In which I gently disagree with my colleagues

It appears that the American Academy of Pediatrics has some ideas about how to prevent choking.
Parents and caregivers should... be made aware of foods that could be choking hazards. The risk of choking depends on the shape, size and consistency of the item, along with the developmental and behavioral capabilities of the child. Many foods that are thought to be “kid friendly” are actually dangerous. Foods like grapes, popcorn and nuts can easily become lodged in a young child’s throat or lungs. Hot dogs pose the greatest risk, as they cause more choking deaths than any other food.

“If you were to design the perfect plug for a child’s airway, you couldn’t do much better than a hot dog,” said Dr. Smith, also a Professor of Pediatrics at The Ohio State University College of Medicine. “It will wedge itself in tightly and completely block the airway, causing the child to die within minutes because of lack of oxygen.”

So far, so good. All of this is entirely true. Hot dogs are not kid-friendly foods, at least not in their original conformation. Increasing awareness of this risk so parents can take proper steps to obviate the risk of choking is a good thing. Maybe not so good are these other recommendations:
According to the policy statement, the AAP recommends:
• Warning labels on foods that pose a high choking risk
• A recall of food products that pose a significant choking hazard
• The establishment of a nationwide food-related choking-incident
surveillance and reporting system
• A commitment from food manufacturers to design new food and redesign
existing food to minimize choking risk, to the extent possible

Er. Methinks this goes a wee bit far.

I don't have a problem with warning labels per se. While I'm not familiar with any evidence that they actually effect much change (and if anyone out there actually has data on this, please feel free to share in comments), neither would warning labels on hot dogs be terribly onerous.

The other three recommendations I think are patently ridiculous, and I can only assume are part of some quasi-Dadaist attempt to raise awareness of the issue by creating a stir about the crazy, alarmist AAP.

Aside from hot dogs (which I'll get to in a minute), the other foods mentioned by the lead author are grapes, nuts and popcorn. Proposing a recall of these foods is absurd. They aren't choking hazards because of a design flaw, unlike recalled toys. They're choking hazards because of how they are naturally formed. A recall would do... what? This recommendation is so laughable I can't believe it made it into the statement.

The same goes for a national surveillance and reporting system. Choking doesn't occur in outbreaks. If some child chokes on a hot dog on the beach in Malibu, it has no bearing on the choking risks of anyone else. Assuming that most children who have choking-related emergencies are given emergent medical care, the data on choking as a health risk is already available. I suppose one could posit some manufactured food that caused a wave of choking deaths, in which case there could possibly be some benefit to a reporting system. But again, the foods that are cited as being the worst risks have been that way forever and ever, and a surveillance system will have no impact on their inherent risk. (One could make an argument about toys, but the recommendation specifically says "food-related.") From what I gather, the FDA is already doing a decent job of covering issues related to new foods, so this seems like over-reach.

Which brings us to the proposal for a redesign. Again, this can only apply to hot dogs, unless there's a mutant nut research project going on about that I don't know about. Clearly, the way hot dogs are currently manufactured produces a risk of choking for children. It is a problem inherent in the design.

Which is why parents need to cut them up. Yes, an intervention is necessary to prevent injury. That intervention is most appropriately effected at the point of consumption by those who are most directly responsible for the care and safety of children -- their parents. While hot dogs do cause more choking deaths per year than any other food, the number is still very, very low. Rather than rejiggering an iconic food, consumed safely by untold millions of Americans every year, in the hopes of preventing less than 100 (admittedly tragic) deaths, it would be best if we focused more on discussing choking hazards at well child visits, and encouraged parents to communicate with other caregivers about what foods are safe and which are to be avoided, even on fun trips to the ballpark.


  1. What're you, kidding? Oscar Meyer should jump at the chance to manufacture a new food item. Introducing "vermicelli dogs" and "angel hair hot dogs" for those parents too lazy to chop the weiners into small pieces. Or, for those who don't want noodle dogs but too stupid to know how to cut hot dogs appropriately (cross sections themselves cut into semi-circles, in my view), we could institute a national training course. ;)

  2. I had the exact opposite response to this warning than the one intended. Huh, I thought. Choking is much much rarer than I thought. I've been really quite vigilant about it because I thought it posed a much greater risk.

    Not that I'm about to start stuffing entire hot dogs down my kid's throat. But still. I feel much more reassured than they probably want me to.

  3. I'm trying not to reveal how bemused I am that pediatricians aren't more concerned with what's *in* hot dogs than that 100 children die each year because their parents don't cut them lengthwise.
    Warning labels on grapes. I'd like to see how that would be worded.
    Could the medical establishment terrify us any more about pregnancy, childhood, and life in general? Jeez. Go fix pollution, or something, and leave the freaking popcorn people alone.
    And while I'm on this soapbox...30 million American children live in poverty. I don't think 100 choking deaths, from tubed meats, vine fruit, and exploded vegetables should be the AAP's focus.