Nonfatal Choking on Food Among Children 14 Years or Younger in the United States, 2001-2009

Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
PEDIATRICS (Impact Factor: 5.47). 07/2013; 132(2). DOI: 10.1542/peds.2013-0260
Source: PubMed


The objective of this study was to investigate the epidemiology of nonfatal choking on food among US children.

Using a nationally representative sample, nonfatal pediatric choking-related emergency department (ED) visits involving food for 2001 through 2009 were analyzed by using data from the National Electronic Injury Surveillance System-All Injury Program. Narratives abstracted from the medical record were reviewed to identify choking cases and the types of food involved.

An estimated 111,914 (95% confidence interval: 83,975-139,854) children ages 0 to 14 years were treated in US hospital EDs from 2001 through 2009 for nonfatal food-related choking, yielding an average of 12,435 children annually and a rate of 20.4 (95% confidence interval: 15.4-25.3) visits per 100,000 population. The mean age of children treated for nonfatal food-related choking was 4.5 years. Children aged ≤ 1 year accounted for 37.8% of cases, and male children accounted for more than one-half (55.4%) of cases. Of all food types, hard candy was most frequently (15.5% [16,168 cases]) associated with choking, followed by other candy (12.8% [13,324]), meat (12.2% [12,671]), and bone (12.0% [12,496]). Most patients (87.3% [97,509]) were treated and released, but 10.0% (11,218) were hospitalized, and 2.6% (2911) left against medical advice.

This is the first nationally representative study to focus solely on nonfatal pediatric food-related choking treated in US EDs over a multiyear period. Improved surveillance, food labeling and redesign, and public education are strategies that can help reduce pediatric choking on food.

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    ABSTRACT: To review the literature on pediatric food choking risks, with the long-term goal of supporting legislation regulating the production, labeling, and distribution of high-risk foods. A PubMed search (Keywords: choking, obstruction, asphyxiation, foreign body, food) was conducted in July-September 2010 with publication dates ranging from 1966 to 2010. Study selection: Articles related to pediatric foreign body aspiration (FBA) were selected by three independent reviewers. 1145 articles were initially identified. Abstracts were then screened utilizing a tool designed to isolate relevant pediatric choking events; this tool helped to only select abstracts which presented data on patients younger than 18 years of age who had choked on food items. Through this, a total of 72 pertinent articles were isolated (55 observational studies, 17 case reports/series). Data extraction: For each study, patient age, sex, foreign body location, presenting signs and symptoms, utility of radiographic studies, and type of foreign body detected in the majority of study participants were determined. A "majority" of patients for each study was predetermined arbitrarily to be 2/3 of the studied population. The majority of patients in each observational study was determined to be: male (87% of all studies) and age <5 years (95% of all studies). Aspirated foreign bodies were mostly detected in the right main bronchus foreign body (72% of all studies), and there were abnormal radiographic signs (81% of all studies) at the time of evaluation. Food-object foreign bodies were the most frequent factors associated with choking (94% of all studies). Childhood aspiration of food-objects is a significant public health issue. Although there is substantial legislation regulating non-food items that pose a choking hazard, equivalent guidelines do not exist for high-risk foods. Our study identifies and confirms several risk factors for pediatric FBA events. In doing so, it echoes the concerns and suggestions of various groups in supporting the development of legislation which may reduce the incidence of food-object aspiration.
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