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Pediatricians' alert focuses on choking dangers

The AAP's call to redesign foods like hot dogs and to require warnings on certain toys could reduce children's choking deaths.

By Christine S. Moyer — Posted March 11, 2010

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Pediatrician Garry Gardner, MD, has received countless phone calls at his Darien, Ill., practice from panicked parents with choking children. He also has treated young children who choked on hot dogs and peanuts.

"It's something we [pediatricians] deal with on a regular basis," said Dr. Gardner, who chairs the American Academy of Pediatrics' Committee on Injury, Violence, and Poison Prevention.

This is why, he said, the AAP's updated policy statement on choking prevention is so critical for physicians and others. The statement, published online Feb. 22 in Pediatrics, details what steps should be taken to prevent food- and toy-related choking among children age 3 and younger (link).

The AAP is calling on food manufacturers to redesign products, including hot dogs, and wants the government to label potentially dangerous toys sold in retail stores and online. The academy also recommends that the Food and Drug Administration require warning labels on foods that pose a high choking risk to children, recall food products with a significant and unacceptable choking hazard, and establish a national surveillance and reporting system warning the public of food-related choking hazards.

The Consumer Product Safety Commission should work with manufacturers to improve the effectiveness of recalls of products that pose a choking risk to children and increase efforts to prevent the resale of these recalled products on online auction sites, according to the AAP.

Physicians are urged to intensify choking prevention counseling and continue guiding parents on age-appropriate food and toy selections for their children.

"The idea is we need to start somewhere, and this policy statement for AAP was our way of saying, 'It's an important problem. Here's our position, and here's a call to action,' " said Gary Smith, MD, DrPH, lead author of the statement; immediate past chair of the AAP's Committee on Injury, Violence and Poison Prevention; and director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio.

Each year, about 66 to 77 children younger than 10 die from choking on food, according to the AAP. Food-related choking incidents also account for more than 10,000 emergency department visits among children age 14 and younger each year. The most common culprit for these incidents is the cylindrical, airway-sized hot dog, according to the policy statement.

The AAP says other high-risk foods include apples, chewing gum, chunks of peanut butter, hard candy, marshmallows, nuts, popcorn, raw carrots, sausages, seeds and grapes.

Dr. Smith said a draft of the policy was shared with the FDA and the Consumer Product Safety Commission before it was finalized.

In a statement, the FDA said it will review the AAP's recommendations and continue to work with the Consumer Product Safety Commission on assessing choking hazards associated with food. The FDA said it is "concerned about the deaths and serious injuries caused by choking" and will take action against unfit food products case by case.

The Grocery Manufacturers Assn. applauded the AAP for bringing attention to the issue but emphasized the role of physicians, parents and others in preventing choking among children. "We take our working relationships with FDA and [U.S. Dept. of Agriculture] very seriously and look forward to continuing to work with the agencies to ensure that our products are as safe as possible," the association said in a statement.

The American Meat Institute is considering AAP's recommendations, but hot dogs are an iconic food known for their distinctive shape, said AMI spokeswoman Janet M. Riley, who also is president of the National Hot Dog and Sausage Council.

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