Childhood aspiration on food is a public health issue


Recently, new dietary guidelines were released, recommending reducing sugar intake overall, and reducing meat intake in growing boys.  Last year, as we remain in the throes of a nationwide obesity epidemic, the FDA changed the nutritional labels we’ve become all-too-familiar with. The emphasis is now on calorie count of an “appropriate” serving size. So much for my pretending that the “appropriately served” pint of ice cream I just downed had 350 calories. What? That was per serving? From now on, we’ll be able to enjoy our 350 fat-filled calories in the microscopic “appropriate”  portion it was meant to be. And no way should we share those sugar-laden calories with our already tainted, meat-loving children.

I understand the importance of the health of our nation, but I fear that we are missing a big boat. Childhood aspiration (or choking) on food is a major public health issue. Anywhere from 10,000 to 20,000 kids visit emergency rooms each year in the U.S. alone, after having suffered a food-choking accident. Hundreds die each year, either in the hospital or before they make it in the door. Most of these kids are under the age of 5, and most of their parents will have had no idea that their child had choked on a high-risk food. The vast majority are preventable, had we only known the risks in advance.  The number one cause of food choking deaths in school-aged children is hot dogs, which also happen to be a top food served to children in school cafeterias.

In stark contrast to the well established legislation that all toys and games intended for young children must have safety labeling, similar legislation for food products does not exist. The Food Choking Prevention Act was introduced and reintroduced multiple times to Congress. The 2002 rendition directed the FDA to establish an Office of Choking Hazard Evaluation, in efforts to oversee identification and labeling of potentially hazardous food products. This act was ultimately dismissed by Congress in 2002, 2003, and again in 2005. The most recent attempt was devised with a focus on promoting public education about prevention of food object aspiration. Unfortunately, the introduction of this bill was also dismissed by Congress.

Until we have support by our legislators, we will continue to do our best as physicians to educate the public about high-risk foods for young children. The American Academy of Pediatrics (AAP) recommends that the following foods not be given to children under 5 years old:

  • hard candies or gum
  • raw vegetables in chunks
  • nuts and seeds
  • whole grapes
  • hot dogs
  • chunks of meat or cheese
  • popcorn
  • sticky candy
  • chunks of peanut butter

None of these foods have safety labels. Hot dogs have some suggestive wording, but it’s still not the warning label needed to steer parents and caregivers of young ones clear of potential choking risks. Even the healthy stuff, when served in an unsafe way, can be the unhealthiest of them all.

Nina Shapiro is a pediatric otolaryngologist.  She is the author of Take a Deep Breath: Clear the Air for the Health of Your Child, can be reached on her self-titled site, Dr. Nina Shapiro, and can be reached on Twitter @drninashapiro.

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