Welcome to The Art of Patients, I’m Dr Golly and today I’m going to focus on one of the most frightening things that can happen to your child, and unfortunately, something that happens often – and very easily. I’m talking about choking episodes, how best to prevent them – and what to do if your child begins to choke.
The word choke comes from the middle English word cheken and literally means suffocate. It occurs with a blockage to the windpipe, preventing oxygen from getting in to the lungs. Let’s have a look at our airways and what happens when a blockage occurs (turns with marker)…
The reason choking episodes can happen so easily – and to anyone – is because at the very back of our throat – the pharynx – you’ll find the opening of two tubes. One to let air in and out – our trachea, and one to let food down – the oesophagus. The trachea divides into two tubes – the left and right bronchus, to enter the lungs – so we definitely don’t want food making its way into the lungs! To try stop this from happening, the top of the trachea has a protective cover, which we call the larynx, or vocal cords – but we constantly open and shut them in order to breathe and talk – meaning food, liquid – or other solid objects – can find their way into the breathing tubes. With these inhaled foreign bodies, about 15% get stuck in the larynx or trachea, 26% in the left bronchus and 59% find their way to the right bronchus.
This is because the right bronchus is bigger and more vertical than the left, making it easier for foreign bodies to end up down the right side. If a child has inhaled a foreign body, it will cause either a complete or partial blockage and the most important thing is to recognise that your child may be choking. The signs that suggest a complete blockage include: your child not breathing, causing the skin to go pale or blue, your child not making any sounds and no air passing from your child’s mouth or nose – this will result in a loss of consciousness very quickly.
First aid is crucial in this instance. The first thing to do is call 000 – we’ll talk about first aid and CPR a little later.
Sometimes it’s hard to know if there is a partial blockage. These more subtle signs can even develop over hours to days, include a loss of voice, choking noises, worsening cough, gagging or vomiting, wheeze, chest pain or agitation. If your child is able to cough, encourage them to do so – as this will help dislodge the foreign body. If you can see that part of a toy is missing, or there are numerous small choking hazards found near your child, take them to your local emergency department for assessment. This is especially important if there is a chance they’ve swallowed or inhaled a battery or sharp object. Let’s head back to the whiteboard and talk about first aid and CPR, if necessary (turns to whiteboard)…
In children under 1 year of age, clear any visible food or objects from their mouth. If they are breathing, place them in this recovery position (facing downwards) on your arm and wait for the ambulance to arrive. If they are not breathing, or stop breathing when in the recovery position, lie them on their back and commence CPR. This means two fingers in the centre of their chest, compressing 30 times, followed by two breaths. Remember to encircle their whole mouth and nose in your mouth. The compressions should be roughly 100 beats per minute.
For older children and adults, the process is the same, but their recovery position is lying on their side.
Some parents ask me if it’s dangerous to breathe into the child’s airway, if there is a blockage – for fear of pushing it further down. This is ok, because pushing the foreign body down one bronchus will allow air to at least enter the other lung, providing much needed oxygen to the child. Performing CPR is very frightening for parents and emergency workers. It is always best to perform regular first aid courses, so that you remain calm and confident – should the need ever arise.
You’ve been watching another episode of The Art of Patients. I’m Dr Golly, I’ll see you next time.