Children and Choking: Prevention and What to Do

Recently, in the classes I have been teaching there has been an overwhelming amount of questions regarding choking in children and how to prevent it and what to do when it happens? With choking being one of the top 5 killers of children in the United States, there is never a bad time to cover choking in children and what we as parents and caregivers can do to prevent and deal with the situation.

Let’s face it, children choke on almost anything. If you have children or are a caregiver to children then you know that children love to put new things into their mouths and taste test everything and the younger the child, the more stuff they will put in there without any regard for what it might be. The questions of how to prevent choking in children has a lot to do with age. What I tell new parents or soon to be parents and grandparents are to go home. This may sound silly but home is where the battlefield is. I tell them to go home and see their home from a new perspective. We as adults see the world from very high up, our perspective tends to make us look down on most things in our homes. A small child or infant will see the home from an entirely different perspective looking up at most things in the home. So what I recommend to the adults is to go home and lie down on the floor in every room and see what an infant might see. It’s a whole new world down there with things like splinters under wood furniture, nail heads or staples sticking out, strings from fabrics, and the most important thing of all being that the infant or small child will find everything you have lost under all your furniture, including pills, paperclips, popcorn, you name it. So as I said before, go home and gain a child’s perspective on your home.

Preventing choking in older children has mainly to do with food and how it is prepared and eaten. We have all said “don’t stuff your face” or “chew your food “a thousand times, but the preparation is where we can make a significant difference. What I tell parents is to cut, cut and cut again. With foods like hot dogs, grapes, fruit and many other solid foods, cutting beforehand is the key. Other, lesser known culprits like popcorn, peanuts and even cereals can be broken down by simply putting them in a bag beforehand and crushing them a little bit to break them down.

What to do when the choking begins are the most important and the most frightening, but thinking is the key.

If you have an infant that starts choking at home, the first step should be to bring the infant to you by taking them out of whatever apparatus they are in at the moment, highchair or bouncer for example. Secondly, you should scream for anyone you are with to call 911 and inform them of a choking infant, or you may have to bring baby to the phone and call 911 while relieving the choking yourself. Even if the choking was sudden and the event ends right away, at least help is on the way. The third thing should be to be seated and position the infant face down with the legs straddling your arm and your hand on the infants jaw, all while keeping the baby’s head pointed down in order to use gravity should anything come out or loose. You will use the palm of your free hand to strike down, but towards the head of the infant, between the shoulder blades 5 times. Then you will put your free hand on the back of the baby’s head and sandwich the baby and flip them over to your other leg and then place your two fingers between the baby’s nipples and do 5 chest compressions or chest thrusts. You will repeat this until the object is removed, the baby starts breathing, or the baby becomes unconscious.

Should the baby go unresponsive, lie the baby down on a hard, flat surface and begin cpr on the baby.

Choking for the older child is much the same as choking for an adult, just on a smaller scale. If you notice an older child that appears to be choking, you can ask them “are you choking? “ and if given confirmation that they are choking then you will kneel down behind the child, so you can be roughly the same height, and use the Heimlich maneuver, (see the picture at the top of the page) the same one you use on adults, to relieve the choking. If it is unsuccessful and the older child becomes unresponsive then lay the child down on a hard, flat surface and begin cpr.

The most important times in this event are the identification of choking, the sooner the better, and the call to 911, again the sooner the better. There are a million things anyone can choke on and our homes are where most of the action takes place so please take a little time and do some prevention work around our homes and as always, I recommend taking an official American Heart Association CPR class in your area that will cover the CPR and choking (click here to find a course) and give you ample practice time so you can be better prepared.

Thank you and be safe.

The Kurbo Program: Healthy Weight Mgmt for Kids and Teens

The growth of childhood obesity in the United States is staggering. We have now reached a point where 1 out of 3 kids are overweight or obese.

My name is Joanna Strober and my son was one of those kids struggling with weight. As a mother, concerned about my child’s health and well being, I set out on a mission to find help. I was searching for a tool, something that could easily fit into my son’s life and effectively help him manage his weight. However, after multiple doctor visits and endless hours on the Internet, I found nothing beyond “eat less and exercise more.”

I knew of some weight loss apps for adults, but, like Weight Watchers and Jenny Craig, they were all either unsafe or ineffective for children. Then I discovered the nationally recognized Stanford Pediatric Weight Control Program at Lucile Packard Children’s Hospital, where I finally found the effective tools and practical guidance I was looking for. University based weight loss programs for kids are highly effective for local families – but what about children and families that do not live near a University based program? How can they receive help, guidance and support to control and manage their weight?

I wanted to find a way for the program’s proven weight management tools to reach more kids. Recognizing this gap in the marketplace, I came up with a plan: to adapt Stanford’s program to a scalable, mobile platform for kids and teens. Thus, the idea for Kurbo was born.

To carry out my plan, I needed an expert in the field of pediatric weight control, so I teamed up with Thea Runyan. Thea is the Lead Behavior Coach for the Stanford program and for over 12 years, has successfully helped over 600 families manage weight and lead healthier lifestyles. With her experience and dedication to taming the childhood obesity epidemic, Thea connected to my vision and recognized its potential to positively change the lives of kids, teens and their families.

With the help of $5.8 million in venture capital funding, we launched Kurbo Health. Kurbo Health licensed the program from Stanford University’s acclaimed pediatric weight control program and incorporated the programs’ tools and principles into a fun, engaging mobile app and weekly live-coaching sessions. It’s the first safe, effective and accessible mobile weight management program for kids, teens and their families.

The Kurbo Program teaches kids how to change their eating and exercise habits in order to reach and maintain a healthy weight. It is not about dieting, calorie counting or deprivation. These imply short-term results, create a negative stigma and hyper-focus around food and only magnify the issue at hand. Instead, Kurbo is about gradually gaining control of your health by making healthy lifestyle choices. Kids start seeing real signs of success after 3 to 4 weeks of the Kurbo Program.

A critical component of the Kurbo Program is the free, easy-to-use mobile app. Kids use the app to track their food and exercise using a version of the research-based Traffic Light system. Here’s how the system works: green light foods include fruits and veggies, yellow light foods include grains, lean protein and low fat dairy and red light foods are high in unhealthy fats, sugars and high calorie density foods. Once kids start tracking their red, yellow and green light foods, they become aware of their eating habits and start making healthier choices. The goal is to eat a well-balanced diet by increasing green light foods, moderating yellow light foods and minimizing red light foods over time. This is a safe way for kids to eat healthier and manage their weight. The app also includes videos and games that introduce concepts like food classification and portion size and provides instant feedback, reminders and rewards to keep users on track. Kurbo also encourages challenges, like having a red-free day or trying a totally new green light food, that keep kids engaged and motivated to achieve their goals.

The Kurbo Program provides weekly supportive coaching sessions with a trained Kurbo coach. These sessions can either be via text or email. Each week, your child’s Kurbo coach evaluates their progress by reviewing food and exercise choices, making actionable suggestions and working with your child to set reasonable goals for the next week. Coaches also teach your child how to plan ahead and budget their number of red light foods for the week. Say, for example, your family is going to a birthday party on a Friday. Your child’s Kurbo coach will help him or her use the app to rebudget reds, adding more reds on Friday (and fewer on other days of the week) to make sure he can eat pizza and cake and still meet his red-light goal for the week!

Not only is the Kurbo Program fun and affordable, it works. Kurbo’s beta test results showed that 88% of kids (ages 8 to 18) who met with Kurbo coaches for 10 weeks reduced their BMI (body mass index), lost an average of 5-10 pounds, exercised more frequently and felt healthier, happier and more confident.

While Kurbo kids gain tools to lead healthier lives, Kurbo parents get to take a break from being the “food police.” Kurbo reduces the tension and conflict around food and exercise that many parents face with their children. Coaches become a source of support, motivation and accountability. However, parents are still encouraged to be actively involved in their child’s Kurbo journey. Parents can participate in coaching sessions, receive a weekly email newsletter and have access to parent-focused experts who can answer their specific questions and concerns. Kurbo invites the whole family to use the Kurbo app, because kids are more successful when their families are tracking along with them. In fact, many parents lose weight too.

I created Kurbo Health as a solution for families, kids and teens who are struggling to lose weight. What started as a mission to help my son, has become a mission to help millions of kids and teens live healthier, lose weight, adopt better eating habits and feel really good about themselves.

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HEALTHFUL HINTS

Here is a Healthy Family Checklist to help manage your family’s healthy habits:

• Do 60 minutes of physical activity every day. Incorporate exercise in a family routine like walking after dinner.
• Limit TV, computer and video game time to 2 hours/per day
• Eat dinner with your family at a regular time
• Eat a fruit and/or vegetable at every meal (at least!)
• Drink lots of water!
• Limit Red light Foods like candy, chips, and crackers by buying less!
• Switch to non-fat or 1% milk
• Don’t drink your calories! Avoid sugary drinks like soda, sports drink and juice.
• Eat breakfast, lunch and dinner everyday. Don’t skip meals!
• Encourage your kids and teens to get least 8-9 hours of sleep a night

One feature about Kurbo that generates some concern is the weight tracker: kids are encouraged to weigh themselves once a week and record it in the Kurbo app. Thea Runyan, Kurbo co-founder, provides her advice for creating a healthy mindset around “stepping on the scale:”

• Don’t make the scale scary, it’s just a tool: It is important that parents don’t transfer their fears about the scale to their kids. At Kurbo weight measurement is simply another tool to assess progress, just like food and exercise tracking.
• Encourage kids and teens to weigh themselves NO MORE than once a week: Research shows that weighting yourself regularly (not obsessively) is very important for managing a healthy lifestyle.
• Success is not measured in pounds: At Kurbo, a child’s success is not defined by weight loss but instead, by learning and maintaining healthy behaviors and making smart choices about food and exercise.

What Should I Do If A Baby Is Choking?

If a baby is choking, you need to assess the situation quickly to see how best you can help.

This information applies to babies aged under one year old. For information relating to adults and older children, see What should I do if someone is choking?

Choking happens when a person’s airway suddenly gets blocked so they cannot breathe. Their airway can be partly or fully blocked. In babies, choking is often caused if they put small objects in their mouths, which then get stuck. It can also be caused by food getting stuck.

Choking in Babies Under One Year Old

A baby who is choking will be distressed and may be unable to cry, cough or breathe.

• Lie the baby face down along your forearm or thigh, with their head low. Support their head.
• Give up to five firm slaps to the baby’s back between the shoulder blades with the heel of your hand. (The heel is between the palm of your hand and your wrist.)
• Stop after each slap to check if the blockage has cleared. Look inside the baby’s mouth and remove any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage. You may push it further in.
• If the airway is still blocked, give up to five chest thrusts (see below).
• Stop after each thrust to check if the blockage has cleared.

If the baby’s airway is still blocked after three cycles of back slaps and chest thrusts, you should:

• Dial 999 (UK) or 911 (US) for an ambulance immediately. Do not leave the baby – take him or her with you to the phone
• Continue with the cycles of back slaps and chest thrusts until help arrives

Chest Thrusts for Babies Under One Year Old

In babies under one year old, chest thrusts are used in an emergency to clear a blockage from their airway. Important: do not use abdominal thrusts with babies under one year old.

• Lie the baby along your forearm on their back, with their head low. Support their back and head.
• Give up to five chest thrusts. Using two fingers, push inwards and upwards (towards the head) against the baby’s breastbone, one finger’s breadth below the nipple line.
• Check if the blockage has cleared after each thrust, by looking inside the baby’s mouth and removing any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage as you may push it further in.

Complications

Once the baby’s airway is cleared, some of the material that caused the blockage can sometimes remain and cause complications later. If the baby still has a persistent cough or difficulty swallowing, they need to see a health professional urgently. You should take the baby to A&E, an NHS Walk-in Centre or your GP if it’s during GP hours (UK).*

*In the US, take the baby to the ER, an urgent care clinic, or your primary care physician, if during office hours.

Further information:

• Where can I find out about basic first aid?
• What should I do if someone is choking?
• Accidents and first aid
• Accidents to children in the home
• Ambulance service
• British Red Cross: how to deal with choking

Build Kitchen Skills, Memories with a Kids’ At-Home Cooking Camp

We all want to raise our kids to be healthy eaters. Right? We also want meal times to be pleasant. Don’t we? And, we surely want to raise our kids to be competent, able adults. Of course we do.

An in-home cooking camp does all of those things and builds lasting memories together as a family.

Not much of a cook yourself? No problem. Explore with your kids. And if you love cooking, relinquish control. This is not about perfection, and there should be no high expectations for the finished product. It’s about exploring as a family – in the kitchen – and hopefully having your kids learn at least one skill each time you do an in-home cooking camp.

For this adventure, you will need:

1. Kids (Exhibit A):

My silly children, Hannah age 9, and Evan, age 6.

2. At least one parent, but both parents are best. If you do this as a family, it will have maximum impact. Good emotion (fun times with family) surrounding a learning experience will be sure to solidify in their minds for years to come.

3. A recipe or task to create.

Follow along with our family as we do a Dinner Helpers Camp by making Vitamix’s bacon cheddar potato soup (linked!) with a mixed green salad. We also started making some homemade ice cream that we finished making the next evening.

You will soon learn that this is less about the recipe that you are creating than it is the experience together. Let’s practice some kitchen skills and have some fun!

Before you get started with anything in the kitchen, reinforce your hand washing rule in your home.

Make it fun. Have them sing the Happy Birthday song while washing their hands with warm soapy water.

SKILL: HAND WASHING

After Hannah washed her hands, she started helping my husband Jeff start the ice cream preparation.

SKILL: MIXING

SKILL: POURING

While we have Hannah working on the ice cream, we start Evan on the chopping of onions for the potato bacon soup. A veggie chopper like this one from Pampered Chef is a wonderful tool that allows kids to chop food without the risk of getting cut. And it’s fun for them!

SKILL: CHOPPING

Hannah is managing the bacon on the stove. Since she is now 9 years old and has been helping me since toddlerhood, we allowed her to cook the bacon with close supervision.

SKILL: COOKING WITH HEAT

After the bacon was cooked, we had Hannah break the bacon up into small piece before it went into the Vitamix.

SKILL: HAND PREPARATION

The soup calls for shredded cheddar cheese. Evan practiced his measuring skills by measuring out some cheese.

SKILL: MEASURING

Now it’s time to put all the components of the bacon cheddar soup into the Vitamix. Hannah’s turn is up! In these photos – what you don’t see – is that Hannah spilled the milk all over the place when she was pouring it into the blender. She was pretty upset with herself, but we said that it was part of cooking. Messes happen!

SKILL: COMBINING

We got the Vitamix on the soup setting, and we’re ready to get the table set!

Kids love to be helpful and part of the team! And our team is Family Lemond.

SKILL: SETTING THE TABLE

Family Lemond was thrilled at the finished product, and the kids loved the fact that they helped make the soup.

Challenge: Tell your kids that the family is doing a cooking camp together and do it. Make being in the kitchen an event that they see as fun. Even if you are just making dinner, each experience is something they will cherish for years to come. Family memories + kitchen skills = divine.

From our home to yours.

Family MyPlate Night: Where Kids Choose!

In one of my previous posts, we discussed the Top 3 Ways to Get Your Child to Choose Healthy Foods. One of the ways was to involve your children. One thing we do in our home is have a MyPlate night every couple weeks. It’s usually when leftovers are building up in the fridge and there are plenty foods to heat up. This is how it goes:

Kids choose what items they can have for dinner. But they must use the MyPlate components on their plates. Simply print the MyPlate graphic slick and put it on your fridge as a guide, or even get MyPlate plates for the entire family for $10 each on Amazon. Now you have the visual for the family to follow.

Now it’s time to select our items!

Protein

Protein choices could be leftover meat, fish and/or poultry, but it can also be things like peanut butter, nuts, beans, soy or using a second dairy (cheese, Greek yogurt) as the protein.

Grain

Grain choices could span the gamut from whole grain cereals, crackers to leftover rice and pasta. The recommendation is to aim for at least half of our grains to be whole, so it is not necessary for their choice to be whole grain. In our home, 99% typically is whole grain so most likely their choice will be as well.

Vegetable

Veggies could include raw or cooked. Whatever is on-hand. If your child is limited in what s/he likes and picks the same begetable each time, let them do that. Praise them on including any veggie on their plate and it will encourage them to do it again. And maybe next time, they will be encouraged to try something new! Kids love positive reinforcement.

Fruit

Fruit can be served with the meal, or you could give them the idea to have fresh fruit as their dessert. My kids love mixed berries with whipped cream, or even fresh pineapple as a sweet ending to their meal. Have many different fruits for them to choose from.

Dairy

Dairy is a key component of a healthy diet for proper growth. I see many kids in my private practice that are not getting 3 servings of dairy each day, and this could be putting them at risk for things like vitamin D deficiency and poor bone growth. If they do not like the taste of cow’s milk or if they have an actual milk allergy then there are other alternatives such as soy milk or almond milk. If they are lactose intolerant, they can still have dairy! (See Ditching Dairy? CAUTION!)

Keep in mind that this is an empowering activity for your kids, so try your best to not be critical. Remember that your goal here is not necessarily for them to pick the perfect items for that particular evening, but building confidence in your child to make healthy choices long-term.

My 8 year old daughter, Hannah, told me something yesterday that made me smile. She told me that she put a brownie back in order to get a MyPlate at lunch yesterday. I wasn’t necessarily happy she put the brownie back, but that she thought it was more important to get her carrots. At her school, they can fill their tray slots with what they want and she couldn’t have the carrots and the brownie. She chose the carrots so that she would have all the items contained on the MyPlate. MyPlate night at our home helps our kids see foods that should be on their plate instead of what they should not, and that is what it’s all about!

Feeding children is not something we do to them, it is something we do with them. Be sure that you are also participating in MyPlate night and show your enthusiasm when enjoying healthy foods. The MyPlate visual is a wonderful tool to use for your children and for your families to encourage balanced nutrition. Hannah and Evan love when we do this, and I really believe that it helps my kids see all their meals through the MyPlate standard. Try a MyPlate night at your home, and let us know how it goes!

In case you didn’t catch the countless links we included in this post, learn more about the MyPlate and more on practical family feeding, health and wellness by going to http://www.choosemyplate.gov.

Making Mealtime Traditions for Your Family

For Nancy Richmond, Sunday dinners are something to treasure. While her family sits down to eat together in the dining room practically every night (with candles and tablecloths no less), these meals are special. “My husband cooks the same kind of wonderful meals he makes all week long, but it’s different. We’re all more relaxed,” says Richmond. “Sunday night is the evening we’re most likely to invite company and the night my kids invite their friends.”

Mealtime traditions – whether it’s Sunday supper, Saturday morning bagels or Tuesday night pizza – are more than just good food and fun times. They are the glue that holds families together. “These traditions are the things that make us feel we belong somewhere and that we’re special – that our family is different from other families,” says Barbara H. Fiese, Ph.D., director of the Family Resiliency Center at the University of Illinois Urbana-Champaign, and a researcher in the way routines knit families together.

It isn’t easy to pull off a family dinner every night of the week, which is why designating one day for a special meal is so important. “The average meal gets eaten in anywhere from 18 to 20 minutes,” says Fiese. “The average kid watches four to six hours of TV a day. There’s room in there somewhere. Just turn off cell phones, computers and the TV and sit down together.”

Here’s how to keep everyone at the table…and happy to be there:

Tweak your tradition… Sooner or later, most kids will groan and snort at the idea of spending any more time at the table than they have to. “As kids grow up, expect plenty of eye-rolling but don’t give up,” says Fiese. “Teens may act like they want you to drop the routines entirely, but they don’t.” Ask if they’d like to try a little cooking instead of always getting stuck with the dishes, for example. For Richmond, allowing kids to invite friends has made a huge difference: “Sometimes we get 10 kids here – there’s always something we can fix in the kitchen to feed them.”

…Or borrow someone else’s. For anyone who grew up in a traditional Italian home, the scent of slow-simmering sauce (known as gravy, to some) is a cherished memory. Many Southerners feel the same way about chicken-after-church dinners. If you love your Sunday dinner tradition, but are tired of your traditional Sunday food, take a page from someone else’s cookbook. Vary the menu on your typical Sunday meals and see what happens.

Make It Extra Special

Tere Estorino and her 3-year-old son, Max, live seven houses away from her parents, so they share many meals together. But her favorite occasion is the monthly brunch her parents host, when her siblings and their kids all converge for an hours-long Sunday brunch – Cuban style. “I love that my son is getting to know his aunts, uncles and cousins this way. I know it’s good for Max, but it’s also good for me,” says the 31-year-old Miami mom. “I so look forward to a Sunday spent talking and laughing with my family. I need that connection, too.”

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