Choking: 'I thought she was dying'
When her daughter started choking, the terrifying few minutes that followed showed Kate Hilpern just how unprepared we are for this common emergency. She shares the lifesaving advice every parent should know
Tuesday 24 May 2011
My three-year-old daughter loves blueberries almost as much as she loves ice cream. So one day when we'd come in from the weekly shop, I decided to push the boat out and give her both for pudding. She grinned as she held up her first spoonful to show me. The next thing I knew, she couldn't breathe.
The smoothness of the ice cream must have made the blueberry slide down her throat, where it lodged in her windpipe. Her arms and legs started moving in a frenetic, almost involuntary way I'd never seen before.
Her mouth was frozen wide open and her eyes were begging me for help. Scariest of all was the silence. The blockage was so airtight that she couldn't cough, shout or even splutter.
As I grabbed her out of her chair, I realised I hadn't got a clue what to do. Why, oh, why had I never got round to a bloody first aid course? Shaking, I reached for the phone, but who should I call? And did I have time? I threw the phone to the floor and acted on instinct instead. I sat on the stairs, leaned her forward and started whacking her back.
Nothing. When I turned her face towards me, it had turned a deep shade of scarlet and her eyes were bulging and watery. I began to wonder if she might die. I have never felt so desperate. I tried again. And again. And then it happened – the blueberry flew across the floor, landing under the radiator. She burst into tears and so did I.
We were lucky. Choking is the third most common cause of infant death in the UK, after road traffic accidents and house fires. This March, a boy of seven months died after choking on a marshmallow during a family meal at a restaurant in Hertfordshire. The same month saw parents of a toddler speaking out after the inquest of their toddler son, who died after choking on a piece of sausage while eating his lunch at a nursery in Huddersfield. He was left so brain damaged that four days later, they made the agonising decision to turn off his life-support machine.
One in two people don't know what to do when someone chokes, according to St John Ambulance.
"You could say the fact that half of all people do know what to do seems good. But actually it's really bad that more don't because the action you need to take is so simple," says Isobel Kearl, first aid development officer for St John Ambulance.
She adds that if it's your own child choking, you are inevitably going to panic. No question. "If you know how to respond, it gives you something definitive to do."
If the child is over 12 months old and coughing, she says, you should always let them continue. "It's the body's way of ridding itself of the object. The problem comes if they can't make any noise. That's the point at which to lean them forward, support them with your arm and hit them between the shoulder blades using the heel of your hand."
So far so good with my own instinct, then. The trouble would have come if the blueberry hadn't flown out, for you're only supposed to hit them up to five times. After that, you try the same number of abdominal thrusts.
"This basically involves standing behind the person and making a fist with your thumb inside your hand," explains Kearl. "Place it just above their belly button, then bring your other hand round the body and pull in and up in a scooping motion. If you've ever seen Mrs Doubtfire, you'll probably remember the scene when she does it."
If the thrusts don't clear the blockage (it's important to keep an eye on the floor in case you miss it), return to five of the back blows, repeating the cycle three times. That's the time to call an ambulance, continuing the cycle until the person becomes unconscious, at which point you need to start CPR.
The only difference with a child under 12 months is that you lay them face down along your forearm, with their head low, to do the back blows, and turn them over onto your arm, with the head still low, to do the abdominal thrusts – which should be done using two fingers in the middle of the chest pushing inwards and upwards. There's no time to waste. When choking occurs and the airway is blocked for 90 seconds to two minutes, brain damage can occur; after three minutes the person can die – as Louise Hill knows only too well. Her six-year-old son Toby suffered a serious brain injury that left him unable to walk or talk after picking a grape off another child's plate when he was two.
"I always cut up grapes for him and when I saw him take it, I was especially anxious because he was laughing. I was worried that would mean he'd swallow it whole. He did," she says.
Louise's instinct was to call an ambulance immediately and luckily for her, they arrived quickly. Her thumps to his back hadn't worked and so even by the time they arrived an incredible three minutes later, Toby was already unconscious. "But they said they could feel a faint heartbeat and that night, when he was in hospital, they thought he would be ok. They said that by morning, he'd have a sore throat, but that would be about it. But the next day came and he didn't wake up.
Almost a week later, they discovered he had fewer reflexes than a newborn baby and was in pain, so he was transferred to Great Ormond Street Hospital. Even three months after the accident, he couldn't see or voluntarily control any of his movements. He couldn't hold his own head or stop dribbling. Largely thanks to the Children's Trust, Toby has now started talking again and he can even take a step, albeit with support. "But he has no safety reflexes or balance and his concentration isn't good," says Hill.
About half of all choking accidents in young children involve food, with sweets and fish-bones the most frequent culprits. The number of incidents involving small parts from toys is also rising.
"Young children learn about the world around them by putting things in their mouths – it's part of normal development," explains Sheila Merrill, public health adviser for the Royal Society for the Prevention of Accidents (ROSPA). "But their airways are narrow and they don't yet have a full set of teeth."
No wonder prevention is seen as better than cure, with the Child Accident Prevention Trust advising parents of young children to particularly avoid ice cubes, nuts, whole grapes and large chunks of apple. "Hot dogs are often described as the perfect plug for a child's airway," adds chief executive Katrina Phillips, who says children should never walk around while eating and that you should always watch them, occasionally mimicking an exaggerated chewing action.
But with the best will in the world, you can't always escape risk, which is why it's so surprising that so many parents, like me, aren't clued up.
Sam Donkin has no doubt her first aid training – which she has to do because she runs a nursery school – saved her daughter's life. "She was about 15. We were in a restaurant and she suddenly went blue and couldn't breathe. I tried the blows and the thrusts that you're supposed to for what seemed like an eternity. There was a mirrored wall in front of her and she said she thought that was the end of her life. But one final really hard knock dislodged this bit of meat. I shudder to think what would have happened if I hadn't known what I did."
First aid courses range from three hours to several days and many specialise in infant and child first aid, but the take-up isn't as large as you'd think.
"Mostly it's because people think they won't need it or it won't happen to them," says Joe Mulligan, head of first aid at British Red Cross.
"But I think with some parents, there is a reluctance to learn because they don't want to confront the idea that they may need to use it on their own children. We get lots of parents signing up only after they've had a scare."
Like me. And despite Mulligan claiming that you can also learn a lot from first aid videos online, I've booked my morning of training for next month. I'm not taking any chances again. But I still can't quite work out how a researcher like me hasn't even researched what to do if my child is at risk. Every day, an estimated 40 under-five-year-olds are hospitalised after choking, so I admit I'm feeling very ashamed.
Choking in children and adults
The British Red Cross advises the following for anyone over one year old.
* Give five back blows between the shoulder blades with the heel of your hand.
* Check the mouth quickly after each one and remove any obvious obstruction.If the obstruction is still present:
* Give up to five abdominal thrusts. Place a clenched fist between the navel and the bottom of the breast bone and pull inwards and upwards. Check the mouth quickly after each one. If the obstruction does not clear after three cycles of back blows and abdominal thrusts, dial 999 (or 112) for an ambulance.
* Continue cycles of back blows and abdominal thrusts until help arrives and resuscitate if necessary. Any casualty who has been given abdominal thrusts must seek medical advice.
Burns : Cool the affected area by holding it under running cold water for at least 10 minutes. If the pain continues, put it back. This calms swelling and stops the area continuing to burn. Remove clothing, but if any is stuck to the burn, leave it on. Use either a clean, non-fluffy cloth or cling film for a dressing and no matter how small the burn, get it checked out, because a child's skin is far more sensitive than an adult's.
Nose bleed: Lean the child's head forward to allow blood to drain, and pinch the bottom part of the nose (not the bridge) to encourage the blood to clot. Continue for 10 minutes, reapplying for two further sessions of 10 minutes if the bleeding doesn't stop. If there is still bleeding after 30 minutes, get the child to casualty or the GP.
Broken, strained or sprained bones: If the bone is broken, keep the person still, in the same position you found them and get help. If it's a sprain or strain, use RICE – Rest, Ice, Compress (using a firm bandage) and Elevate. If you can't tell, assume it's broken.
Electric shock : Don't touch your child if they're still in contact with the electric source as you could get electrocuted through them. Switch off the electric current if you can. If you can't, move the child by standing on some dry insulation material, such as a phone directory, and then take something made from non-conductive material (wooden broom or newspaper, for instance) and push the electric source away. Check their breathing and apply CPR if necessary. Call an ambulance as even small electric burns can cause internal damage.
Seizures: Parents usually assume this is epilepsy and panic, but any child whose temperature rises too high can get a febrile seizure. Place soft things around the child so they can't hurt themselves and don't try to restrain them. Once they have stopped being stiff, they will start to shake and feel very tired – now remove their clothing and fan them down. Call an ambulance.
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