Wednesday, July 20, 2011

E is for Ernest, Who Choked on a Peach

(With my apologies to Edward Gorey)

Ah, gummy worms.  My two older children love making their “worms and dirt” dessert every year for the Halloween school fair.  (Gummies + crushed Oreos atop chocolate cupcakes.)  But imagine my surprise when I saw the teacher at Joseph’s daycare passing out gummy worms to all the 1-year-olds!  Aside from being concentrated sugar bombs, aren’t gummies a choking hazard?  Fortunately, she stopped handing them out when I pointed out the danger, but it got me wondering – what are the most common choking hazards in children?  I’m constantly scooping Jojo out of the Lego Room, lest Darth Vader finds himself lodged in his airway.

I started with a simple search for “gummy” on Pubmed, and got a respectable 158 hits.  Turns out almost all of these papers were about the treatment of “gummy smile,” which sounds like the kind of smirk you wear when you’re trying to chew Bubbalicious surreptitiously.  It’s actually a description of when a person flashes too much of his or her upper gums, vampire-style.  Not that this has anything to do with choking, but FYI, gummy smile can be treated with Botox or a medieval procedure called “miniscrew anchorage.”  I also uncovered a case report from the Journal of Emergency Medicine (they have the craziest cases in there!) about a patient with abdominal pain who had an abnormal CT scan after ingesting a bag of gummy bears from the hospital gift shop. 

I don’t think they ever uncovered the official cause of his abdominal pain, but maybe the hospital should stop selling gummies?

Since I couldn’t find any papers specifically about choking on gummy candy, I broadened my search to look at all causes of foreign body aspiration and asphyxiation (the medical terms for “choking”) in children.  One registry of over 700 choking injuries from 19 European countries found that 85% of foreign bodies were “organic” (meaning “food,” not meaning “from Whole Foods”), only 3% were due to toys or toy parts, and in 72% of cases, an adult was present during the event.  In other words, the most dangerous thing you can do to a young child is feed him.  Of course, what you feed him is the most important determinant of choking risk:  54% of foreign bodies were nuts, seeds, berries, peas, corns and beans, and 19% were fish bones and bones (though interestingly, in Finland, 69% of foreign bodies were fish bones).  Surprisingly, only 1 child died in this study, which was published in the European Archives of Otolaryngology.  Which foods are most likely to kill you, if you do choke on them?  To answer this question, I looked at an older article, published in 1984, in the Journal of American Medical Association.  Of 103 childhood deaths over a 3-year period, here were the most common culprits:

Hot dogs (17%)
Candy (10%)
Nuts (9%)
Grapes (8%)

So there it was – candy.  There wasn’t a breakdown of what kinds of candy were implicated, but that was enough for me to keep the worms out of Joseph’s reach, at least until he’s old enough to start going to Halloween school fairs.

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