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The American Academy of Pediatrics issued a policy statement this week on choking prevention, which includes a recommendation for the government to oversee food choking hazards. After all, they regulate non-food choking hazards such as toys and games, so why not food? The AAP also issued a request to the food industry for the redesign of foods that pose an exceptionally high choking risk for children. Among the worst offenders? Hotdogs top the list, followed by hard candies, popcorn, nuts, peanut butter, and anything hard, sticky or chewy. In other words, your toddler can bite but not chew, so carrot sticks, chunks of apple or hunks of cheese are all risky items. Now I completely understand the AAP’s position from one standpoint: if we label non-food items and have a system in place to quickly identify newly-emerging hazards, why don’t we do the same for edibles? It’s a bit ridiculous that a marble comes with a big warning label on it but a gumball is marketed towards children. A few years back, it was found that a particular chewy gel candy was responsible for several choking deaths in children but it took much longer to link the cases and have the product pulled from store shelves than it would have if the offending item had been, say, a mascara wand. Wouldn’t it make more sense to label the things that people actually intend to put in their kid’s mouth?

On the other hand, where do we draw the line? There is no piece of solid food that I can think of that a little one couldn’t at least partially choke on. If we label the most offensive choking risks (such as the hotdog which is the perfect size and shape to completely plug the airway and is nearly impossible to get back out before it’s too late), are we going to make parents complacent about other food items that may not be quite as risky but can still pose a hazard? Or should we slap a sign on door of your local Safeway declaring the entire place to be a danger zone? I really don’t know the answer to this but I am going to use this forum to remind you of the most dangerous choking risks in your kitchen and beseech you to take extra care when feeding your kiddo. Hotdogs should be sliced lengthwise and into small pieces. Grapes get cut in half or quarters. Anything that can’t be mushed with a little tongue shouldn’t be bigger than mini-bite-size. Things that are sticky or gummy can clog up the throat. Don’t let kids run around when eating (which, is by the way, possibly one of the greatest choking threats!). Cookie Monster feedings and speed contests are not appropriate at the dinner table. Just use your brains.

So until the government decides whether it wants to get involved or until Oscar Mayer decides to redesign the dog (into what, exactly, I don’t know), use common sense. You wouldn’t give your kid a cold beer at a barbeque, so why give him a hotdog? Some foods are just not a good idea for a little one unless they are sliced, mushed, peeled, chopped, diced or blended. Don’t be afraid to keep kid-unfriendly food out of your child’s way. More for you that way.

Dr. Lara Zibners, Feb 25, 2010

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When your body gets sick, the immune system kicks in to start fighting the infection and runs a messenger up to the brain’s temperature center telling it to jack up the heat and help get rid of the bad guys. Therefore, when a fever is the result of being ill (as opposed to being locked in a hot car or some other outside cause of fever), it is the body’s own doing. And the body is not going to do anything to harm itself. Therefore, you should think of fever as a symptom, not a bad thing in and of itself. But parents often lose sight of this and focus on the fever, growing more and more fearful as the numbers grow higher. Pediatricians call this fear of the thermometer “Fever Phobia.”

Fever is a worry for certain groups of kids. If your child has other health problems that affect the immune system, such as cancer, then a fever with no other symptoms would prompt a call to the doctor. A baby under 3 months with a temperature of 100.4 F or higher also gets seen by the doc, and babies under 28 days usually have to spend a couple days in the hospital to make sure there isn’t a serious infection. But for kids over 3 months who are otherwise healthy, the presence of a fever is not nearly as important to me as how the kid is otherwise acting. I don’t worry about 104 F, I worry about how a kid is breathing, whether she is drinking enough to stay hydrated, if she’s showing any interest in the TV or playing games. Kids who are working to breathe, are very irritable or very lethargic or who have other worrisome symptoms need to be seen, regardless of whether their fever is 100 or 106.

Of course, fever makes us feel cruddy and a high temperature can make a kid breathe funny or be very irritable. While some doctors argue that you shouldn’t treat fever because fever can be beneficial to the immune system, I would say that if your kid acts like the fever is making him uncomfortable, go ahead and treat him with an age and weight-appropriate dose of an over-the-counter fever reducer such as ibuprofen or acetaminophen. (Aspirin is not appropriate for treating fever or pain in kids). Then if he is still acting really ill once he’s more comfortable, that is the time to put in a call to the pediatrician.

I’ll just end it here because I could go on and on and on. I did a whole chapter on fever and probably could write a whole book about why fever is scarier than it ought to be. We’ll address some more of this in the weeks to come because I’ve just got bunches on this one.

Dr. Lara Zibners, Feb 19, 2010

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