Choking & Development Disabilities: What You Need to Know

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“You talk very easily of hours, sir! How long do you suppose, sir, that an hour is to a man who is choking for want of air?”
– Charles Dickens

Choking is a major cause of respiratory emergencies and cardiac arrest in infants and children. But there are other individuals who are also at high risk for choking, such as those with severe learning disabilities, Down syndrome, people who have an incomplete dentition, the elderly and those taking a significant number of psychopharmacological medications.

The Wilton Volunteer Ambulance Corps would like to stress the importance of “foreign body airway obstruction” recognition because immediate identification and appropriate intervention is key to saving a life. In addition, everyone should be educated and trained how to distinguish choking from other emergencies such as fainting, cardiac arrest, seizure, or other conditions that may cause sudden respiratory distress, cyanosis, or loss of consciousness and be able to respond effectively.

In addition, many individuals with intellectual disabilities can be taught how to signal that they are choking as well as what to do should they begin to choke while alone. This type of training is especially important for individuals and families who have suffered psychological trauma from prior choking incidents.

People with developmental disabilities share a number of common characteristics that place them at high risk for choking such as:

  • Decreased or absent protective airway reflexes as occurs in cerebral palsy
  • Poor or underdeveloped oral motor skills that do not permit adequate chewing or swallowing
  • Gastroesophogeal reflux disorder (GERD), which may cause aspiration of refluxed stomach contents
  • Epileptic seizures
  • Inability to swallow certain fluid consistencies and/or food textures
  • Medication side effects that decrease or relax voluntary muscles, causing delayed swallowing or suppression of the protective gag and cough reflexes
  • Impaired mobility, that may leave individuals unable to properly position themselves for adequate swallowing

People with swallowing disorders are at a higher risk of aspiration (breathing food into the lungs) of food and liquids. Food that is difficult to chew or swallow because of its shape, size, or texture further increases the risk of aspiration or choking. People with swallowing disorders should avoid a variety of foods such as hot dogs, corn chips, grapes and nuts, just to name a few.

Care should be taken that individuals at risk for choking do not eat or drink too fast and that food is chewed well prior to swallowing. In addition, a reminder not to place too much food in the mouth is especially important.

The American Heart Association Recommends abdominal thrusts for treating a choking person who cannot speak, cough and who begins to turn blue or stops should be attempted. This is a thrust that creates an artificial cough. It may be forceful enough to clear the airway.

How to perform abdominal thrusts:

  • Lean the person forward slightly and stand behind him or her. Make a fist with one hand. Put your arms around the person and grasp your fist with your other hand in the midline just below the ribs. Make a quick, hard movement inward and upward in an attempt to assist the person in coughing up the object. This maneuver should be repeated until the person is able to breathe or loses consciousness.
  • If the person loses consciousness gently lay him or her flat on their back on the floor and begin CPR.

You are choking and you are alone:

  • You can deliver a true “self”-abdominal thrust with your own hands. This is done by positioning your hands in the same fashion as if you were performing the maneuver on another person and delivering an inward and upward thrust.
  • Another option is to bend your belly over a firm object, such as the back of a chair, and thrust yourself into the object.
  • You may pass out before you expel the object and before help arrives. In most communities, the 911 emergency system has what is known as enhanced 911. Whenever a call is placed through 911 (from a land line only, not a cell phone) to the dispatch center, the dispatcher has the phone number, address of the telephone, and owner of the line of the incoming call. If the dispatcher has no response on an open line, the call must be investigated.

Anyone who has had abdominal thrusts performed on them should be immediately examined by a medical professional. Thrusts must be forceful and may result in the person actually being lifted off the ground. It is traumatic to squeeze someone, particularly a loved one, with such force, but be assured that even if you do break a rib while performing the maneuver, it is the right thing to do.

The Wilton Volunteer Ambulance Corps Inc. is a nonprofit 501(c)(3) corporation.