Carrots and apples and cookies, OH MY!
Dear parents of young children,
We need to talk about choking.
I know many of you are nervous to give your tot foods he can hold in his hands when you spend most of your day diligently chasing him to make sure he does not put small items in his mouth. It's scary and it's confusing! "How can I give my child a cracker when he might choke on a block the same size?!" "How can she possibly chew fruit with no teeth? "She gagged on a cracker so she’s not ready!" "It's dangerous..."
I know it's scary. I know because you tell me. As a feeding therapist and a friend to many new parents, I have listened to these fears. I also see it in your eyes when I suggest trying a piece of fruit or a cracker for the first time. I hold your hand and reassure you as we watch your cherub explore the new solid. We watch your baby scale his first of many new mountains and stumble and get back up. It is no doubt scary.
However, there is a difference between scary and dangerous.
I know I can't possibly understand what it's like to give a child of my own something so potentially dangerous! That’s true, but I can tell you that I have watched someone I love choke. My mother choked on a cookie while we were walking in a mall when I was 12. It was terrifying. I started screaming and a Good Samaritan gave my mom the Heimlich to expel the piece of white chocolate macademia lodged in her trachea.
Why are you telling me this horrible story while telling me not to worry about choking?!
First, to tell you that I understand why you are scared, the fear of choking is real and visceral. I get it.
Second, to make a plug for taking a first aid and CPR course so you know what to do 'God forbid' something does happen to your child or anyone else around you. (Thank you to that Good Samaritan at Garden State Plaza in 1995 whoever you are!)
Third, to point out that choking can happen at any time and at any age, but certain circumstances make it more likely. I know you are concerned about giving your 1-year old a cracker, but I am much more worried right now about your 3-year old walking around with a bowl of grapes** or running while eating fruit snacks. If you want to implement one rule that will help reduce your child’s risk of choking, try my favorite rule: "You sit when you eat". Your toddler can eat snacks or run around but not at the same time. Your preschooler can try eating a carrot like a rabbit but not while hopping around like one. She can sit on your lap, a couch, a park bench or the ground! She just needs to be sitting.
I know that children don't like rules we don't follow ourselves. (You could try to implement it as a household, which would probably be the latest fad diet since it reduces snacking. However, it's probably not very realistic in our harried lives).Your rules do not have to apply to you though. There are kid rules, and that is okay! You do not have to hold an adult's hand when you cross the street because you are one. Likewise, you don't have to sit while you learn to eat because you learned to eat; your children are still learning!
Eating takes a lot of cognitive effort and attention before it becomes automatic. Your child needs to focus his attention on the act of eating and all the oral motor skills and sensory integration it requires. Like with any other complex motor activity, mastery requires experience. Which brings up my last point, the Herculean task of eating takes practice.
Practice with different textures and sizes of foods helps your child learn how to control his tongue and more safely navigate food around his mouth. Jarred “babyfood” does not give him this practice. If your child does not encounter solid foods until he is 16 months, he is not going to magically know how to control it in his mouth because he is chronologically older. He increases his skills through practice. Improved skills mean safer eating and lower risk of choking!
Practice won’t always be pretty. When a child learns to ride a bike, she will often fall off several times. Likewise, you will watch your child spit, sputter, gag and maybe vomit. However, gagging is not choking. Gagging can look scary, but it is amazingly protective! Eating safely means that a child learns how to get food out as much as she learns to chew and swallow safely. The gag reflex on an infant is much closer to the front of the tongue than ours is, and it is only through mouthing objects and foods (experience!) that the gag reflex migrates further back on the tongue and ultimately to the back of the throat.
So, if you offer your child a new food and she starts gagging, sit on your hands for a moment and let her practice getting it out before rushing in to help. Put on your best flight attendant face (the one that hides your fear inside) and then celebrate her trying a new food! Your tot will most likely react to your concern more than her gag reflex, so try your best to stay positive and cheery even if you are flailing on the inside. There is a lot of research that confirms just how reactive a child is to your emotions (check out Joseph Campos’s work https://www.youtube.com/watch?v=p6cqNhHrMJA). Your tot may not try a new food simply because your facial expression is saying “Beware!”.
Parents, I know how little support there is for you in this endeavor. I do not mean to belittle you or to make light of the task of feeding. It is difficult and scary, and I have the utmost respect for how hard you work and how much you love your child! I wish I could be there for each of you to hold your hand through this, but do not be afraid to ask for help. Ask a family member, a friend or a neighbor to be there next to you while you give your infant a new food; you will feel better knowing you are not alone! Also, ask questions about feeding to other parents or the teachers at your child’s daycare. Feel free to write or call me with questions as well. It takes a village!
A caring and concerned OT
** As mentioned in previous post, certain foods are greater hazards than others.http://pediatrics.aappublications.org/content/125/3/601
American Academy of Pediatrics (AAP) has listed these foods as particular risks: Hot dogs hard candy, peanuts/nuts, seeds, whole grapes, raw carrots, apples, popcorn, chunks of peanut butter, marshmallows, chewing gum, and sausages
However, by cutting them appropriately, making sure your child is always sitting while eating/snacking and helping to model safely biting and chewing these and other foods, your child can learn to manage new foods safely.