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Choking deaths among U.S. children have dropped dramatically since 1968

The greatest annual declines occurred after warning labels started appearing on children’s products.

An image from a 2006 press conference showing toys that the U.S. Public Interest Research Group says demonstrate a hazard to children.
REUTERS/Jason Reed

The number of American children, particularly those under age three, who die from choking on household objects has dropped dramatically — by 75 percent — over the past 50 years, according to a study published in the Journal of the American Medical Association (JAMA).

This positive news underscores the important role that government regulations and public health initiatives can play in saving lives.

After 1979, for example, products designed for young children could not contain parts that could fit into a cylinder the size of the upper airways of a 3-year-old child (about the size of a toilet paper roll). And starting in 1994, products for older children that contained small parts had to contain a warning label that clearly stated they presented a choking hazard for children under age 3.

“Some of the regulations from the last 50 years have forced people to do the right thing,” said Dr. John Cramer, the study’s lead author and an assistant professor of otolaryngology at Wayne State University, in a released statement. “When you buy toys or cribs now, products are designed so that they can’t be choked on. If you’re a parent and you go buy a crib, you don’t have to think about buying a crib without small parts. It’s already regulated.”

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Five decades of data

For the study, Cramer and his colleagues analyzed data collected by the National Vital Statistics System on object-related (not food-related) choking deaths in the United States from 1968 through 2017. They found there had been 20,629 such deaths among children and teens aged 0 to 17 during that period.

The rate and number of object-related choking deaths declined precipitously over those 50 years, particularly among children younger than 3 years old. There were 719 deaths (1.02 per 100,000 children) in 1968. That number had fallen to 184 (0.25 per 100,000 children) by 2017.

The greatest annual declines occurred after warning labels started appearing on children’s products.

“In the 1990s, there was a sharper decline in choking deaths in children younger than three years, exceeding 8 percent annually, compared to over 2 percent annual decrease in the years before and after,” says Dr. Jennifer Lavin, one of the study’s o-co-authors and an assistant professor of otolaryngology at Northwestern University, in a released statement. “The warning label legislation certainly appears to have made a difference.”

“More national efforts are needed to make an even greater impact toward eliminating deaths from choking in young children,” she added.

One of those efforts should be to use a smaller cylinder for testing choking hazards, Lavin and her co-authors argue. Currently, almost one in four (23 percent) of the object-related choking deaths that occur in children involve an item that passed the current cylinder test, the researchers say.

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Keep your home safe

With the holiday season rapidly approaching, it’s particularly important that parents — and everyone else who will be welcoming young children into their homes — keep all items that are choking hazards out of the children’s reach. The American Academy of Pediatrics (AAP) urges us to pay particular attention to these objects:

  • Coins
  • Buttons
  • Toys with small parts
  • Toys that can fit entirely in a child’s mouth
  • Small balls, marbles
  • Balloons
  • Small hair bows, barrettes, rubber bands
  • Pen or marker caps
  • Small button-type batteries
  • Refrigerator magnets
  • Pieces of dog food

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Many foods are also choking hazards and thus should also be kept away from children younger than 4 years old, particularly:

  • 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
  • Chewing gum

“Be aware of older children’s actions,” the AAP adds. “Many choking incidents are caused when an older child gives a dangerous toy or food to a younger child.”

FMI:  You’ll find an abstract of the JAMA study on the journal’s website. Parents and others can find information on how to respond to a choking emergency on the AAP website.