitely. And I started my daughter got early age with, you know, some peanut butter mix into her oatmeal or mixed into her yoghurt, I think a great it's great for analogy standpoint, but it was very, very careful. And I have been very careful with her not to have solid bits of nuts because of this risk. Right. So giving the peanut product as a form of preventing peanut allergies, but not giving whole peanuts, so don't get aspiration. Okay, great. Yeah. Now, are there any other foods that parents should avoid until five years old? Or is it just peanuts and nut products, popcorn popcorn is another one. Popcorn begins same thing those kernels have that slippery oil, they can slip down. When a child's maybe when it's three or four, if you're careful, like it's my daughter now is almost four, she likes some popcorn, I make sure the pieces I give her are totally popped that there are no solid kernels in there. And I also make sure that my daughter is sitting still and eating no kids, unfortunately. And she does. A lot of other things will move around when they're eating. And I tell her when there's things that I have to have her be careful to eat, have them sit down. It's a very conscious conscientious eating where they're sitting. And you're they're focusing on chewing and not getting distracted. But it's funny after these experiences, I've told her Sorry, no nuts until you're fine, because I don't want her to have to go through this. Absolutely. No, I think that's a great point to reiterate that kids, it's really important that they sit when they eat that they're not you know, running and eating or walking and eating, if possible. So do you do you know, as an EMT, what do you do when you notice that there's a peanut in the lungs? Can you can you fix it? How do you fix it? Yeah, so I mean, typically this the other differences, like we talked about the big pieces of foods that are hard to dissolve, those kids will present very quickly, right? They mean your co Trier choking, hopefully you or somebody else knows how to do the Heimlich and other ways of evacuating it. This is, you know, there are a lot of courses that parents can take to learn these things. And those have to be you know, evacuated quickly. The child who chokes on a peanut or aspirates a peanut, it goes out into their airway. It's it looks very, very different. So they'll cough and both the patients I saw parents were not that alarmed at the choking, they were eating there. They coughed one child had some almonds over yoghurt, the other child had was eating chicken, but I'm sure there was pretty cashew chicken because that's what was done in his airway. They'd coughed mom seemed to have helped them clear it, he cleared it they they thought, okay, everything's fine. And then these kinds of kids tend to present a little bit later. So all of a sudden, a child who doesn't have asthma is now wheezing or coughing and coughing during the day coughing at night. They can look fine. I mean, both kids were kind of talking to me in the in the office. But you kind of hear a little something they're breathing. And typically in my office, I when I listen to them, I can I sort of start the picture starts to come together, right? They had this little choking event, got wheezing, they're not responding to the usual nebulizers and stuff that are given to help kids who are wheezing. When you listen, when I listen very carefully, one side usually is a little bit softer. I don't hear the breath sounds moving as well. And that's what I usually have my suspicions and I have to have the conversation with the parents that in order to treat this, I have to put the child under anaesthesia. And we have long metal tubes that when the child's sleeping, going through the mouth, let me go down into the trachea. And we're using a lot of visualisation different cameras and whatnot and grabbers. I believe a special kind of grabbers take the pieces of the nut out of the bronchus. And it's it's pretty remarkable because right away the the air starts flowing again into that into that lung space. It's amazing. You really save the day. Yeah. Do you have any advice so a lot of kids they they choke really easily when they're first learning how to eat they gag and I always tell parents this has actually really helped For reflex because we want them to protect their airway, so it's good that they have an overly sensitive gag reflex. But I can't tell if that's really helping parents, they still get nervous when their kids are eating. So do you have any general advice for parents on how to advance solid foods, how to go from purees. And then to move on to more solid forms of foods? I agree with you, I think babies and young children have a very sensitive gag reflex. And I agree, it's their body's way of sort of protecting them from choking. So as long as you're giving children soup foods that you know are safe for them, right. So you're not going to give those raw veggies to a little one with the sound of teeth. You sort of against very conscientious eating. So they're sitting in a highchair sitting properly, you're watching this is not a time to be doing 15 other things. And you present the foods and if they if they gag, you actually give them a moment to gag and bring the food out. I've unfortunately seen seen other instances where I've had to go to the operating room, where parent or grandparent in all good intentions, tries to help the child who's gagging and ends up pushing the food down. And now the food get actually gets stuck most of time that strong gag reflex, the baby will kind of push it out with their tongue or even vomited out and clears it out. So unless the child gets into distress, where they obviously they can't breathe, and that's when you can step in with the Heimlich otherwise, take a breath watch them if they're if they're gagging, but still breathing and and able to vocalise they're probably okay, let them do it on their own, they probably will clear it. And again, that's the reason to make sure that we're only giving safe foods. If a child's gagging, and happened to have a piece of nut in there, that little nut will find its way down into their way, unfortunately. So that's why it's very important to make sure you keep those foods away from them. So can we talk about baby led weaning, I'm curious what your thoughts are as a paediatric EMT. There's this movement to feed kids, young kids, whole vegetables and other solid foods. What are your What are your thoughts? It's a very funny question. So prior to having my own daughter, I was against the idea of baby led weaning, my partner scared me he's like, Oh, I read this, you know, stories, baby led weaning, and he was a boxer, he was a expert witness and child choked in a banana and all this stuff. So I was petrified of it until I had my own daughter who refuse to eat purees. And I would go through all the effort of mashing food and mixing food and oatmeal and child would have like two bites, and she was just done, and then wanted everything from my plate. So I did some very quick learning on baby led weaning. And I actually that's how she ate and she never, I've been probably I've had her first few purees was done. And by seven, eight months was just doing baby led weaning. So I think it is, I think it is actually valuable. Actually think it's probably how most of the rest of the world feeds their babies where baby food in jars is not so readily accessible. I'm sure they do mash foods as well. But it is important to give safe food. So actually, the weird thing with baby led weaning is you don't have these microscopic little pieces, you actually let them kind of go swimming through a banana or something soft, you actually let them break off as much as they can. And it's very surprising, but they for the most part, they know what to take. So again, but it's when we were doing this, and she was a little very, very conscientious, no distractions, I was sitting there right with her. And we were very careful giving food but she you know what, she just wanted me what I was eating. So a little piece of cooked cooked chicken that she could kind of hold her hand and manipulate or teeth or little teeth in her mouth. And she managed and there was some gagging, and she would bring up some food. And again, we'd watch her let her do it. Spit it out. But for the most part, she learned very, very quickly. I have to say that's not the answer that I was expecting you to say because i i Always assume like the specialists that you know, see the worst things that experienced choking would be the most over protective. But I'm actually pleasantly surprised that you said the opposite. I started like it had to be pureed and then my child taught me she's she's kind of that child anyhow so that she had her own ways of doing things and and so I just was very careful and just make sure you know a lot of it was for example cooks cooked asparagus, it was one of our favourite first foods and she would take that spear and she would cook kind of on it and get the flavours and she didn't want me to mash the avocados. She actually wanted a piece of avocado but that was I figured that's a soft food and she can manipulate it and can watch it right it just did definitely took a lot of close observation and really can't just have somebody kind of haphazardly feeding the child so and then you do this while staying away from those choking hazards that we talked about before. Yes, that is that is the most important thing so even like giving a piece of chicken it's not a big as big a piece of chicken that they can pick up but not so big that it would block their airway. I get nervous when I talk about raw vegetables when it comes to baby led weaning. That's the part that I take issue with is that I makes me uncomfortable to see a baby Maybe knocking on a on a rock carrot. But yeah. Yeah, once they have sort of enough teeth that they can actually knock on it, right? I mean, before that it probably won't matter anyhow. But again, kind of watching them and you can't look away. So they're nine. And you see, usually they break off really, really small pieces, very tiny pieces. And in the beginning, honestly, most of its cooked. So it was a lot more cooked vegetables and cook things that were soft. But yeah, as they as they start to get some tea that does take a little bit of, you know, breath holding and being calm and heavy, it was a lot easier actually than having to deal with the purees. Because it was literally wherever we went, I just found foods that were soft and hard for her to eat, and she would do it. I honestly don't blame kids that don't like purees. I mean, I know myself that I don't find them very interesting. So I can see why they'd want to move quickly to real food. Right. And I think they you know that very quickly, Once babies get to that point, they see us eating and they want it. I mean, in my daughter's defence when this all started, we were travelling in Europe, and I was eating amazing pastas. And I don't think she wanted the baby food she wanted. She wanted what I was eating, right had her first taste of Italian truffle pasta, it's seven months, that makes a lot of sense to me, like, you know, puree compared to a delicious pasta meal makes sense. Why have that preference. And I'm just thinking like, what what I find so interesting about this conversation is that it gives parents more to think about if like that we can't assume that a cough is from asthma or a cold, or from allergies, that it's also important to keep in mind that it's possible that choking may be the culprit. You know, obviously you don't want every child who has here's a child caught every parent, they think, Oh, my child's coughing, it's got to be, you know, they aspirated and stuff there, they have wheezing. Now, you know, children do have asthma, those things. So, you know, if your child has typically wheezing after a cold, it's probably what it is, it's probably asthma. However, if your child never has had wheezing after a cold, and then now is on has wheezing, and and start to processing? Oh, well, you know, we did kind of there was those nuts that were out and I don't think he had any or she had any, but maybe they did. That's when you want to sort of put those two together, you know that there's there might be something going on there for the challenges doesn't really respond to both of my patients. And the patients I've seen just don't typically respond to the typical asthma medication. So they maybe cough gets a little bit better, the wheezing is a little bit better. But it's it's not going away. It is something that we always have to kind of keep in the back of our heads is that whenever it doesn't add up the way it normally should. You must have some great stories. Oh, yeah. Yes. Yeah, a lot of trying times in the operating room is definitely the one of the more stressful things that we do. It's very gratifying once we clear the knot. But it's definitely one of those more stressful moments in the operating room for us. Do you have any recommendations where parents can take a Heimlich course? Or a CPR course? Yeah, so I who my daughter was actually she was I still pray to my daughter, I did a course called I think it says save a little life or something was the name of the course. And obviously, I'm familiar with CPR and those sort of things being in medicine. But obviously my husband wasn't and my rest of my family wasn't it was important. It was actually important to me not only to have your both mom and dad there, but also grandparents, who would be potentially watching the children as well. So that was one particular course they were great. They came, they couldn't get a group together and they come out to your house and they bring the dolls and they teach you everything about resuscitation. And it was also good because they taught you things. For example, like about burn injuries, things that maybe I didn't even realise about, you know, your, your child touches something that's hot how you deal with that. And if you can't find that course, which Oh, they are local, there's certainly some others if you just I'm sure if they Google, you know, CPR courses for parents, then sure. I've still got a few choices there. Yes, I'll make sure to put a link to an online CPR class below in the description. So any other words of wisdom or any other take home points for parents? I think you've got some great I think there's been some great information given for parents to think about that are listening. Yeah, I mean, I think just a lot eating is something serious it's not something that we just take lightly so I mean, I'm I'm guilty of it. My daughter doesn't like to sit still during dinner time. But really trying to work to you know, being at the table sitting being you know, conscientious with our with our eating, making sure we avoid those things that are not safe for kids to eat when they're little so those big hardstyle pieces of food. So they have a really good mounting bunch of teeth in their mouth able to control it. And those nuts wait till you know five years old, the solid pieces and that's because you know it's heartbreaking when I have to sell apparently that's what we have to do and thankfully I The other end, I got to say, We did it, your child's great, they're gonna go home and a little bit. But it's it's not an easy conversation. So I'm much, much much, much happier if paid to avoid this kind of thing in the future. The other thing we sort of mentioned his kids also aspirin and toys every once in a while I've had that happen, I had, did have a patient who had aspirated piece of Lego. So those things can happen as well. So if you have older children in the house, and you have a little one, it's one of those things right where you have the toys that they have to play in a separate area away from the little one, because little kids will see these things and they don't know and they'll, they'll eat them and tell them to do their aspirate them or get stuck in their oesophagus, the other place where we have to go take things out. So another big one to mention, just so parents are aware are latex balloons. A lot of kids will put balloons in their mouth, and then they get pieces of latex in their mouth. And they and it's a it's an important choking hazard. That's a that's a particularly bad wine because those are very hard to clear. And the child actually, unfortunately can die from not being you know, from exfoliation not being able to breathe. When other ones you touch on is coins, those don't get those will get stuck. Typically they will pass the trachea, they will not go down. But they get stuck in the oesophagus. So that you have a child who has a hard time eating and all sudden like there's some points, they're shiny, right these little usually again, a little kids put them in their mouths. And then also they're not eating very well. Or maybe they're drooling, and they'll same sort of thing they usually present to the emergency room, we'll get an x ray and there'll be a pointer sitting right here in the lowest part of the neck. And they also need a trip to the afternoon for us to go in and take those out of the oesophagus. So I know my daughter was little I told my husband, you cannot leave your change on the counter or table that has to go and put into her a jar for your child if you have a little piggy bank or whatever. Or it's just you know, the car in a secure spot where kids are not going to get it. Because that's another thing. I'm so glad that you mentioned coins because that happens all the time. And I always tell parents that as long as they're acting normally, you know feeding normally talking normally that we just assume it's past. But it's those instances that you mentioned, if they're not feeding Well, or they seem bothered that we refer to the emergency department or an auntie definitely yeah, but the you know, the kids usually at work get stuck are usually under three. It's rare. The kids has over three and it stuck. It's usually like a big coin like a quarter or silver dollar, which does happen occasionally. But yeah, it's the little ones even a penny in a little child a penny can get stuck there. And yeah, they won't eat very well. They're drooling. They just seem a little uncomfortable. But you're right. The older kid, four or five years old, who put some money in their mouth. That usually will pass into the stomach and you wait a couple of days and it comes out the other end. I know I always tell people if I added up all the coins that I've heard over the years that people have swallowed, I'd probably have enough to pay for a nice date night. Yeah, when I was back at Children's Yeah, we used to have like a collection of how much money we would take out sometimes there'd be two pennies down there. Sometimes it would be a nickel always looks bigger than it really is. But oh, yeah, there. It's it's very, very routine that we see a lot over there. But it's something that's pretty easy for parents to prevent again, yes, we got little ones in the house. Get it Get a little piggy bank, you'll be surprised how much money ends up in there after a while and you're keeping your little one safe from potentially putting in putting a coin into their mouth and having a get stuck in the oesophagus. That's why I so appreciate this conversation because I think choking is something that parents worry a lot about, but it is 100% preventable. So I think it's really great to talk about all of these precautions because I think it can make a big difference. Definitely. Thank you so much for coming on. I really appreciate your words of wisdom. It's my pleasure to be back and I just really thought it was important to share this with your audience. Absolutely. Absolutely. A big thank you to Dr. Stryker for joining this week's podcast. If you know anyone who would benefit from this conversation, please pass it along. As the saying goes an ounce of prevention is worth a pound of cure. Also, if you could take the time to rate review and subscribe to ask Dr. Jessica I would be so appreciative as your support is what helps this podcast grow. Thank you and see you next Monday.