7/29/2013
by Michael Smith, MedPageToday.com
Candy is dandy — for causing children to choke.
That’s one of the findings of the first multiyear, nationally representative study of food-related nonfatal choking injuries to kids, according to Gary Smith, MD, of the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues.
On average, 12,435 children, ages 0 to 14, are treated in emergency departments a year because of choking on a food item, they reported online and in the August issue of Pediatrics.
The most important cause of such events is hard candy, followed by other forms of candy, meat, and bone.
Choking is an important cause of morbidity and mortality among children, the researchers noted; in 2001, some 17,537 children under 14 received emergency care for a nonfatal choking episode involving either food or nonfood substances, such as small toys or coins.
New regulations since then have aimed at reducing the risk of choking from small toys, but choking on food — the largest part of such episodes — remains “a relatively under-addressed problem,” Smith and colleagues noted.
They used data from the National Electronic Injury Surveillance System–All Injury Program, a nationally representative sample of hospitals, which each year collects data on roughly 500,000 injury-related emergency ward visits.
The data yielded a 9-year national estimate, for 2001 to 2009, of 111,914 cases involving children under 14, for an annual average of 12,435 and a rate of 20.4 visits per 100,000 population.
On average, kids treated for nonfatal food-related choking were 4.5, and children younger than a year accounted for 37.8% of cases.
Boys were more likely to be involved, accounting for 55.4% of episodes.
Hard candy was the cause of 15.5% of cases, while other forms of candy caused 12.8% of choking episodes, and meat and bone caused 12.2% and 12%, respectively.
More than four-fifths of patients (87.3%) were treated and released, 10% were admitted to hospital, and 2.6% left against medical advice, Smith and colleagues found.
Given that almost 90% of children were treated and released, the episodes “might not be a big deal,” although they’re frightening for parents, commented Wendy Pomerantz, MD, of Cincinnati Children’s Hospital Medical Center.
“We just don’t know the severity of the injuries,” she told MedPage Today.
“It would be interesting to look and see which ones were the most important ones, which ones caused admission,” she said.
But physicians can help parents by counseling them about the risks of choking on hard candies and seeds and nuts, as well as foods such as such things as hot dogs that are the approximate size and shape of a child’s airway.
The researchers cautioned that the data did not include all choking incidents because many would have been resolved at home. Also, the actual cause of an incident was sometimes difficult to pin down, so that some cases of food-related choking might not have been included.
Finally, the data wasn’t sufficient to pin down answers to such questions as whether adults were present during the choking episode, how the child obtained the food, the use and success of choking rescue attempts, and the use of any diagnostic or therapeutic medical procedures.
The study had support from the CDC. The journal said the authors indicated they had no relevant financial conflicts interest.
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