TE_CYS-07_Annex_F_MoreAboutTheTopicFoodRelatedChokingPrevention_20140929.pdf

IMCOM G9 CYS SERVICES SEP 14

What standard is this related to?

B.6.b.6 Food arrives in the classroom ready to be served. FCC Providers ensure food is ready to eat.

Guidance: Certain foods are not served (hot dogs, grapes, large chunks of hard food) for children under three years. Prior to food leaving the CDC kitchen staff/FCC providers prepare food which can cause a choking hazard not larger than ¼” square for infants/pre-toddlers (less than 24 months) and ½” square for toddlers (24-36 months). Soft finger foods for children who can feed themselves are appropriate without cutting into ¼” - ½” (ex., banana, steamed fish

(check for bones) or steamed vegetables that when squeezed between two fingers, turn to mush.

The Facts

Choking is the fourth leading cause of unintentional death in children under 5.

The most common cause of nonfatal choking in young children is food.

A child in the US dies every five days from choking on food, with infants being at the highest risk.

More than 10,000 children are taken to hospital emergency rooms each year for food choking injuries.

The size of a young child’s windpipe is the diameter of a drinking straw.

All of us must be vigilant in ensuring that food served to children in Army child development programs is appropriate for their age, and has been prepared in such a way to eliminate the choking risk. You, as Army

CYS Services staff and providers, play a key role in the prevention of such incidents.

The following foods are most responsible for sending children to the emergency room. 10% of these children require hospitalization. Hot Dogs and Nuts/Seeds are the two most common choking hazards responsible for actual hospitalization of children.

Hard Candy 15%

Other Candy/Marshmallows 12.8%

Meat other than Hot Dogs 12.2%

Bones 12%

Fruits and vegetables 9.7%

Formula/Milk/Breast Milk 6.7%

Seeds/Nuts 6.5%

Chips/Hard Pretzels/Popcorn 4.6%

Biscuits/Cookies/Crackers 3.1%

Hot Dogs/Sausages 2.6%

Bread 2.3%

French Fries .8%

All Other Foods 11.7%

So how do we make sure we have done all we can to prevent children from choking?

STEP ONE:

Know the developmental stage of each child in your program. It’s a lot more than just practicing Family Style Dining!

Be aware that children need:

o The ability to sit up straight when eating solid food. No feeding children who are lying on the floor! Infants and some children with special needs are particularly vulnerable to choking and may require adaptive equipment.

o A certain number of TEETH in order to CHEW and

SWALLOW so they won’t choke.

o To learn how to CHEW properly. Are you modeling chewing? Do you "take small bites", pause between mouthfuls, "stay seated while eating", and never talk with food in your mouth?

o A calm, unhurried, pleasant meal and snack experience that includes time to chew and swallow their food, AND to be directly supervised while eating. NEVER leave a child unattended while eating.

o To not be distracted by other tasks while eating. So no watching TV or playing with toys – focus on the mealtime.

experience!

Food-Related Choking Prevention

ANNEX F

STEP TWO:

Review your daily menu (including any special religious/medical diet requests) to ensure:

No foods are served that are not authorized by the Army (even if they are approved by the USDA Child and

Adult Care Food Program).

The foods you serve are not identified as choking hazards OR, if they are, there is a method to modify the food to make it safe (such as cutting sandwiches into halves or quarters or finely cutting leafy vegetables depending on the age).

STEP THREE:

Look for foods that are easily “substitutable.” While this list is not inclusive, it does provide information on some of the foods served in Army Child Development Centers and Family Child Care Homes.

WHITE Bread is a choking hazard due to the fact that it can form a round gummy ball on the roof of the mouth. It does not need to be cut in ¼” – ½” pieces, but is still a risk. Switch to WHOLE GRAIN Bread which is NOT a choking hazard.

Dense, hard crackers (such as graham or animal) can be choking hazards. Crackers that are “flaky” or “melt in your mouth” are not and don’t need to be broken into smaller pieces. NOTE: It is not the intent to cut hard crackers into ¼” or ½” pieces nor are they “banned,” however, you should break them into smaller pieces.

Look out for crackers that seem “perfect” to feed children such as small, round saltines. While they might be easy for children to hold, they are also just the right size to become lodged in a windpipe. Try a different size cracker.

Typically, no one chokes on one sunflower seed. However, seeds and nuts are most often consumed by the handful, which leads not only to a choking problem, but also the possibility that small seeds will be inhaled into the lungs.

Use nut butters instead as AGE APPROPRIATE. Follow the Army protocol when nut allergies are present. Nut butters pose a risk if served in hard “chunks.” Therefore, nut butters should be soft, spreadable and served in small portions. NOTE: It is OK to have an age-appropriate “science project” such as scraping out a pumpkin and toasting the seeds as a “taste test” during the fall harvest season. Activities of this kind should be done in small group, and closely monitored by the teacher. Do not serve nuts/seeds to more than a few children at a time. The American

Academy of Pediatrics does not recommend whole nuts/nut pieces for children under 7. And finally……

STEP FOUR:

Cut or soften the food to make it safe for young children:

Meat, poultry and hard cheese must be cut into ¼” (infant/pretoddler) and ½” (toddler) pieces. Older children should have small slices (cut against the grain as applicable).

Stringy vegetables such as string beans and celery and other hard vegetables such as carrots should be thoroughly cooked, blanched until soft, or cut into appropriate ¼” – ½” pieces for infants and toddlers. For preschoolers, these vegetables should be prepared in such as way as to eliminate the choking hazard such as in small pieces or sticks.

Fresh hard fruit should be served in manageable slices for preschoolers or pureed (such as applesauce) for infants/young toddlers instead of large chunks.

WHEN IN DOUBT, CUT IT UP!