He Put What In His Mouth??

The mom came in with the ambulance crew, sobbing “She is so fast!”  Her 2 year-old daughter was skipping past dad as he watched TV.  She grabbed a piece of his popcorn and before anyone could react, tossed it in her mouth.  She suddenly stopped skipping, a look of surprise on her face, and began gagging and coughing before settling down to a steady wheeze.  The parents called 911, and she was brought in still struggling to breath. The x-ray showed the popcorn in her windpipe, just below her vocal cords.

It would take a surgery to reach down that far and get it out, so I made the calls and waited for the crew.  Meanwhile we stood by watching her struggle, not wanting to agitate her more, for fear that if she got more worked up, she could suck the popcorn further down and completely block her airway.  After an eternity of watching her breathe, watching her get more and more tired from the effort, the OR stretcher showed up.  Everything in surgery was ready, and off she went.  It took the surgeon a good hour to fish out the piece, but in the end the girl did well.

Toddlers are choking episodes waiting to happen.  First, they like to explore the world, and they explore it most with their mouths.  Their mouths are the most sensitive things they have, so everything gets licked and tasted.  If the object of curiosity fits, they pop it in for a really good going-over.  Second, toddlers have zero good-judgement.  They know nothing about what is safe to put in their mouths.  Dimes, electrical cords, bees, whatever they can put in, they will.

Finally, as we often say in this column, toddlers can not be watched every second of the day.  And they are doing potentially dangerous things all the time.  I myself have come home to the babysitter sobbing, “She is so fast!” when my toddler daughter, without warning, ran over and kicked my infant son.

There are some good rules for preventing choking episodes like happened with the girl above.  The first rule is not feeding your toddler unsafe foods.  Such foods are small, hard to chew, and too yummy for toddlers to pass up.  These are foods like candy, gum, nuts and seeds, hot dogs, hard meats, and small firm fruits and vegetables like raisins.

Toddlers and infants haven’t got many teeth to properly chew up these foods to make them safe to swallow.  Toddlers also, like we said before, have lousy judgement about what to eat.  Who cares if that hard candy is a choking hazard and bad for their teeth?  If it tastes good and is in your purse, they will fight you for it just the same.

Another good rule for toddler and infant eating is sitting down.  Small children should only be allowed to eat when they are sitting and being supervised.  No walking, playing, running, or lying down while eating.  Kids breathe harder and eat more carelessly when they are moving.  Just like the old joke about some adults being unable to walk and chew gum at the same time, toddlers can NOT safely walk and eat and breathe.  Not only are they safer sitting still when they are eating, but you can watch that only safe things are going in.

All homes with infants and toddlers should be swept for choking hazards.  Get down on your hands and knees and crawl around everywhere at your child’s eye level.  Pick up small objects that your child could inhale- coins, marbles, deflated balloons, small toy parts.  Particularly dangerous are button batteries and magnets- both can cause deadly internal injuries if swallowed.

Finally, all parents should take a CPR class to learn the Heimlich maneuver.  If our girl with the popcorn in her windpipe had suddenly stopped breathing, that would have been our best life-saving intervention.  The Heimlich is easy to learn, easy to do, and works great.

So be careful about what foods you let your toddler eat.  Get down on your hands and knees and clean house.  And sit your kids down anytime they eat- that way you can know What He Put In His Mouth.

3 thoughts on “He Put What In His Mouth??

    • Good question! We thought about it, but the heimlich rule is to do it if the airway is completely obstructed. This patient was “moving air” as we say, and stayed awake and hung in there until the surgeon arrived. However, if the patient suddenly stopped breathing because the popcorn moved and completely obstructed the airway, the heimlich was our next option.

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