Brian Volckmann was packing for his family's move from Nashville to Spring Hill, Tennessee, a couple of years ago when he noticed that his 1-year-old son, Evan, had something in his mouth. After some coaxing, Evan parted his lips just enough to show the head of a one-inch nail that had apparently fallen out of the wall when his dad was taking down pictures. But when Volckmann finally got him to open his mouth again, the nail had disappeared. "I couldn't believe my kid had swallowed a nail right in front of me!" says the father of two.
He took Evan to the E.R. There, the doctor did an X-ray and saw that the nail was in Evan's stomach, not lodged in his esophagus or airway, so he recommended letting it pass on its own. A week later, when Evan had a follow-up X-ray, the nail was nowhere to be seen, and his parents never found the nail in his diaper. "It was as if it had never happened," says Volckmann.
Although Evan was incredibly lucky, not all kids are. Every year, about 100,000 children under age 4 are treated in the emergency room after they ingest or are injured by foreign bodies, according to the Centers for Disease Control and Prevention.
Don't Put That in Your Mouth!
Children are most likely to choke on small objects when they're between 6 months and 3 years old. Not only are babies and toddlers more eager to pop things in their mouth, but they don't yet have molars to chew food completely, so large chunks can get lodged in their throat or slip into their windpipe. Coins are the most commonly swallowed objects that cause problems, along with hard candy, peanuts, hot dogs, grapes, popcorn, small toys, and balloons. Warning signs that your child has something lodged in her airway or esophagus: coughing, gagging, trouble swallowing, and vomiting.
Fast-action steps If your child is coughing but is still able to breathe and make noise, let her try to cough the object up on her own. Don't interfere by raising her arms or patting her back. If she isn't able to expel the object after a few minutes, call your doctor or 911. Immediately call 911 if she seems to be having difficulty breathing or is turning blue or losing consciousness, and then follow the steps in "Lifesaving First Aid," above. Call your pediatrician anytime you suspect your child may have already swallowed an item.
Medical treatment When something's stuck in your child's airway or esophagus (but she can breathe), the doctor will want to remove it right away. He may do imaging tests to locate the object and then push it into the stomach with a thin tube or pull it out with a tool that has a grabber or a scoop at the end. If the object is small and blunt, he may thread a balloon catheter past it, inflate the balloon, and pull the object out.
No! Not in Your Ears!
Fast-action steps If the object is visible and not lodged too deeply, tilt your child's head to the side and tell him to shake his head gently until it falls out. Don't reach into his ear with your fingers, tweezers, or a cotton swab; you could push the object deeper into the canal. Call a doctor if the object remains stuck.
Medical treatment Your doctor may treat your child in her office or send you to the emergency room or an ear, nose, and throat specialist. The doctor may use forceps to grasp the object, or slide a right-angle hook or wire loop behind the object to pull it out. Other techniques include applying suction to the ear canal and irrigating the ear canal with water or mineral oil. She may apply a topical anesthetic before treatment. Sometimes a child will need to have surgery in order to remove an embedded object.
Nothing in the Nose!
Small kids frequently stuff little toys, bits of food, and soft, pliable items such as blanket fuzz, wads of tissue, or modeling clay in their nose. Signs that your child may have something stuck up there: bad breath and foul-smelling drainage from one nostril.
Fast-action steps If you can see the item, gently grasp it with your fingers and pull it out, or apply gentle pressure to the unobstructed nostril and have your child blow her nose. Don't use tweezers or another tool to try to dislodge the object because you could end up pushing it farther into the nasal cavity. Call the doctor if you are unable to remove it.
Medical treatment If the object isn't wedged too tightly in your child's nostril, your doctor may place a respirator mask over her mouth and send a puff of air through it to expel the object. Depending on what's up there, the doctor may also decide to use forceps, a balloon catheter, or an instrument that has a scoop or a loop at the tip to pull the item out. If your child has gravel, sand, or other loose debris up her nose, the doctor may try to flush it out with water.
Lifesaving First Aid
Take a CPR class so you'll know what to do if your child swallows an object and is unconscious. Every second counts. If your child is choking -- and unable to breathe, cough, or cry -- call 911 and then follow these steps.
Place your child face down on your forearm with your hand supporting her head and neck. Support her so that her head is lower than the rest of her body.
--With the heel of your free hand, give five firm back blows between her shoulder blades.
--If she still can't breathe, place your free hand on the back of her head with your arm along her spine, and position her on her back, keeping her head lower than her body.
--Using the pads of two or three fingers just below an imaginary line between her nipples, give five smooth thrusts.
--Alternate back blows and chest thrusts until the object is dislodged.
Lifesaving First Aid
Ages 1 and Up
--Stand or kneel behind your child, place one arm diagonally across his chest and lean him forward. Firmly strike between his shoulder blades with the heel of your other hand five times.
--Next, wrap your arms around your child's waist, make a fist with one hand and hold it with your other hand.
--Place the heel of your hand just above his navel, well below the bottom tip of his breastbone and rib cage. Then give up to five quick upward abdominal thrusts until the object is expelled.
--If the object remains lodged, continue alternating five back blows and five abdominal thrusts until the object is dislodged.
How to Protect Your Curious Kid
1. If your child is under age 4, don't give him nuts, seeds, popcorn, raisins, hard or sticky candy, chewing gum, whole grapes, hot dogs, or any raw fruits, vegetables, or other round, firm foods unless you cut them into pieces no larger than one-half inch.
2. Watch your child carefully during meals and at snacktime. Teach her to take small bites and chew completely before swallowing. Make sure that she sits while she's eating and doesn't play or run around with food or any other object in her mouth.
3. If your child is crawling, keep tables, counters, and floors clean, and regularly look under furniture, sofa cushions, and window blinds for small items that he could choke on. Teach older kids to pick up their toys and keep small items away from their younger siblings.
4. Watch your child especially closely if she has put small items in her mouth, ears, or nose in the past -- because she'll probably do it again. E.R. doctors say that many of the kids they treat are repeat offenders.
5. Follow all of the age recommendations and warning labels. Make sure that toys and parts are larger than the opening of a toilet-paper tube, or purchase a small-parts tester tube, a safety tool you can use to determine if a toy or a small part is safe for children under 4.
Originally published in the December 2009 issue of Parents magazine.
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