Physicians warn about choking danger to children from grapes and other foods

Choking is a leading cause of injury and death among children, especially those aged 3 or younger. In the United States, an average of 140 children choke to death each year, and thousands of others end up requiring emergency care after a choking episode.

Some of those children experience permanent brain damage.

Most parents are aware that small toys (especially balloons) pose a choking risk to children, and warnings about that risk are required on toy packaging (although not all toys are accurately labeled). But parents and others who care for children are less attuned to the choking danger posed by certain types of food.

Yet, as reported a few years back by the American Academy of Pediatrics (AAP), choking on food causes the death of approximately one child every five days in the United States.

Tragically, one of those deaths occurred here in Minnesota last summer, when a 4-year-old Mankato girl choked to death on a whole grape.

The hazard of grapes

In a recent report in the journal Archives of Disease in Childhood, two Scottish physicians make “a plea for awareness” about the choking hazard of grapes and other food items.

“Despite the fact that items of food account for over half the fatal choking episodes in children up to 5 years of age, warnings are routinely absent on packaging, and public knowledge of many of the dangers is not widespread,” write Dr. Amy Lumsden, a physician at the Royal Aberdeen Children’s Hospital in Aberdeen, Scotland, and Jamie Cooper, the program director of the hospital’s emergency department. 

Grapes, which are a popular food with young children, are particularly dangerous, they stress. A grape is larger than a child’s airways and has a smooth surface, which allows the fruit to form a tight seal when it gets wedged in the airways — so tight that it is very difficult to dislodge without special equipment.

Three cases, two fatal

Lumsden and Cooper describe three choking cases involving young boys — two fatal — that occurred recently at their hospital in Aberdeen. In one, a 5-year-old boy choked on a whole grape at an after-school club. Despite first-aid measures to dislodge the grape by school staff and paramedics, as well as aggressive emergency actions at the hospital, the boy suffered a heart attack and died.

In the second case, a 17-month-old boy began choking on a grape while eating lunch at home with his family. The child’s parents and later paramedics were unsuccessful at dislodging the fruit in time to save his life, and he was declared dead soon after he arrived at the hospital.

The third case had a happier ending. It involved a 2-year-old boy who was snacking on grapes at a park with his family. When he began choking, his parents performed the Heimlich maneuver, but without success. An ambulance was called. Fortunately, it was nearby and arrived on the scene within minutes. This time, paramedics were able to remove the grape, and the child began to breathe spontaneously. He suffered two seizures en route to the hospital, however, and was put into intensive care, where he stayed on a ventilator for five days.

After being taken off the ventilator, a brain scan revealed no apparent permanent damage. “He made an excellent recovery and was discharged home 4 days later alert and playing normally,” write Lumsden and Cooper.

Prevention is key

As these three cases make clear, children can choke on grapes with tragic results. And, yes, timely interventions can sometimes lead to the removal of the grape — and a happy ending for the child — but such interventions can also end in failure.

As Lumsden and Cooper stress in their paper, intervention efforts after the fact are not going to be enough to save all children’s lives:

In all three instances, adults were present, identified the problem quickly and promptly instituted appropriate first aid manoeuvres for the treatment of choking but with no success. In fact, even when these measures were performed by trained ambulance personnel, they were also unsuccessful and all three cases required that the grape be removed under direct laryngoscopy, clearly something that requires specialist expertise and equipment.

Though we would wholeheartedly support the wide dissemination of the knowledge and skills to promptly identify a choking child and intervene appropriately, prevention is better than cure.

Preventive efforts should include, they stress, a simple warning label on the packaging of grapes and other similarly shaped foods (such as cherry tomatoes). The label should highlight the potential choking hazard and recommend that the foods be divided in half or preferably quartered before being served to children.

The AAP has also called for labels on foods that pose a high choking risk to children.

What you can do

Still, the key to ending these tragic deaths must start with educating parents and other caregivers of young children about the danger. Here are the AAP’s preventive tips: 

• Keep foods such as grapes, hot dogs, raw carrots, or peanuts away from babies and young children.

• Cut food for babies and young children into pieces no larger than one-half inch.

• Encourage children to chew food well.

• Supervise meal times. Insist that children sit down while eating. Children should never run, walk, play, or lie down with food in their mouths.

• Be aware of older children’s actions. Many choking incidents are caused when an older child gives a dangerous toy or food to a younger child.

• Keep the following foods away from children young than four years: hot dogs, nuts and seeds, chunks of meat or cheese, whole grapes, hard or sticky candy, popcorn, chunks of peanut butter, chunks of raw vegetables and chewing gum.

FMI: You’ll find more information about reducing choking hazards in your home at the AAP website. Lumsden and Cooper’s article in the Archives of Disease in Childhood can be read in full on that journal’s website.