By Agnes Kyotalengerire
BEATRICE Othieno, a first time mother, recalls the day she was called back home to attend to an emergency. Her baby had swallowed a tyre of his toy car and choked to death.

Dr. Nambasi Nkalubo, an ear, nose and throat specialist at Mulago Hospital, says all children are at risk of choking. Dr. Micheal Aubwa, an ear, nose and throat specialist at Mulago Hospital, says 90% of the deaths from choking occur in children younger than five years.

“Children easily choke on objects because they have small airways and do not have a lot of experience in chewing, so they tend to swallow things whole.

Choking occurs when something gets lodged in the trachea (the airway), preventing air from flowing normally in and out of the lungs. The trachea is protected by a small flap of cartilage (epiglottis).

The trachea and the oesophagus share an opening at the back of the throat and the epiglottis acts like a lid that shuts over the trachea every time a person swallows. It allows food to pass down the oesophagus and prevents it from going down the trachea.

Once in a while, the epiglottis does not close fast enough, so an object can slip into the trachea.

Aubwa says if food or an object partially blocks the trachea, it is likely that it will be coughed up, and breathing will be restored a few seconds later. “But sometimes an object can block the airway. If airflow into and out of the lungs is blocked, and the brain is deprived of oxygen, choking can become a life-threatening emergency,” he says.

Signs of choking
Inability to speak, cough, cry, or make noise
Weakness
Difficulty in breathing or high pitch inhalation
Loss of consciousness
Gasping or wheezing
Blushing
Grabing the throat and waving
Panic

Prevention
Keep objects and food that poses choking risks out of children’s reach
Keep an eye on your child as he eats
Serve a child’s food in small portions. Teach children to sit and not to talk or laugh as they eat

Choose safe, age-appropriate toys. Follow the manufacturer’s age recommendations
Learn and practice abdominal thrusts and child resuscitation (chest compressions).

First aid
If the airway is partially blocked, a child can cough, talk or breathe. Encourage a child to cough, but do not slap the back because this might push the object further down.

If the airway is totally blocked, a child is unable to cough, talk or breath. Call for assistance while you follow the steps below:

Kneel and place the baby, face down along your forearm. Rest your forearm on your thigh so that the baby’s head is lower than the body and support the face in your palm. Slap the baby firmly up to five times between the shoulder blades.

If the slaps are unsuccessful, hold the baby’s head with one hand and turn the face up to lie on your arm

Keep the baby’s head lower than the body, with the back of the head in your palm. If there is no foreign object in the mouth, place two fingers on the centre of the baby’s chest, between the nipples and give five quick downward chest thrusts

If the baby is conscious but still unable to cough, talk or breathe, repeat the back slaps and do five chest thrusts until the object is dislodged.

If the baby is unconscious, place him face-up on the floor. Open the airway (head tilted and chin lifted) and check for breathing. If the baby is breathing, turn him onto his side as you wait for help

If the baby is not breathing, open the mouth and carefully remove any visible foreign object. If you cannot see the object, do not push your fingers into the mouth.

Put your mouth over the baby’s mouth and nose and give one breath per second. If there is no breathing or movement start resuscitation while you look out for an object each time you open the airway.