Very young children can choke to death on whole grapes, warn doctors writing in the Archives of Disease in Childhood.

Foodstuffs account for over half the episodes of fatal choking among the under 5s, with grapes the third most common cause of food related choking after hot dogs and sweets. But public awareness of this potential hazard is not widespread, they say.

They describe three cases of young children, all of whom required emergency treatment after eating whole grapes.

One case involved a 5 year old who started choking while eating whole grapes at an after school club. Prompt and appropriate attempts to dislodge the grape didn’t work and the child went into cardiac arrest. The grape was later removed by paramedics, using specialist equipment, but the child died.

In the second case, a 17 month old boy was eating sandwiches and fruit with his family at home, when he choked on a grape. Attempts to try and dislodge it were unsuccessful and the emergency services were called. The grape was eventually removed by a paramedic but the child still died.

The third case involved a 2 year old who was snacking on grapes in the park when he started choking. Again, the grape proved impossible to dislodge, and an ambulance was called. Paramedics were on the scene within a minute and successfully cleared the airway.

The child suffered two seizures before reaching hospital and, on arrival, required emergency treatment to relieve swelling on his brain and to drain a build-up of watery fluid in his lungs. He spent five days in intensive care before making a full recovery.

The airways of young children are small; they don’t have a full set of teeth to help them chew properly; their swallow reflex is underdeveloped; and they are easily distracted, all of which puts them at risk of choking, explain the authors.

Grapes tend to be larger than a young child’s airway. And unlike small hard objects, such as nuts, the smooth soft surface of a grape enables it to form a tight seal in an airway, not only blocking this completely, but also making it more difficult to remove without specialist equipment, they emphasise.

“There is general awareness of the need to supervise young children when they are eating and to get small solid objects, and some foods such as nuts, promptly out of the mouths of small children; but knowledge of the dangers posed by grapes and other similar foods is not widespread,” write the authors.

While there are plenty of warnings on the packaging of small toys about the potential choking hazard they represent, no such warnings are available on foodstuffs, such as grapes and cherry tomatoes, they point out.

As such, they advise that grapes and cherry tomatoes “should be chopped in half and ideally quartered before being given to young children (5 and under),” and emphasise “the importance of adult supervision of small children while they are eating.”

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Case report: The choking hazard of grapes: a plea for awareness