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Repeated cases of toddler choking accidents in Japan show warnings ignored

Children are seen eating cut grapes instead of eating them whole to avoid choking on them. (Mainichi/Naomi Hayashi)

TOKYO -- Although the Japanese government has announced a list of foods that pose choking risks, yet another child has recently choked to death, this time on a grape -- one of several foods the government says can likely lead to suffocation. The Mainichi Shimbun took a look into cases of children choking on food and why they keep on occurring.

    According to Takao Police Station of the Metropolitan Police Department and a private kindergarten in the suburban Tokyo city of Hachioji, a 4-year-old boy on Sept. 7 ate a large Pione grape served for lunch, and suddenly stood up in agony. Teachers and others unsuccessfully tried to make the boy spit out the grape by hitting his back. The toddler's death was confirmed after he was sent to the hospital unconscious.

    The boy had choked on a peeled grape measuring 3 centimes in diameter. The kindergarten apparently served cut grapes to children aged 1 and 2, but provided a whole grape to those aged 3 and older.

    Similar accidents have been occurring in Japan, including a case where a 4-year-old boy died in February after choking on a bean during a "Setsubun" bean-throwing festival at a certified child center in the city of Matsue, Shimane Prefecture, western Japan.

    Both grapes and beans are specified on a list of choking hazard foods compiled by the central government. A guideline on preventing and responding to accidents that take place at schools and other child care facilities, formulated by the Cabinet Office and other authorities in 2016, lists items such as grapes, cherry tomatoes and cherries as foods that are likely to cause suffocation, based on past incidents. The government is also asking that such food items not be served for school lunches.

    A sticker warning people to cut cherry tomatoes and grapes in fourths to prevent children from choking on them is seen in this image provided by the nonprofit organization Safe Kids Japan.

    Grapes and cherry tomatoes are round and can easily be swallowed, but have a high chance of causing suffocation once they get stuck at the back of the throat. Beans thrown at Setsubun festivals are also on the list.

    The kindergarten in Hachioji recently had a chance to read through the guidelines, as the national government sent a notice to local governments again about making the risk of such food items widely known, in response to the incident in Matsue. In response, the Hachioji Municipal Government in February sent emails to day care and kindergartens in the city to reconfirm the guidelines.

    However, that doesn't mean recipients of the notice get the proper message. The male head of the kindergarten revealed to the Mainichi Shimbun over the phone that it had entrusted an outside vendor to prepare the menu and cook lunches.

    "I looked through the guidelines in February, but missed the section about dangerous food items as we had left that part up to the vendor. It might sound like an excuse, but it didn't use strong terms like 'prohibited,' and maybe that's why it didn't leave an impression on me. I didn't know that large grapes were dangerous, and I'm painfully aware of my responsibility," he explained.

    Grapes are cut into quarters. (Mainichi/Naomi Hayashi)

    Tatsuhiro Yamanaka, pediatrician and chairman of Safe Kids Japan, a nonprofit organization making efforts to prevent children from getting into accidents, explained, "Choking accidents that are caused by grapes have occurred numerous times in the past, and the recent case is just the tip of the iceberg. Administrative organs naturally assume that facilities have read the guidelines, but it just shows how information hasn't been communicated to workers on site."

    As a prevention measure, Safe Kids Japan has created stickers to warn people to cut cherry tomatoes and grapes into quarters before serving them. On the sticker is an illustration of each food item being cut into quarters, with the words, "Cut into four pieces until age 4." The stickers are being released for free through the organization's website.

    But what are some effective procedures to deal with such an accident if it happens?

    The Consumer Affairs Agency is introducing two types of emergency techniques depending on the child's growth. According to the agency, for infants and those a bit older, someone will need to repeatedly hit the middle of their backs with their palm while the child is lying face down. For senior kindergarten kids and older, someone will have to perform abdominal thrusts.

    Choking accidents, however, can suddenly happen one day, and there is no guarantee that everyone on the site can calmly respond to the situation. Yamanaka said, "When food gets stuck, it doesn't come out easily even if you take emergency procedures, and most of the time even if there is an adult on the scene, they cannot save the child. You must first call the 119 emergency number, and try your best to clear their airway while performing cardiopulmonary resuscitation."

    (Japanese original by Naomi Hayashi, Lifestyle and Medical News Department)

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