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choking accidents are not witnessed by an adult. Food shouldn’t be used as a babysitter. Even if a toddler is safely strapped in the high chair, don’t give him or her a snack and then leave the room to take a shower or go on the computer. The child should be sitting up straight during meals and not eating while running, playing or riding in a car. Eating should be considered an activity in itself, not something that is done on the go. What should be done if the child is choking? If the child is unable to breathe — he or she is not crying or coughing — immediately call 911 and begin to perform the Heimlich maneuver. If the child is old enough to stand, position yourself behind the child, wrap your arms around the child’s waist and give inward/upward thrusts in the mid-abdomen. Repeat this until the object is dislodged or the child begins to cough or cry. An infant can be placed face down on your lap and given a few back thrusts, or can be laid flat on a table or the floor and given abdominal thrusts to dislodge the object. If the object is not dislodged and the child is not breathing, you can attempt to manually clear the airway if you see the object. To do this, place the child on his or her back on the ground and open the child’s mouth, pressing down with your thumb on the tongue and with your fingers wrapped around the lower jaw. Using your other hand, try to remove the object with a sweep of your fingers. This should be done carefully so as not to push the object farther down the airway. What if these efforts don’t work? Begin CPR, for which training is available through the Red Cross and other safety organizations. If the child seems to choke but then coughs, cries or vomits, that means he or she is breathing and there is no need to perform the Heimlich maneuver or CPR. You should, however, still seek medical attention. Many children can choke on an object and then seem fine, but the object may have become lodged in one of the bronchi, the wind passage to the lung, which requires medical attention. To learn more about choking prevention from Dr. Nina Shapiro and to hear the story of one patient, go to: chokinghazards Nina Shapiro, MD Vital Signs Fall 2014 Vol. 64 9