Choking is estimated to kill more than 3,000 people each year. This is unfortunate as the vast majority of deaths associated with choking can be prevented. Although choking can occur at any age the vast majority of choking occurs in children.

What is choking?
Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. This can lead to the cutting off of oxygen to the brain if first aid is not administered as soon as possible.

How do you know when someone is choking?
Most of us can readily identify someone who is choking. The person may give the universal sign for choking which is: hands clutched to the throat. The individual may also display the following:
• Inability to talk
• Difficulty breathing or noisy breathing
• Inability to cough forcefully
• Skin, lips and nails turning blue or dusky (cyanosis)
• Loss of consciousness

What are some common causes of choking?
The majority of childhood choking is associated with food items and foreign bodies. Children are at risk from round food items such as hotdogs, candies, nuts, grapes, popcorn, ginneps and round conforming objects such as coins, small balls and balloons.
Other causes of choking are:
• Trying to swallow large pieces of poorly chewed food
• Drinking alcohol before or during meals
• Wearing dentures. Dentures make it difficult to sense whether food is fully chewed before it is swallowed.
• Eating while talking excitedly or laughing
• Eating too fast
• Walking, playing, or running with food or objects in the mouth.

What are some things parents and guardians can do to prevent children form choking?
The following may help prevent children from choking:
• Do not leave small objects, such as coins, beads and buttons within an infant’s reach.
• Do not let children eat too fast
• Make sure that toys have no small parts that could be pulled off
• Make sure toys are appropriate for age and that they are large enough not to be swallowed.
• Cut up foods that children can choke on into small pieces, e.g. hot dogs.
• Supervise children while they eat

Choking: First aid
If choking is occurring, begin to perform the Heimlich maneuver. If you are the only person around, perform the maneuver before calling 911 for help.
If another person is around that person can call for help while you perform the Heimlich maneuver. Most individuals should know how to perform the Heimlich maneuver. If you need training on this maneuver you can contact the Red Cross here in Anguilla or another certified First aid instructor on the island.
To perform the Heimlich maneuver on someone else you can do the following:
Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
Make a fist with one hand. Position it slightly above the person’s navel.
Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust as if trying to lift the person up.
Repeat until the blockage is dislodged.

To perform the Heimlich maneuver on yourself:
Place a fist slightly above your navel.
Grasp your fist with the other hand and bend over a hard surface-a countertop or chair will do.
Shove your fist inward and upward.

Clearing the airway of an unconscious person:
Lower the person on his or her back onto the floor.
Clear the airway. If there is a visible blockage at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Be careful not to push the food or object deeper into the airway, which can happen easily in young children.
If the object remains lodged and the person does not respond after you take the above measures, begin cardiopulmonary resuscitation (CPR).

Clearing the airway of a choking infant younger than age one year:
Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh.
Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object.
If that does not work, hold the infant face up on your forearm with the head lower than the trunk. Using two fingers place at the centre of the infant’s breastbone, give five quick chest compressions.
If breathing does not resume, repeat the back blows and chest thrust. Call for emergency medical help.
If one of these techniques opens the airway but the infant does not resume breathing, begin infant CPR.

If the child is older than age one year, give abdominal thrust only.

Conclusion
The vast majority of deaths associated with choking can be prevented, but unfortunately, deaths still occur as a result of choking. Parents can take a number of steps to help prevent children from choking. If you do not know how to perform the Heimlich maneuver and CPR please learn these lifesaving techniques as soon as possible as they can help prevent deaths associated from choking.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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