Cough, gasp, cough, gasp, cough, gasp, cough, gasp.
Then gag, gasp, gag, gasp, gag, gasp, gag, gasp.
Then a horrific muted gurgle.
I was up from my desk and headed toward the stairs by the time the gagging started because my mama gut knew the sounds coming from the kitchen where our new babysitter was feeding lunch to my 24 month old were terribly wrong.
When I rounded the corner at the bottom of our staircase, her panicked, "Are you okay?!! ROWAN!" was the only sound in the room. His face was a deep purplish blue and frozen in a gruesome pose. His blue eyes were still, watering and bulging and his mouth hung wide open with drool dripping from his lower lip. And he was staring - not at me, not at his sitter, just eerily staring somewhere just beyond his plate.
As a lifeguard, fitness instructor and healthcare professional I've sat through that boring Red Cross CPR and first aid class no less than 15 times in my life where I've done mock choking drills with plastic mannequins. Somehow in a moment of sheer terror, that training won out over mommy brain. I knew the second I heard and saw the scene at my kitchen table that it was Heimlich Maneuver time and that precious seconds were ticking by before my sweet boy would lose consciousness.
As I sprinted into position behind my silent toddler, I thought, "Three times. I'll do this three times and if it doesn't work - 911." I wrapped my arms around him and grasped my fisted hand - not textbook perfect (I skipped those 5 back blows I was supposed to give) but hopefully good enough.
One thrust - at the end of which I lifted him out of his chair and put his feet on the ground. Silence. I started to feel nauseous and swirly-headed, my mind racing. How long has it been since his last good breath? 45 seconds. Maybe 60. Tick tock tick tock.
A second thrust - food flew out of his mouth and he let out a whimper. The purplish blue immediately gave way to gray and he cried, shook and vomited profusely for the next 5 minutes. And then, color returned to his face and strangely and thankfully everything returned to normal.
Except that it's not back to normal because I know that today and tomorrow and the next day, dozens of other parents and caregivers will have a similar experience. Not back to normal because now I know that every 5 days in the United States, a child dies from choking on food. Not back to normal because it was almost my kid.
Get First Aid Training - NOW
I confess, I didn't ask our new sitter if she's pediatric CPR and first aid trained. I can't believe I didn't ask her! I don't know why I didn't ask her! I cannot stress this enough (and I'll be heeding my own advice from now on) - you and anyone else who cares for your child NEEDS to be trained in child first aid and resuscitation. At this point I hardly care if a babysitter feeds him spoonfuls of sugar and lets him watch Dr. Phil for hours on end, as long as she can save his life if he needs it.
I don't want to even think about what my reaction might have been if I wasn't trained - Freezing? Turning him upside down? Shaking him? Sticking my fingers into his throat? I cannot imagine waiting those excruciating and precious minutes for first responders to arrive while helplessly watching my baby lose consciousness.
Our family will be reviewing CPR and first aid with all caregivers and posting choking and CPR protocols in our kitchen. Click here to access the Red Cross reference sheets if you'd like to do the same.
Choose Safe Foods
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Choking is the fifth leading cause of unintentional death in kids under 5. FIFTH. As parents, sometimes our worry meter is skewed and we are terrified of strangers abducting our kids and shark attacks when we should really be terrified of snacks.
Because I wasn't at lunch with him and because our dog ate whatever food came out of my son's mouth when I did the Heimlich Maneuver, I'm not positive what he choked on. But, I suspect it was a large bite he took from a sticky fig bar from Costco.
Here's a list of foods to avoid or be EXTREMELY cautious of. I've included in parentheses safer alternatives when applicable.
- hot dogs (remove skin and cut into strips)
- all nuts, including peanuts
- dried fruit
- bananas (cut into small cubes or long strips)
- chips and pretzels
- cheese cubes
- ice cubes
- peanut butter - especially from a spoon or on soft bread
- food that are sticky or clump
- grapes and berries (slice them into halves or quarters)
- marshmellows, jelly beans and other candies
I confess that we had gotten pretty casual about this list and didn't even consider some of the foods on it. We've scratched some items from his diet completely (bye, bye cashews) and are changing how we offer others (fig bars in very small bites using Pickease untensils to help him take one bite at a time).
A (long) Word About Baby Led Weaning
Since I also have a 6 month old who's only a few weeks into eating solids, my mind has also been filled these past few days with choking prevention for babies. I'll be really blunt and probably provoke controversy here. But my kid almost died and I'm a trained feeding therapist so I feel like I can speak from experience and with expertise. So here goes:
Giving chunks of choke-able foods (melon, raw apples, meat, bananas, avocado, pasta, etc.) to a baby who hasn't yet developed the oral motor skills to manage them is UNNECESSARILY RISKY.
By 8-12 months of age, most babies with several months of feeding experience can safely manage *very* small bites of soft solids like pasta, cooked apples, avocado, etc. But to introduce solids that can easily be bitten into choke-able chunks to a beginning feeder is a completely unnecessary risk.
Baby Led Weaning is very popular right now. But perhaps you haven't thought about it from a developmental standpoint. Feeding is ultimately a set of skills - of oral-motor developmental milestones - that require practice for mastery. Babies effectively chew, lateralize their tongues to move food over bite surfaces, and safely transport foods from the front to the back of their mouths when ready for swallowing NOT because they hit 6 months of age, but because they learn those skills through practice. And just like your little one will be clumsy when learning to grasp and wobbly when she learns to walk, she will NOT be well-coordinated with these oral motor skill as a beginning feeder. There are much safer ways to allow your baby to learn and practice the oral-motor skills for eating than to give her choke-able foods as first foods.
Let's talk about BLW from a safety perspective. A young child's airway is the size of a drinking straw. That is TINY. If you're really heart-set on offering solids as baby's first foods, I encourage you to cut them smaller than your pinky fingernail (but be aware that your baby's grasping skills may not enable efficient independent eating of bites that small). Many BLW advocates suggest giving your babe big chunks of food to taste. Even a toothless baby can gnaw a choke-able chunk off a slice of apple, a banana, a melon, a piece of soft meat and so on.
I tried some BLW-suggested foods with my firstborn when he was a beginning eater and very quickly realized that he was able to break off choke-able chunks. Luckily, he gagged and vomited all of them back up. But some kiddos aren't so lucky. And 18 months later, his gag reflex just wasn't enough.
The gag reflex (at the back of the throat) is helpful and designed to protect the airway by closing the top of the trachea (airway) and propelling food back toward the front of the mouth. But I am here to tell you from first-hand experience - it is NOT 100% effective. The fact that more than 10,000 children visit emergency rooms each year in the US for food-related choking incidents is further proof that you shouldn't stake your baby's life on his gag reflex.
Is it amusing and cute to see 7 month olds gnawing on pork chops or slices of watermelon? Yes. It there any reason for it? No. Is it wise? Simply, no. Want to offer your baby cantaloupe or chicken as a beginning food? Awesome - put it in a mesh feeder.
You can start a baby on pureed foods and still have mealtimes
be "baby-led". In fact, what's more "baby-led" than progressing toward solids at the rate your baby shows you she's ready?
Friends, puree-shaming and mush-criticism is just silly. We all eat purees and mush as part of our diets - yogurt, mashed potatoes, applesauce, etc. There is NOTHING wrong with beginning a baby on purees - NOTHING. It doesn't mean you can't encourage self-feeding (which I agree with BLW-ers is very important) and it doesn't mean they have to stay on purees for long. Now more than ever, I recommend introducing foods in a developmentally-appropriate progression from purees to solids based on your child's individual signs of oral-motor readiness.
There, I said it. Let the internet hate me forever. But maybe my professional opinion and personal experience will save a few babies' lives and save others from the horror of watching their child stop breathing. To me that's worth losing a few readers or getting some nasty comments.
If you have a BLW success story, great! PLENTY of babies do BLW without choking, there's no disputing that. What I'm talking about is choking risk, not a guarantee of choking. If you read this and still want to proceed with BLW that's absolutely fine and I respect that decision. Ultimately, you have to decide what's right for your family and your kiddo. My goal is that those decisions would be well-informed and intentionally made.
Supervised and Safe Mealtimes
I almost never let my toddler eat in the car mainly because I don't want crackers ground into my car's upholstery. But now I'm more fully appreciating just how unsafe it is. First and foremost, a child eating in a rear-facing car seat is largely unsupervised and difficult to get to in a choking episode.
Additionally, the semi-reclined position of a car seat makes gravity work against your child's safety while eating. Whether in a car seat or in a high chair, your child should not eat semi-reclined (leaning back). Why seat recline is even a feature on high chairs is beyond me. If your kiddo can't sit up by herself, she's not ready to eat solid foods (with the exception of children with special needs with professionals consulting for their safe feeding).
It's also important to make sure your kiddo is seated for mealtimes and snacks. Leave it to a toddler to want to eat upside down while watching Elmo. Or while racing through the house yelling like a wild animal. We have to sometimes be the party-pooper and keep them safe by helping them sit and eat civilly, even if it's not in their crazy toddler nature.
Let's talk more about supervision. I am totally guilty of not adequately supervising my toddler during mealtimes. He's a good eater who independently uses a spoon, a fork and an open cup. And I'm usually prepping a meal for myself, cleaning up the kitchen or tending to his baby sister while he eats. But when I really think about it, he DOES need supervision. He has a tendency to take bites that are too big and to overstuff his mouth - like most toddlers! So from now on, we'll be taking adequate mealtime supervision and help much more seriously and I encourage you to consider doing the same in your home.
I write this article with the image of my baby's silent, blue face seared in my mind forever and an ache in my stomach knowing that I nearly lost him. Whether you're terrified of your child choking or haven't given it too much thought, I hope you glean from this at least one thing you could change starting TODAY to reduce your little one's risk of choking.