One of the biggest fears us Mom's have when raising our babies and toddlers, is choking. Children love putting everything they shouldn't in their mouth, and we've heard many horror stories about chocking which make us live in fear. Some of us have even had terrifying and traumatic choking experiences.
So, we decided to speak to a certified emergency medical expert, Hayley Rosenthal. She is well-known in the South African paramedic, emergency and CPR training field - and we thought she could answer a few questions that many of our Moms have about choking.
Hayley, what is gagging, and what should you look out for? Is gagging good?
The normal Gagging Reflex is an adaptive, vital mechanism for survival, it is the bodies automatic response that helps prevent us from choking. The Gag-reflex is triggered by any object touching hypersensitive areas in the mouth. I.e: the back of your tongue, soft Palette, area around the tonsils or the roof of your mouth. The gagging movement actually alters the shape of the Pharynx and its associated structures causing any foreign body to be ejected thereby preventing the foreign object from progressing further down the airway.
Babies from newborn up until approximately 4-6 months have what is known as the tongue-thrust reflex (Extrusion reflex). When a babies tongue is touched or depressed in any way by a solid or semisolid object the babies tongue will thrust out of their mouth to prevent anything but a nipple from a breast or bottle from coming through.
As babies are introduced to solids this tongue- thrust reflex causes them to often push these new foods towards the front of the mouth so it can be “chewed” a little and is often seen as them “spitting” out the food. As the baby is introduced to more foods and more variety of foods he/she figures out how much he/she can swallow.
What exactly is choking, and what should you look out for?
Very basically put, we have two pipes – an air pipe (Trachea) and a food pipe (oesophagus). We only want air to go down the ‘air pipe’ and food to go down the ‘food pipe’.
When a foreign body (food, toy etc) blocks the air-pipe we have an occlusion of the airway and this is classified as choking. This occlusion prevents the child or baby from breathing effectively and may present in a mild or severe form. In a mild choking the person can cough or make a sound and coughing should be encouraged to help dislodge the object.
However, if the person cannot cough, cry or makes a sound (usually a strangle whistle sound indicating a blockage of the “air pipe”), this is a severe choking and it is important to take the appropriate steps to clear the occlusion as soon as possible.
The child / baby may also rapidly change colour around his/her mouth and lips – appearing cyanosed (blue in colour) – this is an indication that their airway is occluded.
When should a baby start solids, and any tips that parents should look out for to ensure that baby doesn’t choke?
Regarding starting solids, I would speak to your paediatrician as to when your baby is ready, but it's normally around six months, depending on the baby. The most popular things that I have found children – including my own - to have choked on are as follows:
Grapes – please make sure you peel the grapes and cut them longitudinally before giving to babies.
Energade type bottle lids – Children often take the clear lids off these bottles with their teeth to get to the push tops, then proceed to either play with the lid in their mouths or flick it back into the airway by accident
Boiled sweets – often those given out by restaurants with the bill are given to children in the car while parents are driving and not watching the children
Lego Figurine Heads
Steak
Watch Batteries
Coins
Magnets
My rule is – anything that can fit inside the inside of a toilet roll can be a choking hazard.
If you haven’t done a CPR course, and someone around you is choking - what do you do first?
Firstly, ask the person if they can cough – if they can, encourage them to put their hands up in the air and cough forcefully. I taught all three of mine from when they were little to put their arms up and cough should they feel like they were choking and they have managed to clear most of their mild episodes without any further intervention.
Importantly though, please don’t smack on the back when someone is in the upright position – this can cause the object to lodge further down the airway.
Should this not clear the object another person should assist the victim by performing force full upward thrusts into the belly – above the belly button but well below the breast bone. The victim should then be leant forward for backslaps. Alternating abdominal thrusts (5) and back slaps (5) until the object is dislodged or the person becomes unconscious.
Should the person become unconscious start CPR starting with chest compressions (if you are unsure of how to do CPR then you can see more details at the end of this article). After 30 compressions open the airway and have a look inside to see if you can see the object, if the object is visible and is towards the front of the mouth perform a finger sweep to try clear the object, please don’t blindly finger sweep in anyones’ mouth.
Then attempt two breaths – normal breath over one second before resuming with chest compressions.
With a baby you would start immediately with 5 back slaps between the shoulder blades, ensuring babies head is lower than the rest of the body so gravity can assist in getting the object out. Please be aware that babies are head heavy and this procedure should be done close to the floor to avoid dropping the baby on his/her head.
After performing 5 backslaps turn the baby over and give 5 chest compressions in the same position that you would perform CPR. Alternate between backslaps and chest pushes until the object comes out or the baby becomes unconscious. Should the baby become unconscious please start CPR immediately starting with chest compressions.
Why is it so important for parents to do a CPR course, when should they do it, and how often should they do one?
Every parent, nanny, grandparent, or anyone involved in care of children and babies should do a CPR course. The reality is – 4-6 minutes of no oxygen rich blood going to the brain results in irreparable brain damage. By the time you have activated emergency services and they get to the scene this clock will have already started ticking, therefore decreasing the chance of a favourable outcome with no brain damage.
I strongly believe that an accredited CPR & CHOKING course should be done on a yearly basis – if you don’t use the skill you tend to forget how to do it effectively. Nobody knows how they are going to react in an emergency and if you have repeatedly learnt a skill there is more chance of you carrying out the skill due to muscle memory.
Hayley has provided two complimentary documents which you can download here, as part of 1ST CPR. However, in order to understand this properly and be able to give CPR to a victim you need to be trained in CPR and First Aid. To find out more about this CPR & First Aid course, and make an urgent booking if you are not trained, see below.
We hope to hear more from Hayley soon, to address more questions our Moms have in our forum discussions.
Hayley Rosenthal's company, 1st CPR, was first established in 2010 - offering BASIC LIFE SUPPORT, FIRST AID & CPR training courses. The Company was born out of Hayley’s passion for education, The emergency Medical field and the desire to impart valuable life skills to lay rescuers, enabling them to implement life-saving skills when faced with emergencies in their own homes, schools, offices and work places.
1st CPR is a registered Training centre with the RESUSCITATION COUNCIL OF SOUTHERN AFRICA(RCSA), and offers a variety of courses including RCSA, AMERICAN HEART ASSOCIATION, Department of Labour (DoL) accredited and HW SETA accredited courses. Hayley has "hand picked" a passionate team of instructors who are registered with the Resuscitation Council of Southern Africa and the American Heart Association.
Book your family focused First Aid & CPR Course (located in Gauteng) with Hayley and her team through BubHub - broadacres@thebubhub.co.za.
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