Choking

Distractions While Eating

Eating while distracted—such as laughing, not chewing food properly, or being preoccupied with external activities—can significantly increase the risk of choking.

Swallowing Non-Food Items

Occasionally, swallowing non-edible objects might pass through the system unnoticed. However, such objects can become lodged in the esophagus or block the airway, leading to choking.

Dysphagia (Difficulty Swallowing)

People with dysphagia are at risk of food, liquid, or saliva entering the wrong passage, which may obstruct the airway, making it difficult to breathe and triggering coughing or choking.

Neurological and Muscular Disorders

Conditions like cerebral palsy and seizure disorders elevate the likelihood of choking. Damage to the nervous system can interfere with the proper functioning of the nerves that control swallowing.

Gastroesophageal Reflux Disease (GERD)

GERD is a condition where stomach acid continuously leaks into the esophagus. In some GERD cases, individuals may experience chest pain or trouble swallowing, along with the sensation of food being stuck or tightness in the throat.

Dentures

Poorly fitting dentures can hinder the ability to chew food effectively. Without properly chewing, individuals may unknowingly swallow large food particles, which could lead to choking.

A healthcare provider will begin by assessing the patient’s swallowing ability to determine the cause of choking and may recommend further tests and treatments.

Medical History

The healthcare provider will review the patient's swallowing history, focusing on the ability to swallow solid foods, liquids, or both. They will also inquire about the specific symptoms the individual is experiencing.

Laboratory Tests

• Swallow Tests: These tests help assess swallowing abilities by recording the time taken to drink water and the number of swallows required.
• Manometry and 24-hour pH Study: This test measures the functioning of the esophagus. A tube with pressure sensors is inserted through the nose into the esophagus to measure acid reflux from the stomach, helping determine the underlying cause of choking difficulties.

Imaging Tests

• Barium X-ray: The patient drinks a barium solution, which coats the esophagus, making it visible on an X-ray. This helps identify changes in the shape of the esophagus, providing a detailed view of the blockage.
• Endoscopy: A thin, flexible, lighted tube (endoscope) is inserted into the throat, allowing the doctor to visually inspect the esophagus for any abnormalities.
• Fiber-optic Endoscopic Evaluation of Swallowing (FEES): This non-radiation test is commonly used to assess swallowing disorders. It involves inserting an endoscope into the throat to check for blockages and evaluating swallowing using various food and liquid textures.
• Videofluoroscopic Swallow Study (VFSS): Also called a modified barium swallow, this test provides dynamic X-ray images of the mouth, throat, and esophagus, allowing evaluation before, during, and after swallowing.
• Computed Tomography (CT) Scan: This procedure uses X-rays to create detailed images of the neck's soft tissues and organs, including the muscles, throat, and airways.
• Magnetic Resonance Imaging (MRI) Scan: MRI uses powerful magnets and radio waves to create detailed images of the neck’s soft tissues and organs, helping to detect issues related to swallowing.

Prevention of Choking in Adults:

• Cut food into smaller, manageable pieces.
• Take time to chew food thoroughly.
• Refrain from laughing or talking while eating.
• Avoid consuming alcohol before and after meals.
• If you wear dentures, ensure you chew slowly and properly to prevent choking.

Prevention of Choking in Children:

Children under 4 years old are at an increased risk of choking, although older children may also experience choking incidents. Children with disabilities or chronic illnesses are particularly vulnerable.

Avoiding Choking Hazard Foods:

Children under the age of four are more prone to choking due to their lack of molars needed for grinding hard food into small pieces. They are also easily distracted and have narrower airways that can become obstructed. The following foods should be avoided for children under four:

• Hard fruits and vegetables like raw carrots
• Small, round fruits and vegetables like whole grapes, cherry tomatoes, and berries
• Sticky foods such as peanut butter or some spreads
• Pieces and bones from meat, chicken, or fish
• Round foods like hot dogs and sausages
• Whole nuts and seeds
• Foods that are hard to chew, such as chips, cookies, candies, and popcorn

Making Food Safer to Eat:

• Peel fruits and remove seeds.
• Grate or cook hard fruits and vegetables like raw carrots and apples to soften them, then cut into small pieces.
• Serve tender, moist meats that are cut into smaller pieces, removing all bones.
• For children under four, provide finely chopped or crushed nuts and seeds.

Supervision While Eating and Drinking:

• Ensure your child is seated properly while eating or drinking.
• Never allow a child to eat while walking, running, lying down, or in a moving vehicle.
• Maintain a calm mealtime environment with minimal distractions, encouraging proper chewing.
• Do not let babies drink milk from a bottle while lying down as this may cause the liquid to enter the lungs, increasing the risk of choking.

Avoiding Non-Food Choking Hazards:

Young children explore by putting objects in their mouths, which increases the risk of choking. To create a safer environment:

• Keep small, round items like buttons, bottle caps, coins, jewelry, magnets, and marbles out of reach.
• Regularly check for broken toy pieces in areas where children play.
• Follow age recommendations on toy packaging.
• Teach children not to put small objects in their mouths during playtime.
• Encourage kids not to place pencils, crayons, or erasers in their mouths while coloring or drawing.
• To childproof your home, get down to a child’s level and ensure there are no dangerous items within reach.

Specialists to Visit:

Choking can occur for various reasons, and if choking incidents are frequent, specialists can help identify the cause and offer appropriate treatment:

• General physicians
• Neurologists
• Gastroenterologists
• Pediatricians (for children)

Neurologists specialize in conditions affecting the brain, nerves, and spinal cord. Gastroenterologists diagnose and treat disorders of the stomach and intestines. Pediatricians provide medical care for children from birth to age 18.

When to See a Doctor:

Consult a doctor immediately if you experience:

• Difficulty breathing
• Difficulty swallowing
• Confusion or disorientation
• Pain in the neck or throat
• Persistent coughing
• Fatigue
• Noisy breathing

The primary focus when managing choking is to remove the obstruction from the airway. Additionally, addressing any underlying causes is crucial in preventing recurrent choking episodes.

1. The Heimlich Maneuver

If the person is coughing forcefully, encourage them to continue as it may help dislodge the object.

If the person cannot cough, speak, or breathe, they need immediate intervention. Perform abdominal thrusts, also known as the Heimlich maneuver, to prevent suffocation.

Steps for the Heimlich Maneuver:

• Stand behind the person who is choking.
• Wrap your arms around their waist and bend them forward.
• Make a fist and place it just above their abdomen.
• Cover your fist with your other hand and apply a quick inward and upward pressure.
• Repeat the maneuver at least five times.

2. Cardiopulmonary Resuscitation (CPR)

CPR is used when a person becomes unresponsive and is either not breathing or only gasping. It is a life-saving procedure that includes chest compressions and rescue breaths.

CPR for Adults

If you're trained in CPR, including rescue breaths, you should administer both chest compressions and breaths. Otherwise, you should focus solely on chest compressions.

Hands-Only CPR (Chest Compressions)

To perform hands-only CPR:

• Kneel next to the person and place the heel of one hand in the center of their chest.
• Place your other hand on top and interlock your fingers.
• Position your shoulders directly above your hands.
• Use your body weight to compress the chest about 2 to 2.5 inches.
• Allow the chest to return to its original position between compressions.
• Perform compressions at a rate of 100 to 120 per minute until help arrives.

CPR with Rescue Breaths

In CPR with rescue breaths:

• Place your hand in the center of the person’s chest and the other hand on top.
• Press down about 5 to 6 cm and perform 100-120 compressions.
• After every 30 compressions, give 2 rescue breaths.
• To give a rescue breath, tilt the person's head back and lift their chin. Pinch their nose and seal your mouth over theirs. Blow steadily into their mouth for about 1 second.
• Continue the cycle of 30 chest compressions and 2 breaths until the person recovers or medical help arrives.

Note: For children, CPR with rescue breaths is recommended.

3. Intubation

If the Heimlich maneuver is not effective, a breathing tube may be inserted into the trachea to clear the airway and allow air to reach the lungs. If this fails, a surgical procedure called cricothyrotomy may be necessary, where a tube is inserted through an incision in the neck to establish an airway.

If choking is not addressed promptly, it can lead to the following complications:

Aspiration Pneumonia:

This lung infection may develop after accidentally inhaling a small food particle, causing irritation or damage to the lungs.

Hypoxia:

A severe complication, hypoxia can occur from a blocked airway, leading to respiratory arrest, anoxic brain injury, and potentially death.

Abdominal Injury:

The Heimlich maneuver, used to help dislodge a blockage, may cause injury to the abdomen or result in stomach contents being regurgitated.