Children and choking

[sarah707]

The death of a child during messy play at a nursery has really affected me.

Any death is desperately sad but it seems so much worse when it's a child

The Ofsted judgement that lack of supervision contributed to the child's death worries me and I have been thinking about how to protect myself and support colleagues in the aftermath of the inquest findings.

I have written this blog - Sarah's Blog: Children and choking ... some thoughts

The Nursery World article is here if you want to read more x

Ofsted says lack of supervision largely responsible for child's nursery death | Nursery World

[gwm]

I have always had very firm rules about the children and food. They must always be sitting down when eating....No eating along the street and no messing about at meal times. I have been cutting up grapes for years and cherry tomatoes. I won't leave them unsupervised for one second when they are eating.
My own LO will be starting Reception in September and I was thinking, is it time I stopped cutting up his grapes? It bothers me. But, I have become so 'scared' of the thought of any of the children choking (we have had two local cases here of children choking and dying...on a grape at supermarket....and meatball at school) that I think I will be cutting up grapes for years.
Of course, just to fuel my fear, when we visited a friend recently she offered the children UNCUT grapes and my own LO gagged on a grape. I know they have to learn to deal with whole grapes and cherry tomatoes .....and to be honest they probably can already. It is just my fear. The fact that I have done about five first aid courses over the years does not make it any better.

[hummingbird2014]

My lo actually chocked on a strawberry no breathing sounds and lips turning blue I soon got het by the ankles and cleared her airway while dialling 999 only got 99 in the phone and she started crying she's now 19months and I don't chop her grapes up. But I used to deal with stroke victims with swallowing difficulties so used to chocking people and I'm vet confident in my abilities for correct airway management. But this doesn't mean I'm lapsed with rules we sit down to eat an drink at all times and I still supervise them. Just sharing my experience xx

[alex__17]

I've also never cut up grapes or tomatoes once children have teeth although reading that everyone seems to panics me a bit! However I asked all my parents and none of them chop them either and kids all have to sit down while eating and I'm with them so I will most probably carry on like that. A friend's neice died from choking on a pasta twist which would never have been chopped up

[AliceK]

Thanks Sarah, your blog makes very thoughtful reading.

I am so paranoid about children choking on grapes as they are notoriously hard to dislodge, I always cut grapes up and cherry tomatoes and also sausages I cut length ways.
Each of my children have proper choked once, one on a piece of biscuit and the other on a piece of toast, luckily I knew what to do but it is very scary.

xxx

[tigwig]

I always cut up things like grapes. In my opinion this is a tragic accident. I don't think anyone was necessarily to blame. Yes the child should have been directly supervised but as we all know it is not always possible. I guess if it were me with an activity like that out children would always be supervised. But then I could clear it away and a child could pick up a stone from my big 'stone' pit and choke on that. Unfortunately children can and do pick up objects and put them in their mouths. What has happened to this child is truly awful but in all honesty I don't think any of us can ever make our environments 100% free of any risk and a guarantee that no child could ever possibly come to any harm.

[Simona]

Great sharing Sarah...we certainly have to reflect on and I am sure adjust our Risk Assessment to minimise the risk of choking
Free flow is something I have been reflecting on recently...it was widely used in the EYFS 2008 but not really mentioned in the 2012 version nor the 2014...I recall Truss saying clearly free flow was not required in EYFS...both frameworks recommend child initiated and adult led activities but free flow has to be implemented at times

One thought that has come to my mind is the difference between 'supervision' and actual 'engagement' by staff in an activity...personally I think there is a huge difference

This child was not properly supervised...or so the outcome says....if she had been seen choking someone would have acted but in nurseries not all staff are First Aid trained.
my experience is that there are nominated First Aiders but I know of nurseries where not all staff are trained in FA...I also read of settings that train all staff as good practice

Maybe one lesson to be learnt is that ALL practitioners attend the training and choking be given a special time during the training
Another lesson would be to make certain activities...where there is a potential choking risk...always led by an adult...snack comes to mind or anytime children eat ...for me that has to have a clear boundary and that children sit and not walk around munching on food...most cms I think do that
My view of course

[angeldelight]

The death of a child during messy play at a nursery has really affected me.

Any death is desperately sad but it seems so much worse when it's a child

The Ofsted judgement that lack of supervision contributed to the child's death worries me and I have been thinking about how to protect myself and support colleagues in the aftermath of the inquest findings.

I have written this blog - Sarah's Blog: Children and choking ... some thoughts

The Nursery World article is here if you want to read more x

Ofsted says lack of supervision largely responsible for child's nursery death | Nursery World

Like I said brilliant Sarah

You should get lots of replies agreeing I'm sure

Angel xxx

[angeldelight]

Great sharing Sarah...we certainly have to reflect on and I am sure adjust our Risk Assessment to minimise the risk of choking
Free flow is something I have been reflecting on recently...it was widely used in the EYFS 2008 but not really mentioned in the 2012 version nor the 2014...I recall Truss saying clearly free flow was not required in EYFS...both frameworks recommend child initiated and adult led activities but free flow has to be implemented at times

One thought that has come to my mind is the difference between 'supervision' and actual 'engagement' by staff in an activity...personally I think there is a huge difference

This child was not properly supervised...or so the outcome says....if she had been seen choking someone would have acted but in nurseries not all staff are First Aid trained.
my experience is that there are nominated First Aiders but I know of nurseries where not all staff are trained in FA...I also read of settings that train all staff as good practice

Maybe one lesson to be learnt is that ALL practitioners attend the training and choking be given a special time during the training
Another lesson would be to make certain activities...where there is a potential choking risk...always led by an adult...snack comes to mind or anytime children eat ...for me that has to have a clear boundary and that children sit and not walk around munching on food...most cms I think do that
My view of course

That's very true Simona about nursery staff not all first aid trained

It never fails to amaze me to be honest

My daughters work in a nursery and some of the staff are not trained ...why ??

Madness

Angel xxx

[rickysmiths]

It is very interesting reading.

I have always cut up grapes and any other food for small children including pasta, in fact I buy small pasta shapes for the under threes. I was taught to peel fruit as well, apples and pears especially as the peel can stick in their throat and it can cut their throats as well so I peel for all under fives.

I do wonder why cubes of jelly were left out so children could help themselves and I must say there are many other safer sensory opportunities you can offer under 3s. cubes of jelly wouldn't be one of mine. I would make up the jelly maybe a bit less water than if you were going to eat it and then break it up on a tray or in a bowl for them to explore.

I thought all cm sat with their children when they ate? I know I attended a Healthy eating workshop when the free snack system was being encouraged in all Nurseries, that is a table of snacks and a jug of water and cups is left out all through they day for children to access when they want so they play is not interrupted by stopping for a snack at a set time. I must say my jaw dropped at the possible disadvantages of a system such as this on many levels! I have drinks available all the time but with all under 2s at the moment they are in cups on the table I can't imagine the benefits of having fruit etc out and available to graze on all day and out in this heat!!! Never mind the chocking hazards of it all.

[Simona]

It is very interesting reading.

I have always cut up grapes and any other food for small children including pasta, in fact I buy small pasta shapes for the under threes. I was taught to peel fruit as well, apples and pears especially as the peel can stick in their throat and it can cut their throats as well so I peel for all under fives.

I do wonder why cubes of jelly were left out so children could help themselves and I must say there are many other safer sensory opportunities you can offer under 3s. cubes of jelly wouldn't be one of mine. I would make up the jelly maybe a bit less water than if you were going to eat it and then break it up on a tray or in a bowl for them to explore.

I thought all cm sat with their children when they ate? I know I attended a Healthy eating workshop when the free snack system was being encouraged in all Nurseries, that is a table of snacks and a jug of water and cups is left out all through they day for children to access when they want so they play is not interrupted by stopping for a snack at a set time. I must say my jaw dropped at the possible disadvantages of a system such as this on many levels! I have drinks available all the time but with all under 2s at the moment they are in cups on the table I can't imagine the benefits of having fruit etc out and available to graze on all day and out in this heat!!! Never mind the chocking hazards of it all.

I remember years ago when the 'cafeteria style' snack was the rage ...children helped themselves at any time and walked around with food and spilled drinks everywhere ...many nurseries implemented it while others were totally against it
I also think it was Ofsted driven as that is what they were suggesting

I agree cms do sit with their children and the PSED opportunities far outweigh the free style system...but we all do things differently

Angel...one of the reasons for not training all staff could be the cost maybe? I know many LAs charge now but some still offer free FA...mine included at the moment...so I would say they should take advantage of that...silly not too I would say.

One other point of reflection...have you ever experienced a child putting their hand in their pocket and ...out pops a coin? because some parents do give children money without realising the risks...or put olives with stones in their lunchbox for young children...or give huge grapes to babies
I have all those covered in my policy but off I go to stress it even more in bold letters!!

great sharing...thank you all

[rickysmiths]

.....and have children arriving with a handful of grapes because they found them I don't know where from! or the half eaten biscuit consumed in the car where if they had chocked the parent couldn't have got to them (we had a no food or drink in the car rule with our children and I do with the minded ones I carry drinks with me but we stop and have them the mind boggles if you have to do an emergency stop when they were eating or drinking at the time!).

I always give food they bring with them half eaten back to the parent to take home! I then point out the dangers of bringing it into my setting and the dangers of actually having it in the car.

I also take hairclips out of tiny ones hair and hand them back to the parent.

I frisk certain children for the bits of toys, hairclips, money etc both into the house and for things like lego bricks and playmobile parts, on the way out as well!!

I used to check my son's pockets when he came out of Playgroup, he was a terror and I continued to do so all through Primary. The most found item was blu tac!

[Mouse]

It's always so sad when a child dies in a seemingly preventable situation.

While we all try to limit the risks to children, something like this does make you think & reassess what we do.

I think one of the advantages we have is that we know our children very well. We know if they are likely to put things in their mouth, if they're likely to climb, throw, fall, bite, wriggle their arms out of their pushchair or car seat straps etc. We have often looked after them from babies, so can anticipate what they're likely to do and plan activities, resources accordingly. If we take on a new child we tend to be extra vigilant while we're getting to know them.
Also, the fact that we are solely responsible for the children makes us more focussed. In a nursery setting, I wonder how many nursery staff assume someone else is watching the children? If they are busy with one child, do they assume someone else is watching the others? We know that if we are busy with one child, no one is watching the others. I know that makes a difference to me. If we're in the garden, for example, and one needs the toilet, everyone has to come in as I won't leave the others unsupervised in the garden. Maybe in the nursery where the little girl died, it would have made a difference if one person had been given sole responsibility for supervising the messy play activity?

And I'm another person who can't understand why it's not a requirement for ALL nursery staff to have at least some basic first aid training. Maybe they don't all need the full 12 hour paediatric certificate, but they should all have something that covers choking, allergic reactions etc. My son's girlfriend works in a nursery and says she is glad she doesn't have first aid training because she wouldn't ever want to be called on to us it She wouldn't have a clue what to do in an emergency, which is a massive worry when she is left in charge of a room of children.

[jackie 7]

and darling et wanted to increase the ratios!

[hummingbird2014]

Flipping eck! I thought it was a big standard thing that all nursery staff had to be first aid trained! If I had a nursery that would a bog standard requirement for all my staff!

[Mouse]

Flipping eck! I thought it was a big standard thing that all nursery staff had to be first aid trained! If I had a nursery that would a bog standard requirement for all my staff!

I agree. I also think all parents should have the opportunity to get first aid training if they want it and that it should be taught in schools.

[Simona]

The only reference to First Aid for group settings in EYFS 2012 is on page 17 (3.24) and in the 2014 version it is on page 21 (3.25)

I cannot find any other reference that all staff must be trained in a nursery...while for CMs and assistants it is in black and white that we MUST be trained

[Maza]

Of course we all know that accidents still happen even when the children are right under our nose, but, really, how can a group of toddlers be supervised from next door, even if the door was wide open? They just should have had a member of staff in each room.

Yes, Simona - I have had the 'coin in the pocket' thing too! I was gobsmacked! Always frisked that particular mindee after that!

On my first aid course we were told that the majority of choking related deaths in toddlers were caused by grapes.

[Lal]

One of the main reasons I have nannied and am now registering as a childminder is so that I can provide a level of supervision I am happy with. I worked in one nursery where it was common practice for the children to go out in to the garden on their own with the attitude that as long as the window was open so they could be heard and seen through the window it was fine. I wasn't comfortable with it as the only thing stopping the children from going round the corner and completely out of sight was a line of milk crates. There wasn't ever really a division of who was watching which area of which children which I found difficult.
At least with childminding and sole-charge nannying you know YOU are responsible (e.g. if you do leave the children to go to the loo you know you need minimise risks before you leave and check they are all ok when you get back).

[rickysmiths]

Yes coins tend to go straight through.

I was very impressed on my last First Aid Course they had a dummy jacket to put on so you could try thrusts for real. It really demonstrated how hard you have to push up. Not so hard on a child of course!