ON GRAPES AND RISK ASSESSMENT

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.

Daycare-approved grapes :)

Daycare-approved grapes 🙂

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?

22 responses to “ON GRAPES AND RISK ASSESSMENT

  1. My son sleeps with a stuffed animal AND a blanket. The stuffed animal I snuggled with a lot so that it would smell like me, and he won’t go to sleep in his own bed without it. And he gets cold when he sleeps so even if I put him in a sleeper he was still waking up because he was cold. The first time we put a blanket on him was the first day he slept for more than three hours at a time.
    To try to make it safer I use a knitted blanket so that even if it’s over his head he can breath easily, and the stuffed animal we used is a shark. It’s round and stuffed stiffly so there is no loose fabric for him to burrow into.
    Also, he has been rolling over and moving himself around since he was 2.5 months old. He can easily get away from something if it is uncomfortable for him, and does with quite a bit of vehemence. Honestly, he gets pretty pissed off if something gets in the way of his nose (which I find both hilarious to watch, and comforting).
    We are now considering bumper pads because he smacks his head against the side of the crib on a nightly basis. I am looking for an option that would soften the blow when he hits the side, but is not super fluffy. I am open to suggestions if you have any!

  2. We’ve had bumper pads on Oliver’s crib since the beginning — just the regular kind that came with the crib set. Watching him on the video monitor, I am convinced they are necessary for him. The number of times he’s clonked his head against the side of the crib while shifting positions in his sleep… I also think they make the crib more cozy and secure for him. He often likes to sleep cuddled up against them.

    If you’re worried about suffocation risk, you could always buy the breathable mesh bumper pads (I think Babies R Us carries them). They seem to be the best of both worlds.

    How does your son do with a blanket? I only recently put a blanket into Oliver’s crib, and he’s really not that good at keeping himself covered. Mostly he ends up sleeping *on* it. We have always had him in a sleep sack, though, which removes the variable of lost covers and keeps him toasty warm.

    • Drake snuggles his shark like that. It’s adorable. =)
      I’m not really worried about suffocation at this point (he is 7 months old, and quite able to move where he pleases), I wanted to do the mesh ones, but I don’t really see them helping with him bonking his head. Glad to hear you guys just used regular old bumper pads. I think that might help him be more comfortable.
      He does pretty good with his blanket! He frequently doesn’t want it on his feet so he works them out from underneath it. And he will wiggles around until he is either on top of it, or has it more beside him if he isn’t cold (he usually does this in his sleep). But it still keeps him warmer if he can snuggle in to it, and he has been working at picking it up and covering himself back up more recently.
      The sleep sacks are awesome, but little man hates them. It’s his weird foot thing. When we put him in sleepers now we frequently have to leave his feet out.
      If Oliver likes his sleep sack I say go with it! He might just like a little blanket to snuggle, but if not then those uber cautious parents that say not to give them anything until they are 2 will LOVE you =D

    • My 14 mo DS has slept with a blanket since he was about 6 months old and we haven’t had any problems. It’s a small blanket and pretty thin and he LOVES to put it on his face. Since it’s thin it’s not an issue (I think.) I did just sew him a sleep sack since it’s getting colder and I still give him his blanket.

  3. homemade knit blanket since she was 1 week old (and the same one at that!)
    she’s never woken up because she’s lost it. lately, because our house is pretty drafty, we’ve doubled up with a second blanket. no probs 🙂

  4. Having taken care of a kid that did choke on a grape and was not ok afterwards (vegetative) I cannot say I agree with you. Other things that I’ve seen in the lungs of young kids – lots of nuts, hard candies, coins, toy pieces. The usual suspects.

    Generally the kids I’ve seen who have choked on something (and I know this is anecdotal and not real data) have been two or three. I think they might be at greater risk than a younger kid because supervision is not as close.

    I cut grapes and tomatoes because its quick, easy, and I truly don’t believe there is any downside. I also know, from experience, that smooth skinned objects like that are some of the most difficult to remove and can blcok the entire trachea which is why they are so dangerous. Do you really think that cutting a grape in half will deny Oliver a valuable learning/ developmental experience?

    • A valid question, indeed.

      Along the same lines of why we initially introduced “real” solids instead of purées, I do feel that learning to handle increasingly mature foods is a valuable developmental process.

      But it’s always carefully guided by Oliver’s abilities. For example, we initially served quartered grapes, then halved grapes, then whole grapes; progressing as Oliver’s competence in chewing and swallowing improved. We still don’t serve him nuts or raw carrots, as I don’t think he is capable of handling either of those textures at this point.

      In terms of risk assessment, my perception (only my perception — I can’t find any actual stats on this) is that we more greatly reduce Oliver’s risk of a serious choking incident by insisting that he be properly seated whenever he eats; closely supervising his eating; and not allowing him to eat in the car. Of course he *could* choke while properly seated at the table, and so could an older child or an adult. To be honest, though, I am actually more worried about the four to seven year olds I see running around the playground with Ziploc baggies full of grapes than I am about my 15-month-old eating whole grapes at the table.

      I must say that I think there’s always a bit of confirmation bias at play for those who work in medicine and emergency services :), as there are so more opportunities to be exposed to the people who end up on the wrong side of a statistically minimal risk. For example, a friend told me of an ER doc who said he would never leave his children rear-facing in a car seat longer than legally required, after dealing with a child who’d suffered very serious injuries in a MVA while in a RF car seat. In the particular circumstances of that accident, the child would have been better off forward facing. Even though statistically, kids are five times safer in a RF seat, his experience told him otherwise. Likewise, if I personally knew someone whose young child was killed by choking on a whole grape, I would probably perceive the risk to be much greater.

    • I do give my 14 mo son bits of raw nuts. I let him bite off a piece of almond, walnut or peanut and he chews it with his front teeth and the molars that are starting to come through. I think it’s important for them to get used to different texture early. We are always there watching him when he is eating nuts.

      • Interesting. We haven’t tried pieces of nuts yet, only nut butters and nut meal (ground nuts), though I suppose that with his first set of molars, Oliver could probably chew small bits of nuts with little difficulty. Have you ever given your son slivered almonds? I’m thinking that might be a good place to start.

        • We haven’t given him slivered almonds just because we usually don’t have them on hand. We always have whole almonds but we just let him bite off a little piece that we hold. We’ve never just given him a nut to eat while he was sitting in his high chair. Although I would try the slivered almonds.

    • Thanks for posting – yes, there are some things we do that sometimes feel overboard, but not cutting grapes to prove a point also seems to be going a bit far. I had stopped cutting them, but after reading a few anecdotes, I feel this time saver is not worth it. Maybe only 100 kids die from this every year, but my kid isn’t going to be one of them. Most people who drive intoxicated don’t die either. Not a good enough reason to risk it.

  5. From your AAP link:

    “The most common culprit for these incidents is the cylindrical, airway-sized hot dog, according to the policy statement.

    “The AAP says other high-risk foods include apples, chewing gum, chunks of peanut butter, hard candy, marshmallows, nuts, popcorn, raw carrots, sausages, seeds and grapes.”

    The interesting thing about that is that except for grapes, it’s an alphabetic list. Like ‘grapes’ was stuck on at the end after a data-driven list was compiled.

  6. One child dies every five days from choking on something. We need to spread the word about life saving techniques and devices that can help. The heimlick maneuver often works and a new device called Life Vac which helps dislodge the obstruction and clear the airway. LifeVac.net

  7. I would like to stress that the biggest problem with the grapes is that they for just perfectly into the trachea of a toddler so that if they were to choke it is very likely that the Heimlich would not be able to help you. In this case I believe the risks definitely outweigh the benefits. What’s so difficult about cutting them in half? What’s so great about eating them whole? In the case of the bumpers there’s a good reason why you would want them and an actual risk of injury (albeit much less serious) when you don’t have them on the crib. I don’t think that’s comparable in the slightest to this situation.

  8. Obviously your child is onlder now but Wow…. I feel the need to comment… sorry if I am blunt but emotions are running strong at the moment 😦

    I have had 6 kiddos, foster kiddos and been an approved, registered, licensed (& solo) child care provider for over 30 years. My first experience with a grape choking incident was at the age of 15 when a close friend of my family, was feeding her foster child ‘fruit cocktail’ and the toddler choked terribly on a grape. Thankfully, the child survived. I never forgot it.

    What lead me to your post today, is that I learned of another little 2 year old girl, who choked on a grape last night and was not so lucky 😦 She died on her way to the hospital with a grape lodged in her airway.

    LIKELY, the reason the risk is so much higher in a car accident is BECAUSE there are NO OTHER OPTIONS BUT TO PUT THE CHILD IN THE CAR AND TAKE THAT RISK to get anywhere. —- There *ARE* OTHER OPTIONS, to feeding a toddler a grape (or other choking hazards) It is blogs like this, that encourage other young parents to practice unsafe feeding, and bad stuff happens 😦 MOST people think, and ACT appropriately… think about it- if MORE people fed their children irresponsibly= HIGHER CHOKING stats…. THANKFULLY, MOST people are responsible parents, and know what is not a good idea, & DON’T DO IT… these risk levels have fallen significantly since more awareness has been out there & MORE parents act appropriately on those statistics

    I NEVER give grapes to a toddler in my daycare UNLESS I PEEL them, then I QUARTER them. Over reacting? I dont think so! But I tell ya, I have pumped a couple hundred kiddos through my doors, and every single one left here breathing well, and smiling BIG. I will do ANYTHING to ensure NO CHILD will die on MY WATCH.

    Those statistics may not seem bad to you— until someone YOU LOVE *is* in statistic.

    I am not a neurotic parent/provider/grandparent, but am all for common sense parenting… I am not against a light blanket in a child’s bed etc., but you have to practice common sense!

    • I agree! There was a child in the UK who dies from choking on a grape- she was 6 and there was nothing wrong with her. The heimlich also didn’t help the parents.

  9. This article makes light of a serious potential life threatening action that can easily be avoided. I guess unless it has happened to someone you knows child it seems silly. But I know someone who will forever have a huge void in their life. If only that grape had been cut.

  10. It seems like the statistic you really want is what percentage of children who eat whole grapes before the age of four have a severe life threatening choking episode. If everyone is mostly cutting their grapes, then that number which seems so low, might actually still be very significant. Here is another question for you: When did you start forward facing your child in a car seat? I have found that these two things seem to go together, I know zero other parents who rear face their child to the recommended age of four. But the risk of death is five times higher with them forward facing! And this is the highest risk activity (riding in the car) that they do! I just don’t understand why people would want to take that risk. But basically everyone I know does.

  11. I spoke to a pregnant woman once, she was having some alcohol, she said it’s only a few babies who are affected by alcohol, I eat sushi too. Later when the baby was born (thankfully ok), she was giving her honey and tea, when I explained to her about botulism she said” my mom gave me the same thing as a child and I’m fine”. I wish people wouldn’t be so ignorant. Just because YOU think the risk is low, doesn’t mean you should encourage others to do it, that’s like saying give your child a knife because there’s only a chance he will actually die. “Calculated risks” are risks. You wouldn’t leave a bag with all your savings on your sidewalk, why would you take a risk with your most precious gift! The saddest part is that there may be some young parents who don’t know any better, read your post and then don’t take the right care to prepare food, what would you do if a child choked to death because of the “research” the parents got from here?

    Here is an article about a 2 year old who died in hospital 5 days after choking, and another girl was already 6 years old.: http://newsnewsblog.blogspot.co.za/2016/01/the-killer-in-your-childrens-lunchbox.html?utm_source=dlvr.it&utm_medium=facebook

    As for having good first aid skills that won’t always help because the grape is slippery so once it’s lodged in the heimlich maneuver will help very little, and the doctors will need to try and get it out, if you are lucky enough to get to hospital in time.

    I sincerely hope you stop taking “calculated risks” with life and also stop giving such advice to others!

  12. This article is dangerously misleading. I realize it is old, but it came up high in my search. The reason toddlers (children under 4) choke on grapes isnt because of the molars. It is because of the size of their esophagus. It is exactly grape size or smaller. So, in the unfortunate case of a grape getting lodged in it, it can be fatal. It drives me absolutely crazy when parents try to rationalize this by developmental stages of a child, i.e. “my child is an accomplished chewer and eater.” It is biological, not developmental. The size of the esophugus+grape=cant breath. Therefore, the idea that anyone can choke at any age doesnt apply to grapes. An adult could survive swallowing one whole, wheareas a toddler could not. I hope you consider researching and editing this as not to give parents a false sense of security about grapes and very young children. Thank you.

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