Child safety: Focus on choking

Mid-year winter school holidays are here and while it is a fun time for children in need of a break from school, it can also be somewhat challenging for busy parents and caregivers.

During the cold weather it becomes more difficult to keep young children occupied and safe in and around the home, said Netcare.

Dr Anchen Laubscher, Netcare’s Group Medical Director said that children are always curious and it is important that a close eye is kept on them at all times to ensure they are safe.

“While it is critical not to instil a sense of fear in our children, it is necessary to teach them what poses a danger to them and how they can keep themselves safe. They can be allowed increasingly more independence as they get older.”

Dr Laubscher advised all parents, child-minders and others such as teachers who are involved with children daily, to complete a Basic CPR course.

“Knowing what to do in an emergency situation can save lives. It is particularly important to learn cardiopulmonary resuscitation [CPR], an essential life-saving technique in drowning and other situations where a child has stopped breathing.

“The technique of performing CPR on an infant is similar to that used for adults. There are, however, aspects that differ and that need to be adjusted. Chest compressions, for example, should be to a depth of 4cm and the action should be performed using one hand only, or, for tiny babies, using two fingers only.

“Be sure to memorise the number of an emergency medical service provider such as Netcare 911 [082 911], save it on your cellphone, keep it written down next to your telephone or download the MySOS Netcare 911 cellphone app which will allow the Netcare 911 Emergency Operations Centre to automatically determine your location and dispatch the necessary resources to an emergency.”

Dr Laubscher said although it is difficult for some parents, children should never be left without adult supervision. Only leave young children with responsible adults who will be as careful about the safety of your child as you are.

Every home should be child-proofed as far as possible. This includes ensuring that electrical wiring is approved and out of harm’s way, plugs are properly wired and sealed, and all unused electrical wall plugs are covered with plastic protectors. Avoid leaving basins or buckets of water around, as these may be dangerous for toddlers. Anything that could be harmful to children, including any substances or equipment, should be put out of reach or kept under lock and key.

• Choking

David Stanton, Head of Clinical Leadership at Netcare 911 said that choking is one of the most common life-threatening hazards to both children and adults.

“At some point in our lives, we are all likely to witness someone choking. This can be a frightening experience, particularly if it is a small child or even a baby who is choking. Parents and child-minders would be well advised to familiarise themselves with what to do when someone is choking.

“Choking occurs either because of the total obstruction of a person’s airway by a swallowed object, or when something blocks the windpipe instead of going down the food passage,” Stanton explained.

The blockage in the airway limits or completely cuts off the flow of air into the lungs, which can result in the child losing consciousness.

“If the airway is not cleared in time, he or she could suffocate. Choking is, therefore, a medical emergency.”

Stanton noted that suffocation can occur within minutes as one cannot survive without sufficient air to the lungs, which supply the brain with vital oxygen.

“This means that when faced with an adult or young person who is choking, time is of the essence and you have to take the correct action immediately to keep them alive until professional help arrives.”

A child with a blocked airway will be unable to cough, talk or breathe, and will most probably be clutching at his or her throat.

“Assess the situation and, if necessary, have someone phone for emergency medical assistance. If you are alone with the choking child, phone for assistance but put your phone on speaker-mode so that you can begin helping them while calling for help. It is imperative that the caller explains the nature of the emergency and the precise directions to the location.

“Encourage the person to cough forcefully, and do not interfere with their spontaneous coughing which may help expel the blockage. If the obstruction becomes severe, a silent cough or laboured breathing will become evident. Worse still, the person may become unresponsive.”

Try to dislodge the obstruction by administering a series of forceful abdominal thrusts. This is also known as the Heimlich Manoeuvre, and it should be highlighted that it should only be attempted if the choking patient is over the age of one year.

“The Heimlich Manoeuvre involves an abdominal thrust that creates an artificial cough, which may be forceful enough to clear the airway. Quick, upward abdominal thrusts force a rush of air out of the lungs, similar to a cough, and this can force whatever is causing the youngster to choke out of the airway,” explained Stanton.

Step-by-step guide to the Heimlich Manoeuvre (children over the age of one year only)

• Lean the child forward slightly and stand or kneel behind them.

• Make a fist with one hand. Put your arms around the person and grasp your fist with your other hand above the choking person’s navel and just below the ribcage.

• Make a quick, forceful movement, angled inward and upward, in an attempt to assist the person to cough up the object.

• This manoeuvre should be repeated at least five times. Keep checking to see if the object has been dislodged from the patient’s airway and repeat the manoeuvre five times if necessary.

• If the Heimlich Manoeuvre does not work initially, hit the person firmly between their shoulder blades several times using the heel of your hand, then repeat the Heimlich Manoeuvre.

Dealing with choking in small children (younger than a year old)

If a child younger than one year is choking, you have to be extremely careful when trying to remove a foreign object in order to avoid injury, said Stanton.

• Sit down and place the child face down on your forearm, which rests on your thigh for stability.

• Angle the child so that their head and neck are lower than the torso.

• Thump the middle of the child’s back firmly with your other hand several times.

• This motion and gravity together should help to clear the blockage from the airway.

• Keep checking the mouth to see whether the object has been dislodged.

• If this doesn’t work, you can turn the infant onto their back, and give five sharp chest compressions, in the middle of the chest.

“Should a person of any age lose consciousness, you need to start performing cardiopulmonary resuscitation [CPR]. Continue CPR until the object is visible and can be removed, or the paramedics arrive. It is a good idea to sit down with your family and anyone who regularly looks after your children, and talk through the steps of helping a choking patient. You never know when this vital information might save the life of one of your loved ones, or even your own.

“Remember, it is essential that emergency medical services are summoned as soon as possible when someone is choking because, if these steps do not work, choking can very quickly result in the person losing consciousness and suffocating. The sooner paramedics are called, the sooner they will arrive on scene and the greater the chance of a positive outcome.”

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