Risk Of Choking Research Articles

Synthesis of Applied Behavior Analytic Interventions for Packing in Pediatric Feeding Disorders.

Packing, which consists of holding food in the mouth for an extended time during meals, is a form of disordered feeding associated with pediatric feeding disorders. The behavior can disrupt the pace and completion of a meal and lead to increased risk of choking, inadequate food and liquid intake, and elevated caregiver stress associated with mealtimes. Applied behavior analysis research has developed and evaluated behavioral interventions to improve feeding by reducing packing. This systematic review extends prior research by synthesizing characteristics of the packing intervention literature, evaluating the certainty of the evidence provided by studies, identifying potential directions for future research, and discussing the results in the context of evidence-based practice.

Validation of the Choking Risk Assessment and Pneumonia Risk Assessment for adults with Intellectual and Developmental Disability (IDD)

BackgroundRisk assessments are needed to identify adults with intellectual and developmental disability (IDD) at high risk of choking and pneumonia. AimTo describe the development and validation of the Choking Risk Assessment (CRA) and the Pneumonia Risk Assessment (PRA) for adults with IDD. MethodsTest items were identified through literature review and focus groups. Five-year retrospective chart reviews identified a positive choking group (PCG), a negative choking group (NCG), a positive pneumonia group (PPG), and a negative pneumonia group (NPG). Participants were tested with the CRA and PRA by clinicians blind to these testing conditions. ResultsThe CRA and PRA differentiated the PCG (n=93) from the NCG (n=526) and the PPG (n=63) from the NPG (n=209) with high specificity (0.91 and 0.92 respectively) and moderate to average sensitivity (0.53 and 0.62 respectively). Further analyses revealed associations between clinical diagnoses of dysphagia and choking (p=0.043), and pneumonia (p<0.001). ConclusionsThe CRA and PRA are reliable, valid risk indicators for choking and pneumonia in adults with IDD. Precautions for mitigating choking and pneumonia risks can be applied selectively thus avoiding undue impacts on quality of life and unnecessary interventions for low risk individuals.

Treatment of preschool children for schistosomiasis.

Treatment of preschool children for schistosomiasis.

Dietary Supplement Use in Older Adults

Dietary supplement (DS) use among older adults in the USA is prevalent, and thus, healthcare professionals need to be aware of how to best advise this population. The purpose of this review is to highlight key considerations for assessing the potential benefits and risks of supplementation and for evaluating the quality, safety, and efficacy of supplement use specific to older adults. Nutrient deficiencies and risk of malnutrition among older adults can result from decreased appetite with aging, poor dietary intake, and nutrient depletions from medications (among many other factors). Nutrient deficiencies are common in this population and could have a negative impact on neurological and cardiovascular health, mood, immune function, vision, blood sugar control, and bone strength. In certain circumstances, older adults may benefit from supplementation. However, risk of choking and concomitant use of DS and prescription medications (which can increase risk of drug-nutrient interactions) are concerns with supplementation. Decision-making around appropriateness of supplementation for older adults should be determined by nutrition screening and based on individual need. Healthcare providers, especially registered dietitian nutritionists (RDNs), should work with patients to identify quality products and benefits/risks of supplement use.

Effect evaluation of choking risk assessment and intervention on the choking prevention of homeless inpatients with psychiatric

Objective To explore the effect evaluation of choking risk assessment and intervention on the choking prevention of homeless inpatients with psychiatricc. Methods Totally 163 homeless inpatients with psychiatric disorder were selected from July 2012 to June 2016, 56 cases from July 2012 to December 2013 were assigned to the control group, another 107 cases from January 2014 to June 2016 was set as the intervention group. The control group received routine nursing safety management, on the basis of it, the intervention group received choking risk assessment through choking risk assessment scales. To take choking risk intervention on the patients of reached choking danger threshold. The incidence of choking and choking ending were compared between the two groups and the choking risk levels and scores in the intervention group before and after intervention were also compared. Results The incidence of choking in the intervention group and the control group was 0.93% (1/107) and 10.71% (6/56) respectively. Choking ending: 2 heal, 3 aspiration pneumonia, 1 death of 6 cases in the control group and 1 case was cured, no death and aspiration pneumonia occurred in the intervention group, the statistical differences were significant (χ2=9.399,18.554, P < 0.01 or 0.05). There were 28.0% (30/107) reached levelⅠ, Ⅱ and Ⅲ choking threshold in the intervention group and rank mean of choking risk scores were 41.29. After interventions were 8.4% (9/107) and 25.50 respectively, the statistical differences were significant (χ2=10.231, P< 0.05; Z=7.511, P < 0.01). Conclusions The corresponding nursing intervention on the patients of choking risk can reduce and avoid choking accidents and protect the safety of homeless inpatients with psychiatric disorder effectively and improve the quality of care. Key words: Psychotic disorders; Nursing care; Homeless persons; Choking risk assessment

Age-related changes in mastication.

The paper reviews human mastication, focusing on its age-related changes. The first part describes mastication adaptation in young healthy individuals. Adaptation to obtain a food bolus ready to be swallowed relies on variations in number of cycles, muscle strength and volume of emitted saliva. As a result, the food bolus displays granulometric and rheological properties, the values of which are maintained within the adaptive range of deglutition. The second part concerns healthy ageing. Some mastication parameters are slightly modified by age, but ageing itself does not impair mastication, as the adaptation possibilities remain operant. The third part reports on very aged subjects, who display frequent systemic or local diseases. Local and/or general diseases such as tooth loss, salivary defect, or motor impairment are then indistinguishably superimposed on the effects of very old age. The resulting impaired function increases the risk of aspiration and choking. Lastly, the consequences for eating behaviour and nutrition are evoked.

Advancement in Texture in Early Complementary Feeding and the Relevance to Developmental Outcomes.

A child's transition to independent eating is a protracted process that progresses over the course of many years. Although major health agencies, such as the World Health Organization, now offer clear guidance when to begin introducing solids, advice about how to safely transition to progressively challenging foods is varied and comes from a staggering number of sources. The resulting conflicting views have promoted parental confusion and anxiety about what foods are appropriate and when to advance to new textures. Efforts to develop science-based recommendations for complementary feeding include research on the development of chewing motor skills. Chewing development is an essential aspect of feeding readiness that is often overlooked by agencies developing recommendations for complementary feeding, and little is known about the development of chewing motor skills and how children learn to accommodate foods with varying textures. Such information is essential for designing developmentally appropriate foods, minimizing food aversions, providing caregivers science-based guidance regarding the safety and appropriateness of new foods, and identifying children at risk for choking or feeding impairments.

Computational Investigation of Multi-Strut Injection of Hydrogen in a Scramjet Combustor

Multi-strut injection is an approach to increase the overall performance of Scramjet while reducing the risk of thermal choking in a supersonic combustor. Hence numerical investigations of a hydrogen-fueled scramjet combustor at Mach 2.5 have been performed with a three struts combustor combining the central wedge strut as well as additional two wedge strut injectors. These numerical simulations are aimed to study the flow structure, supersonic mixing, and combustion phenomenon for the present combustor configurations. The presence of the multi strut injection improved the turbulent mixing and, consequently, the combustion process.

Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework

Dysphagia is estimated to affect ~8% of the world’s population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3–4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0–7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.

A Baby-Led Approach to Eating Solids and Risk of Choking.

To determine the impact of a baby-led approach to complementary feeding on infant choking and gagging. Randomized controlled trial in 206 healthy infants allocated to control (usual care) or Baby-Led Introduction to SolidS (BLISS; 8 contacts from antenatal to 9 months providing resources and support). BLISS is a form of baby-led weaning (ie, infants feed themselves all their food from the beginning of complementary feeding) modified to address concerns about choking risk. Frequencies of choking and gagging were collected by questionnaire (at 6, 7, 8, 9, 12 months) and daily calendar (at 6 and 8 months); 3-day weighed diet records measured exposure to foods posing a choking risk (at 7 and 12 months). A total of 35% of infants choked at least once between 6 and 8 months of age, and there were no significant group differences in the number of choking events at any time (all Ps > .20). BLISS infants gagged more frequently at 6 months (relative risk [RR] 1.56; 95% confidence interval [CI], 1.13-2.17), but less frequently at 8 months (RR 0.60; 95% CI, 0.42-0.87), than control infants. At 7 and 12 months, 52% and 94% of infants were offered food posing a choking risk during the 3-day record, with no significant differences between groups (7 months: RR 1.12; 95% CI, 0.79-1.59; 12 months: RR 0.94; 95% CI, 0.83-1.07). Infants following a baby-led approach to feeding that includes advice on minimizing choking risk do not appear more likely to choke than infants following more traditional feeding practices. However, the large number of children in both groups offered foods that pose a choking risk is concerning.

Feeding/Swallowing Disorders: Maintaining Quality of Life in Persons with Intellectual Disability

Persons with intellectual disability (ID) have received little attention in systematic studies of healthcare and quality of life. Less attention has been provided to specific disorders, such as those impacting the swallowing mechanism. In comparison to the general population, persons with ID experience noticeably greater healthcare inequalities and despite greater life expectancy, it is still lower than the general population. This paper serves as an introduction to healthcare colleagues regarding the risks involved in choking and swallowing disorders in persons with ID, how to evaluate these potential risks and possible treatments. Associated etiologies are presented. A discussion on feeding disorders versus swallowing disorders is also introduced. The inadequacy of swallowing assessment services to persons with ID may be related to the lack of professionals with specialized training in working with this population, reduced funding for research to explore options for improved nutrition and reduced risk of choking and minimal research on changes in feeding skills and/or swallow physiology in this select group of individuals

Adjustment of Food Textural Properties for Elderly Patients

AbstractOver the next twenty years the number of people over 60 years will exceed one billion. Changes associated with ageing have an impact on food texture choices for healthy elders and those used therapeutically for people with swallowing difficulties (dysphagia). The ideal “swallow‐safe” bolus is moist, cohesive and slippery. A general reduction in muscle strength is seen throughout the ageing oropharyngeal musculature, resulting in a reduced ability to safely and efficiently manage hard or fibrous textured foods. Reduced masticatory ability combined with dental loss further compounds the issue. Dry mouth is commonly associated with old age, making it difficult to propel dry or sticky textures through the pharynx, and increases the likelihood of pharyngeal residue. An age related reduction in laryngopharyngeal sensitivity dampens the ability to detect residue, increasing choking risk. Reduced tongue pressure, increases in pharyngeal transit time, valleculae residue, number of clearing swallows and slower and less efficient oesophageal transit occur with aged swallowing. Food textures that are sticky and adhesive will require increased lingual effort to propel them into and through the pharynx. Taken in combination these factors mean that food textures prescribed to the elderly need to be soft and moist and for fibers to be easily broken. To improve moisture content, additional nutrient dense products (e.g., milk, cream or butter) may be required to artificially moisten the bolus. Careful, individualized attention to diet recommendations will result in a diet that is appealing and also provide a variety of textures that are swallow‐safe and nutrient dense.Practical ApplicationAged related changes in the oral cavity and the oral, pharyngeal and oesophageal phases of swallowing require special thought to the suitability of food textures for the elderly. Foods that are fibrous, hard or dry may be unsuitable due to difficulties with safe particle size reduction and bolus formation for swallowing. Foods that are sticky and adhesive are also problematic and increase risk for both choking and residue. Food texture properties that are ideally suited for the elderly include those that are soft, moist, and easily reduced with minimal chewing effort. Hard food textures that break down and dissolve easily with minimal chewing should be investigated. Increased aroma and flavor may improve appeal lost through reduced variety in food textures. Diet reviews need to consider both textures that can be safely managed and the nutrient density of those textures.

Toy Age-Labeling: An Overview for Pediatricians of How Toys Receive Their Age Safety and Developmental Designations.

Injuries related to toys continue to cause significant childhood morbidity and mortality, despite considerable government regulation of the toy industry. Recent controversy related to toys that contain strong magnets demonstrate the dangers they pose to children. The pediatric community is often unaware of how toys receive their developmental and safety labeling and the degree to which age-labeling on toys can be discretionary. Toy labeling has 2 basic manifestations. The first, safety labeling for hazards like small parts, balloons, or small balls that may present a choking risk, is mandatory. The second, "developmental" age-labeling, describes the age of the children for which the toy is intended, and sometimes has discretionary components. This article provides a review of the regulations governing toy age-safety standards and how they are reflected on toy packaging to help pediatric practitioners apply safety advice across settings and patient characteristics. We review the existing age-labeling regulations and processes and discuss the major areas where children remain vulnerable despite labeling. Finally, we list some recommendations for counseling parents about toy safety.

Risk and prognostic factors for pneumonia and choking amongst Parkinson’s disease patients with dysphagia

ObjectiveTo evaluate the time to hospitalisation and baseline factors associated with pneumonia/choking in Parkinson’s Disease (PD) patients. BackgroundAlthough dysphagia and pneumonia are common problems in PD, scarce research has been performed. MethodsA total of 194 PD patients who underwent a VFS evaluation were retrospectively selected. The mode of feeding and admissions for pneumonia/choking were analyzed. Baseline clinical and demographic variables were compared between feeding groups. Kaplan-Meier survival analysis was performed to estimate time to pneumonia/choking. Clinical variables significantly associated with pneumonia/choking free survival were identified using Cox regression. ResultsHospitalisation for pneumonia/choking occurred in 89 out of 194 patients, with the highest admission rate in rejected enteral feeding group (66.7%), followed by enteral feeding (61.8%) and oral feeding (38.8%) groups. The estimates of median time to event were 11, 14, and 47 months for rejected enteral feeding, enteral and oral feeding groups respectively (log-rank test p < 0.001). The rejected enteral feeding group had the highest risk of pneumonia/choking (HR 4.61, 95%CI:2.33–9.08, p < 0.001), followed by enteral feeding group (HR 2.29, 95%CI:1.25–4.19, p = 0.007), when compared to oral feeding group after adjusting for possible confounders. A stepwise Cox regression showed that the rejected enteral feeding (HR 4.89, 95%CI:2.19–10.88, p < 0.001), enteral mode of feeding (HR 2.43, 95%CI:1.11–5.32, p = 0.026), and Charlson weighted index of co-morbidity (HR 1.27, 95%CI:1.03–1.58, p = 0.028) were independently associated with higher hazard of pneumonia/choking. ConclusionsCompliance to feeding recommendations is important to reduce the risk of hospitalisation for pneumonia/choking. The recommended mode of feeding and comorbidity index was significantly associated with pneumonia/choking risk.

Computational simulation of multi-strut central lobed injection of hydrogen in a scramjet combustor

Summary Multi-strut injection is an approach to increase the overall performance of Scramjet while reducing the risk of thermal choking in a supersonic combustor. Hence computational simulation of Scramjet combustor at Mach 2.5 through multiple central lobed struts (three struts) have been presented and discussed in the present research article. The geometry and model used here is slight modification of the DLR (German Aerospace Center) scramjet model. Present results show that the presence of three struts injector improves the performance of scramjet combustor as compared to single strut injector. The combustion efficiency is also found to be highest in case of three strut fuel injection system. In order to validate the results, the numerical data for single strut injection is compared with experimental result which is taken from the literature.

Prevalence of oral health-related conditions that could trigger accidents for patients with moderate-to-severe dementia.

This study was performed to determine the prevalence of oral health conditions unnoticed by doctors and ward staff that may increase risk of incidents and/or accidents in hospitalised patients with moderate-severe dementia. Dementia patients may not recognise risks in the mouth, such as tooth mobility or ill-fitting dental prostheses and/or dentures. In addition to the risk of choking, injury by sharp edges of collapsed teeth or prosthodontics could pose risks. However, many previous publications were limited to case reports or series. Ninety-two consecutive hospitalised dementia patients (M: 52, F: 40, median age: 82.5 years, range: 62-99 years, from 2011 to 2014), referred for dentistry for dysphagia rehabilitation, were enrolled in this study. Participants referred for dental treatment with dental problems detected by ward staff were excluded. All participants had a Global Clinical Dementia Rating Score >2. Their dental records were evaluated retrospectively for issues that may cause incidents and/or accidents. Problems in the mouth, for example tooth stumps, dental caries, and ill-fitting dentures, were detected in 51.1% of participants (47/92). Furthermore, 23.9% (22/92) showed risk factors that could lead to incidents and/or accidents, for example falling out of teeth and/or prosthodontics or injury by sharp edges of teeth and/or prosthodontics. Hospitalised moderate-severe dementia patients had a high prevalence of oral health conditions unnoticed by doctors and ward staff that may increase risk of incidents and/or accidents.

How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6–8 months

ObjectivesTo compare the food, nutrient and ‘family meal’ intakes of infants following baby-led weaning (BLW) with those of infants following a more traditional spoon-feeding (TSF) approach to complementary feeding.Study design...

Grandmothers' Beliefs and Practices in Infant Safe Sleep.

Background Sudden infant death syndrome (SIDS) and suffocation are leading causes of infant mortality. Supine sleep position and use of appropriate sleep surfaces reduce SIDS risk but are not universally practiced. Mothers' decisions about sleep position and environment may be influenced by guidance provided by infants' grandmothers and other caregivers. Methods A survey was conducted of a convenience sample of grandmothers aged 30-70years who provide care at least weekly for an infant grandchild <6months old. The survey was distributed through community partners of a university-based research team. Respondents received home safety items as compensation. Analyses focused on the relationship of grandmother demographic characteristics and beliefs on their reported practices related to infant sleep. Results Among the 239 grandmothers, 45% reported placing infants to sleep supine on an appropriate sleep surface at the grandmother's house, while 58% reported doing so when the infant was sleeping in the mother's house. After adjusting for other factors, respondents were less likely to adhere to recommended guidelines when they believed supine position increased choking risk (OR 0.34, 95% CI 0.18-0.62) or believed infants are more comfortable or sleep longer when on their stomachs (OR 0.51, 95% CI 0.28-0.93). Discussion Grandmothers do not universally observe evidence-based safe sleep practices, particularly if the infant is not sleeping in the home of the parent. Interventions for senior caregivers focused on perceived choking risk, infant comfort in the supine position, and other recent changes in recommended safety practices are warranted.

Introducing solid foods using baby‐led weaning vs. spoon‐feeding: A focus on oral development, nutrient intake and quality of research to bring balance to the debate

AbstractThe World Health Organization recommends that infants be introduced to first solid foods from 6 months of age to complement milk feeds. The introduction of complementary foods is required to help infants meet their changing nutritional requirements. In recent years, baby‐led weaning and spoon‐feeding have been discussed as mutually exclusive approaches to introducing first solids. Baby‐led weaning advocates that babies direct and control the process of weaning, deciding what they will eat, how much and how quickly. There is an emphasis on parents providing chunks of soft food that babies can pick up and chew. A traditional spoon‐feeding approach involves introducing smooth runny purees as the texture for first foods and progressing to chewable solids as oral motor skills develop. Spoon‐feeding provides an opportunity for infants to develop oral skills necessary for safe management of solids and may facilitate intake of iron‐rich foods at weaning, whilst baby‐led weaning promotes greater participation in family meals and exposure to family foods. The need to supervise infants whilst eating to avoid risk of choking on food is required for both approaches. The review highlights the need for quality, well‐designed research on different approaches to the introduction of first solid foods and suggests that a combined approach to baby‐led weaning should be considered.

Choking in the Pediatric Population

Choking is a preventable, but common cause of morbidity and mortality in the pediatric population, with children younger than 3 years at greatest risk. A number of factors place children at higher risk for choking, including narrower airways, immature dentition, underdeveloped chewing and swallowing ability, and high levels of activity and distractibility. Candy, meat, and bone are responsible for more than half of nonfatal food-related choking, while the hot dog is the most common food associated with choking fatalities. Coins, button batteries, small toys, and toy parts are the leading causes of nonfatal choking not due to food, while latex balloons are the leading cause of nonfood-related choking fatalities. Pediatric choking is an important public health concern that needs to be addressed during well-child visits and through increased public education. Parents and child caregivers should receive training in cardiopulmonary resuscitation and choking rescue maneuvers. Increased efforts are also needed in the areas of public policy, choking surveillance, and food design and labeling.