We have been serving Oliver whole grapes (as opposed to cut grapes) since he was about 13 months old. Evidently, this is a big no-no.
Yesterday I sent him to daycare with a handful of grapes in his lunch. When I came to pick him up, I was pulled aside and told that the daycare will not serve whole grapes to children, even if the grapes are in a lunch that has been packed by the child’s parent. In future I can only include sliced grapes in Oliver’s lunches.
I wondered if this was a case of the daycare being overly cautious, or if I was being overly blasé. When we arrived home, I typed the words “children choking grapes” into Google and found the American Academy of Pediatrics’ most recent (2010) policy statement on choking prevention. The AAP stops short of giving explicit directions as to how long parents should continue to specially prepare “high choking risk” foods for their children, but reading between the lines, it sounds like four is the magic age:
“Children younger than 4 years… are at greater risk of food-related choking. Before the molars erupt, children are able to bite off a piece of food with their incisors but are unable to grind it adequately in preparation for swallowing. Children 3 to 4 years old have molars but are still learning to chew effectively. Children at this age also may be easily distracted when they need to pay full attention to the task of eating…
Behavioral factors may also affect a child’s risk for choking. High activity levels while eating, such as walking or running, talking, laughing, and eating quickly, may increase a child’s risk of choking… Games that involve throwing food in the air and catching it in the mouth or stuffing large numbers of marshmallows or other food in the mouth also may increase the risk of choking.”
I was curious: What are the actual odds of a young child choking to death on a grape — or any piece of food, for that matter?
It turns out that in the United States, between 66 to 77 children die from food-related choking incidents each year, and more than 10,000 are hospitalized.
This is a scary statistic, until you consider the leading causes of death in children aged newborn to 14, traffic accidents and drownings. Did you know that more than 1300 American children were killed in traffic accidents in 2009, and approximately 179,000 were injured? Or that in the four year period between 2005 and 2009, more than 700 children died in drowning incidents (an average of 176 per year), and five times as many were hospitalized with non-fatal submersion injuries?
A child is approximately 20 times more likely to be killed in a traffic accident or drowning incident than he is to choke to death on a piece of food!
When you also consider that children generally have much greater exposure to eating (about five times per day) than they do to being passengers in vehicles or being near water, the relative risk of choking “per exposure” becomes even smaller.
Statistics aside, how do we as parents balance our need to protect our children from harm with our children’s need to continually grow and develop? Some safety decisions are easy — car seats, bike helmets and life jackets, for example — but other decisions are not so black and white.
In the case of Oliver and the grapes, we will send sliced grapes to daycare. Given that the staff are responsible for the safety and well-being of a rather large group of toddlers (i.e. they cannot provide one-on-one supervision during mealtimes), and that different children have different levels of eating competency, I think their concern is valid. I don’t think they’re being overly cautious.
At home, however, we will continue to offer uncut grapes. Oliver has a full set of molars, and he chews his food with a proper side-to-side grinding motion. He doesn’t swallow pieces whole (diapers make this easy to verify :)) and he eats his food under close supervision, while properly seated — not while running around, playing or travelling in the car. And should a choking incident occur (it could happen to any of us at any age), I have made sure to keep current on my first aid.
Some parents believe that any risk to their children’s health and safety, no matter how remote, must be avoided if possible. I don’t. I think that calculated risks are healthy. Besides allowing more room for children to grow and develop, our own process of assessing risks teaches our children how to do the same.
And as long as I’m still strapping my kid into the car several times a week, I can hardly afford to get up in arms about the choking risks of grapes.
What sort of “calculated risks” do you take with your children, and why?