‘Creche coronary’ - A paediatric variant of café coronary syndrome

Abstract

Sudden collapse due to acute upper aerodigestive tract obstruction in infants and young children is most often caused by ingested food or toy parts. The following cases taken from the autopsy files of the ACH demonstrate particular risk factors associated with young children who are otherwise completely well and who attend child care centers (CCCs). Case 1: A 19- month-old boy collapsed and died at a CCC while eating a sausage. At autopsy a large bolus of sausage was recovered from the lower oesophagus. Case 2: An 18-month old boy choked while eating raw carrot at a second CCC. Although resuscitation was performed and a piece of carrot was removed from the trachea, severe hypoxic ischaemic cerebral damage was followed by death five days later. The “cafe coronary” syndrome in adults classically refers to accidental asphyxia in an individual with dentures who has imbibed alcohol and who is dining out on meat. Major predisposing factors are alcohol and sedative drugs, with other risk factors being impaired motor coordination, for example due to Parkinson disease, and impaired mentation due to senility. Similarities exist between the classical “cafe coronary” syndrome of adults and fatal food asphyxia in young children at CCCs; these include the presentation of collapse due to choking on food while eating away from home, inadequate dentition and underappreciation of appropriate food bolus size. Features which separate the two entities are the young age of the victims and absence of alcohol intoxication or drug ingestion in the latter group. Given that second molar teeth erupt 12 to 20 months after the incisor teeth, there is a significant period of time during which a young child is able to bite off fragments of hard food without being able to properly masticate prior to swallowing. It is therefore helpful at autopsy in such cases to accurately record the stage of dental development and the condition of the teeth.