Monday, February 22, 2010

Redesign Hot Dogs? Huh?

Some pediatrician group suggests a major change in food: Pediatricians Want Redesign of Hot Dogs, Candy to Curb Kids' Choking :
The leading group of pediatricians in the United States is pushing for a redesign of common foods such as hot dogs and candies, along with new warning labels placed on food packaging, to help curb sometimes fatal incidents of child choking.

"We know what shape, sizes and consistencies pose the greatest risk for choking in children and whenever possible food manufacturers should design foods to avoid those characteristics, or redesign existing foods when possible, to change those characteristics to reduce the choking risk," said Dr. Gary Smith, immediate-past chairman of the American Academy of Pediatrics' Committee on Injury, Violence and Poison Prevention and lead author of the organization's new policy statement on preventing choking.

"Any food that has a cylindrical or round shape poses a risk," he pointed out. Smith said that hot dogs were high on the list of foods that could be redesigned -- perhaps the shape, although he said it would be up to the manufacturers to figure out the specifics.
Now, I'm a big fan of protecting children from hazards - but view that job as one best performed by parents - you know - unless there are mass deaths resulting from a risk not controllable by parents.

How big is the risk posed by cylindrical or round hot dogs, carrot sticks and hard candy? Are we killing thousands of kids or what?

Well, according to the Center for Disease Control here:
* In 2000, 160 children ages 14 years or younger died from an obstruction of the respiratory tract due to inhaled or ingested foreign bodies. Of these, 41% were caused by food items and 59% by nonfood objects (CDC, unpublished data).
 * For every choking-related death, there are more than 100 visits to U.S. emergency departments. In 2001, an estimated 17,537 children 14 years or younger were treated in U.S. emergency departments for choking episodes.
o Sixty percent of nonfatal choking episodes treated in emergency departments were associated with food items; 31% were associated with nonfood objects including coins; and in 9% of the episodes the substance was unknown or unrecorded.
o Candy was associated with 19% of all choking-related emergency department visits by children ages 14 years or younger; 65% were related to hard candy; and 12.5% were related to other specified types of candy (chocolate candy, gummy bears, gum, etc.). The type of candy was not specified in the remaining 22.5% of the cases. Candy was associated with 5% of all choking-related visits for infants less than one year of age; 25% of visits for children ages 1 to 4 years; and 28% of visits for children ages 5 to 14 years.
o Coins were involved in 18% of all choking-related emergency department visits for children ages 1 to 4 years.
o In 2001, 10.5% of children treated in the emergency department for choking episodes were admitted to the hospital or transferred to a facility with a higher level of care.
So, in one year, a total of 160 kids 14 years and younger died due to respiratory tract obstruction.  That's sad, but it is not an epidemic. Further, of these 160, 41% or 65 children died because the obstruction was "food items." Now, "food items" might include hot dogs - or it might not- it could include grapes, apples or chunks of steak. I should note that grapes are troublesome because they, like insufficiently chewed/chopped hot dogs or hard candy, can form a seal at the back of a throat.

What we can infer from emergency room visits is that 19% of the 65 food related deaths, or roughly13 deaths a year involve "candy." Of these, we can further infer that "hard candy" was involved in 8 deaths.

Yes, I'm cold-hearted, but see here:
Risk of choking is very low in children. The risk is highest in the oldest, but even in the oldest old the annual risk of death by choking is less than 1 in 1,000.

Risk of death

All of us will choke from time to time - eating too fast or too much, a cold, a laugh, something that surprises us, or no good reason. Few will die. However, fear of choking, especially in the young, has meant a rush of safety notices, especially catching Bandolier's eye in restaurants in New York city. The implication of these notices was that children were at particular risk, so we thought we would look for the evidence.
Data were available by age from the National Safety Council in the USA. If you root around on their website you can find a downloadable report on all causes of deaths in the USA - slightly more readable than the British version that uses codes. It allows calculations of risk in terms of 1 in X per year.


Figure 1 shows the results for choking deaths, with the annual risk of death in a motor vehicle for a comparison. Choking deaths are clearly age-related, while those in motor vehicles, by and large, are not. The greatest risk of death by choking is in the oldest old.

Figure 1: Annual risk of death by choking or motor vehicle in the USA, by age

It appears from the chart that children under 14 may actually be at a lower risk of choking than older people.

Another view here:
Childhood asphyxiation by choking or suffocation.
Source JAMA. 244(12):1343-6, 1980 Sep 19. Abstract
Medical examiner records were reviewed for 42 Maryland children younger than 10 years who died of asphyxiation from 1970 through 1978. Twelve children choked on food; six of these deaths involved hot dogs. Eight choked on
nonfood objects.
So, in an eight year period in Maryland, 6 deaths (50% of the total deaths) involved hot dogs. Eight deaths involved "nonfood objects." Under these facts, the logical thing to do would be to ban "nonfood objects." These include balloons and coins.

In any event, reshaping the hot dog, even if it's "up to the manufacturers to figure out the specifics," seems a bit extreme.

Parents- chop up or break up childrens' food -especially hot dogs, grapes, cherries, popcorn, chicken nuggets and the like.

And, as you get older and don't chew quite as well, you ought to do the same for your own food.

The rest of us can eat hot dogs just as they are, provided we chew our food.

Or we can all revert to strained peas, carrots and beets. Maybe we'll live forever. Except for car wrecks, cancer, heart disease, etc.

UPDATE: Or maybe hot dog packages should be clearly marked:

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