“I really didn’t
suspect until in the beginning Rachel started complaining of her
throat hurting,” Lisa Alphin explains, “and I thought
it was maybe just the beginnings of a sore throat.”

But soon afterwards her daughters pain moved from her throat
to her chest. That’s when she assumed Rachel must have swallowed
something.

“That’s excellent, because normally you wouldn’t
expect her sore throat to go down to her chest,” say Dr.
Cedric Miller.

“The first thing that we always consider when we have that
story though,” explains Dr. Miller, “is not necessarily
what the foreign body is, but where the foreign body is.” To
find out, they take x-rays.

“And it’s stuck in an area right near where the two
tracheal bronchi branch off,” the doctor points to the x-ray, “So,
the coin got stuck in that narrow area.”

It’s a coin, and it’s stuck in her esophagus, where
it can easily be removed. “So we’re gonna have her
seen by one of the endoscopists, who will actually go down with
a little camera and take that out,” Dr. Miller explains to
Lisa.

The procedure is routine, but Rachel will be put under anesthesia,
and her parents are still very worried.

Within an hour, Rachel is out of surgery. The culprit- a penny.

The doctor says this happens often, even with the most vigilant
parents, “It’s not a reflection on the ability of the
parent, or the attentiveness of the parent. It’s simply a
reflection on the fact that two-year-olds can get into trouble
in the one second that you’re not around them.”

More than 2,800 people die each year from choking, and many of
them are children. According to one study, nearly two-thirds of the children
who choked to death during a 20-year period were 3 years old or younger.
Another study found that nearly 70 percent of choking deaths among children
ages 3 and under were caused by toys and other products made for children,
and yet another found that nearly 70 percent of choking cases presented in
the emergency department were caused by foods such as hotdogs, nuts, or vegetable
and fruit pieces. The one constant found through all the research and studies
is that if a child can put something in his/her mouth, he/she can choke on
it.

According to the American Academy of Pediatrics (AAP), the following
items are common choking hazards:

• Hot dogs and sausages
• Chunks of meat
• Grapes
• Hard candy
• Popcorn
• Peanuts and other nuts
• Raw carrots
• Fruit seeds
• Apple chunks
• Coins
• Toys with small parts
• Small balls and marbles
• Balloons
• Arts and crafts materials
• Ballpoint pen caps
• Watch batteries
• Jewelry

The AAP says children are likely to choke on small, round, pliable
objects that conform to the shape of the airway.

Putting things in their mouths is one of the
ways that babies and small children explore the world. Anything that fits
can be a danger. Food, toys and other small objects that can easily lodge
in a child’s small airway usually cause choking. Experts at the American
Medical Association encourage parents to pay special attention to the following
to prevent your child from choking:

Food

• Don’t give a child under age four any hard, smooth foods that
  can partially or completely block the windpipe. These include nuts
  of any type, sunflower seeds, watermelons with seeds, cherries
  with pits, raw carrots, raw peas, raw celery, popcorn and hard
  candy.
• Some soft foods can also cause choking because they are the
  right shapes for blocking a child’s windpipe. These foods, including
  hot dogs, sausages, grapes and caramels, can be served if they
  are chopped into small pieces. Spoonfuls of peanut butter and chewing
  gum should also be regarded as potential choking hazards.
• When babies begin eating solids, beware of foods like raw apples
  and pears, which may be difficult to chew without teeth (or with
  just a few teeth).
• Encourage children to sit when eating and to chew thoroughly.
  Teach them to chew and swallow their food before talking or laughing.
• Never let children run, play sports or ride in the car with
  gum, candy or lollipops in their mouths.
• Be especially vigilant during adult parties, when nuts and other
  foods might be easily accessible to small hands. Clean up early
  and carefully, and check the floor for dropped foods that can cause
  choking.

Toys

• Always follow all manufacturers’ age recommendations when buying
  toys. Some toys have small parts that can cause choking, so heed
  all warnings on a toy’s packaging.
• Never buy vending-machine toys for small children; these toys
  do not have to meet safety regulations and often contain small
  parts.
• Check toys frequently for loose or broken parts – for
  example, a stuffed animal’s loose eye or a broken plastic hinge.
• Warn older children not to leave loose game parts or toys with
  small pieces in easy reach of younger siblings.

Balloons and other small objects

• Never give balloons to a child younger than age eight. A child
  who is blowing up or chewing on a balloon can choke by inhaling
  it. Inflated balloons pose a risk because they can pop without
  warning and be inhaled.
• Safely dispose of button-cell batteries.
• Encourage children not to put pencils, crayons or erasers in
  their mouths when coloring or drawing.
• Don’t reward small children with coins.

To reduce the chances of choking, experts at the Centers for Disease
Control and Prevention offer the following tips for parents and caregivers
of infants and small children under age 4:

• At mealtime, insist that your children eat at the table or at
  least sitting down. Watch young children while they eat. Encourage
  them to eat slowly and chew their food well.
• Cut up foods that are firm and round and can get stuck in your
  child’s airway, such as hotdogs (always cut them lengthwise
  and then into small pieces), grapes (cut them into quarters) and
  raw vegetables (cut them into small strips or pieces that are not
  round).
• During playtime, follow the age recommendations on toy packages.
  Any toy that is small enough to fit through a one-and-a-quarter
  inch circle or is smaller than two-and-a-quarter inches long is
  unsafe for children under 4 years old.
• Don’t allow young children to play with toys designed
  for older children. Teach older children to put their toys away
  as soon as they finish playing with them so younger siblings can’t
  reach them.
• Frequently check under furniture and between cushions for dangerous
  items young children could find, including coins, marbles, watch
  batteries, pen or marker caps, cars with small rubber wheels that
  come off, small balls or foam that can be compressed to a size
  small enough to fit into a child’s mouth, etc.
• Never let your child play with or chew on uninflated or broken
  latex balloons. Many young children have died from swallowing or
  inhaling them.
• Don’t let your small child play on beanbag chairs made
  with small foam pellets. If the bag opens or rips, the child could
  inhale these tiny pieces.

If you’re a parent, grandparent or other caregiver, learn
how to help a choking child and how to perform CPR in case of an
emergency. Choking prevents oxygen from getting to the lungs and
the brain, and when the brain goes without oxygen for more than four
minutes, brain damage or even death may occur. According to the AAP,
you should start first aid if …

• The child cannot breathe at all (the chest is not moving up
  and down).
• The child s airway is so blocked that there is only a weak cough
  and a loss of color.
• The child cannot cough, talk or make a normal
  voice sound.
• The child is found unconscious. (Go to CPR.)

DO NOT start first aid if …

• The child can breathe, cry, talk or make a normal voice sound.
• The child has a strong cough. (A strong cough means there is
  little or no blockage.)

Two
days ago, four-year-old Shyanne swallowed a nickel. The ER doctors
thought it would pass in a day or so, but, “she finally went
to the potty early this morning and all we’re getting is
bloody stool,” Shyanne’s mom worries.

With blood in her stool, Shyanne is put through a series of tests. “So
what we’re gonna do is a couple things,” Dr. Goo tells
Shyanne and her mom, “I’m gonna get an x-ray to see
where the nickel is…we’ll also check the stool for
blood, what we call a hemocult.”

The hemocult card measures blood in the stool. “After we’ve
put the sample on the card, we’ll turn it over and we’ll
put this developer on to see if there’s blood in the stool,” says
Dr. Goo, “in this case, there’s no evidence of blood
from the stool sample.”

There was no blood in her stool. The redness must have come from
something she ate. As for the x-ray, it shows the coin is still
there. “The coin’s in the rectum, okay,” explains
Dr. Goo, “it’s far down, it’s not causing any
problems. My plan would be, because I think she’s got some
constipation, is to give her an enema here and then hopefully we
can get her to pass the stool.”

“During that time the mother reported that she saw the
nickel in the toilet and flushed the nickel down,” says Dr.
Goo. Finally the nickel came out.

The doctor’s advice, “I think that in general kids will
put things in their mouths, and so kids and coins are probably not
a good mix.”

More than 2,800 people die each year from choking, and many of them
are children. According to one study, nearly two-thirds of the children
who choked to death during a 20-year period were 3 years old or younger.
Another study found that nearly 70 percent of choking deaths among
children ages 3 and under were caused by toys and other products made
for children, and yet another found that nearly 70 percent of choking
cases presented in the emergency department were caused by foods such
as hotdogs, nuts, or vegetable and fruit pieces. The one constant found
through all the research and studies is that if a child can put something
in his/her mouth, he/she can choke on it.

According to the American Academy of Pediatrics (AAP), the following
items are common choking hazards:

• Hot dogs and sausages
• Chunks of meat
• Grapes
• Hard candy
• Popcorn
• Peanuts and other nuts
• Raw carrots
• Fruit seeds
• Apple chunks
• Coins
• Toys with small parts
• Small balls and marbles
• Balloons
• Arts and crafts materials
• Ballpoint pen caps
• Watch batteries
• Jewelry

The AAP says children are likely to choke on small, round, pliable objects
that conform to the shape of the airway.

Putting things in their mouths is one of the ways
that babies and small children explore the world. Anything that fits
can be a danger. Food, toys and other small objects that can easily
lodge in a child’s small airway usually cause choking. Experts
at the American Medical Association encourage parents to pay special
attention to the following to prevent your child from choking:

Food
• Don’t give a child under age four any hard, smooth foods that
  can partially or completely block the windpipe. These include nuts
  of any type, sunflower seeds, watermelons with seeds, cherries with
  pits, raw carrots, raw peas, raw celery, popcorn and hard candy.
• Some soft foods can also cause choking because they are the right
  shapes for blocking a child’s windpipe. These foods, including hot
  dogs, sausages, grapes and caramels, can be served if they are chopped
  into small pieces. Spoonfuls of peanut butter and chewing gum should
  also be regarded as potential choking hazards.
• When babies begin eating solids, beware of foods like raw apples
  and pears, which may be difficult to chew without teeth (or with
  just a few teeth).
• Encourage children to sit when eating and to chew thoroughly.
  Teach them to chew and swallow their food before talking or laughing.
• Never let children run, play sports or ride in the car with gum,
  candy or lollipops in their mouths.
• Be especially vigilant during adult parties, when nuts and other
  foods might be easily accessible to small hands. Clean up early
  and carefully, and check the floor for dropped foods that can cause
  choking.

Toys
• Always follow all manufacturers’ age recommendations when buying
  toys. Some toys have small parts that can cause choking, so heed
  all warnings on a toy’s packaging.
• Never buy vending-machine toys for small children; these toys
  do not have to meet safety regulations and often contain small parts.
• Check toys frequently for loose or broken parts – for example,
  a stuffed animal’s loose eye or a broken plastic hinge.
• Warn older children not to leave loose game parts or toys with
  small pieces in easy reach of younger siblings.

Balloons and other small objects
• Never give balloons to a child younger than age eight. A child
  who is blowing up or chewing on a balloon can choke by inhaling
  it. Inflated balloons pose a risk because they can pop without warning
  and be inhaled.
• Safely dispose of button-cell batteries.
• Encourage children not to put pencils, crayons or erasers in
  their mouths when coloring or drawing.
• Don’t reward small children with coins.

To reduce the chances of choking, experts at the Centers for Disease
Control and Prevention offer the following tips for parents and caregivers
of infants and small children under age 4:

• At mealtime, insist that your children eat at the table or at
  least sitting down. Watch young children while they eat. Encourage
  them to eat slowly and chew their food well.
• Cut up foods that are firm and round and can get stuck in your
  child’s airway, such as hotdogs (always cut them lengthwise
  and then into small pieces), grapes (cut them into quarters) and
  raw vegetables (cut them into small strips or pieces that are not
  round).
• During playtime, follow the age recommendations on toy packages.
  Any toy that is small enough to fit through a one-and-a-quarter
  inch circle or is smaller than two-and-a-quarter inches long is
  unsafe for children under 4 years old.
• Don’t allow young children to play with toys designed for
  older children. Teach older children to put their toys away as soon
  as they finish playing with them so younger siblings can’t
  reach them.
• Frequently check under furniture and between cushions for dangerous
  items young children could find, including coins, marbles, watch
  batteries, pen or marker caps, cars with small rubber wheels that
  come off, small balls or foam that can be compressed to a size small
  enough to fit into a child’s mouth, etc.
• Never let your child play with or chew on uninflated or broken
  latex balloons. Many young children have died from swallowing or
  inhaling them.
• Don’t let your small child play on beanbag chairs made
  with small foam pellets. If the bag opens or rips, the child could
  inhale these tiny pieces.

If you’re a parent, grandparent or other caregiver, learn
how to help a choking child and how to perform CPR in case of an emergency.
Choking prevents oxygen from getting to the lungs and the brain, and
when the brain goes without oxygen for more than four minutes, brain
damage or even death may occur. According to the AAP, you should start
first aid if …

• The child cannot breathe at all (the chest is not moving up and
  down).
• The child s airway is so blocked that there is only a weak cough
  and a loss of color.
• The child cannot cough, talk or make a normal
  voice sound.
• The child is found unconscious. (Go to CPR.)

DO NOT start first aid if …

• The child can breathe, cry, talk or make a normal voice sound.
• The child has a strong cough. (A strong cough means there is little
  or no blockage.)

Centers for Disease Control and
Prevention
American Medical Association
American Academy of Pediatrics

“Well,
I hear you have quite a story to tell,” Dr. Nelson says to
the Culverhouse’s as she walks in the room. Two days ago
their 17-month-old daughter Mekenzie fell down. They thought she
had a broken arm, so they brought her to the ER.

“[The doctors] first x-rayed her lower arm, they couldn’t
find anything. So, they x-rayed her upper arm and her clavicle,” explains
Dr. Nelson. Nothing was broken, but they did find something else.

“Well, here we have Mekenzie’s x-ray,” shows
Dr. Nelson, “and you can see that she’s got a coin
that’s lodged right at the inlet of her esophagus. What we
don’t know is how long it’s been there, though, because
she’s been pretty asymptomatic.”

She was sent home to pass the coin, but it didn’t move.
So, her parents brought her back for an operation called esophagoscopy,
where “the surgeon went down with what was called an esophagoscope
and a light and looked under direct visualization put a long tweezer
in and pulled it out,” explains Dr. Nelson.

It was a penny. She had swallowed a penny. And after the operation, “according
to her parents, the first thing she did was reach for a potato
chip. So I think she’s probably gonna feel fine and not have
much trouble,” says Dr. Nelson.

If there’s no fever and she eats well, Mekenzie will go
home in the morning, and as Dr. Nelson says, “I guess it’s
just fortunate that she fell off the bed and hurt her arm.”

More than 2,800 people die each year from choking, and many of
them are children. According to one study, nearly two-thirds of the
children who choked to death during a 20-year period were 3 years old
or younger. Another study found that nearly 70 percent of choking deaths
among children ages 3 and under were caused by toys and other products
made for children, and yet another found that nearly 70 percent of
choking cases presented in the emergency department were caused by
foods such as hotdogs, nuts, or vegetable and fruit pieces. The one
constant found through all the research and studies is that if a child
can put something in his/her mouth, he/she can choke on it.

According to the American Academy of Pediatrics (AAP), the following
items are common choking hazards:

• Hot dogs and sausages
• Chunks of meat
• Grapes
• Hard candy
• Popcorn
• Peanuts and other nuts
• Raw carrots
• Fruit seeds
• Apple chunks
• Coins
• Toys with small parts
• Small balls and marbles
• Balloons
• Arts and crafts materials
• Ballpoint pen caps
• Watch batteries
• Jewelry

The AAP says children are likely to choke on small, round, pliable objects
that conform to the shape of the airway.

Putting things in their mouths is one of the ways that
babies and small children explore the world. Anything that fits can
be a danger. Food, toys and other small objects that can easily lodge
in a child’s small airway usually cause choking. Experts at the
American Medical Association encourage parents to pay special attention
to the following to prevent your child from choking:

Food

• Don’t give a child under age four any hard, smooth foods that
  can partially or completely block the windpipe. These include nuts
  of any type, sunflower seeds, watermelons with seeds, cherries with
  pits, raw carrots, raw peas, raw celery, popcorn and hard candy.
• Some soft foods can also cause choking because they are the right
  shapes for blocking a child’s windpipe. These foods, including hot
  dogs, sausages, grapes and caramels, can be served if they are chopped
  into small pieces. Spoonfuls of peanut butter and chewing gum should
  also be regarded as potential choking hazards.
• When babies begin eating solids, beware of foods like raw apples
  and pears, which may be difficult to chew without teeth (or with
  just a few teeth).
• Encourage children to sit when eating and to chew thoroughly.
  Teach them to chew and swallow their food before talking or laughing.
• Never let children run, play sports or ride in the car with gum,
  candy or lollipops in their mouths.
• Be especially vigilant during adult parties, when nuts and other
  foods might be easily accessible to small hands. Clean up early and
  carefully, and check the floor for dropped foods that can cause choking.

Toys

• Always follow all manufacturers’ age recommendations when buying
  toys. Some toys have small parts that can cause choking, so heed
  all warnings on a toy’s packaging.
• Never buy vending-machine toys for small children; these toys
  do not have to meet safety regulations and often contain small parts.
• Check toys frequently for loose or broken parts – for example,
  a stuffed animal’s loose eye or a broken plastic hinge.
• Warn older children not to leave loose game parts or toys with
  small pieces in easy reach of younger siblings.

Balloons and other small objects

• Never give balloons to a child younger than age eight. A child
  who is blowing up or chewing on a balloon can choke by inhaling it.
  Inflated balloons pose a risk because they can pop without warning
  and be inhaled.
• Safely dispose of button-cell batteries.
• Encourage children not to put pencils, crayons or erasers in their
  mouths when coloring or drawing.
• Don’t reward small children with coins.

To reduce the chances of choking, experts at the Centers for Disease
Control and Prevention offer the following tips for parents and caregivers
of infants and small children under age 4:

• At mealtime, insist that your children eat at the table or at
  least sitting down. Watch young children while they eat. Encourage
  them to eat slowly and chew their food well.
• Cut up foods that are firm and round and can get stuck in your
  child’s airway, such as hotdogs (always cut them lengthwise
  and then into small pieces), grapes (cut them into quarters) and
  raw vegetables (cut them into small strips or pieces that are not
  round).
• During playtime, follow the age recommendations on toy packages.
  Any toy that is small enough to fit through a one-and-a-quarter inch
  circle or is smaller than two-and-a-quarter inches long is unsafe
  for children under 4 years old.
• Don’t allow young children to play with toys designed for
  older children. Teach older children to put their toys away as soon
  as they finish playing with them so younger siblings can’t
  reach them.
• Frequently check under furniture and between cushions for dangerous
  items young children could find, including coins, marbles, watch
  batteries, pen or marker caps, cars with small rubber wheels that
  come off, small balls or foam that can be compressed to a size small
  enough to fit into a child’s mouth, etc.
• Never let your child play with or chew on uninflated or broken
  latex balloons. Many young children have died from swallowing or
  inhaling them.
• Don’t let your small child play on beanbag chairs made with
  small foam pellets. If the bag opens or rips, the child could inhale
  these tiny pieces.

If you’re a parent, grandparent or other caregiver, learn how
to help a choking child and how to perform CPR in case of an emergency.
Choking prevents oxygen from getting to the lungs and the brain, and
when the brain goes without oxygen for more than four minutes, brain
damage or even death may occur. According to the AAP, you should start
first aid if …

• The child cannot breathe at all (the chest is not moving up and
  down).
• The child s airway is so blocked that there is only a weak cough
  and a loss of color.
• The child cannot cough, talk or make a normal voice sound.
• The child is found unconscious. (Go to CPR.)

DO NOT start first aid if …

• The child can breathe, cry, talk or make a normal voice sound.
• The child has a strong cough. (A strong cough means there is little
  or no blockage.)

Centers for Disease Control and Prevention
American Medical Association
American Academy of Pediatrics