Boy choked at nursery. Advice needed from medic -minded mnetters

[bubble99]

And subsequently died. I was so, so upset to hear about this.
It's got me thinking. If an accident happens in a nursery, however serious, there is usually a lot that a first aider can do to keep the child alive until an ambulance arrives. Effects of shock can be minimised, blood loss can be controlled etc. With an obstruction of the airway there is nothing anyone can do in a first aid situation if the object cannot be removed. What is striking though, is that simple suction will (usually) easily remove the object. If an ambulance crew can get to a child in time and administer suction, the outcome is usually good.
We run two nurseries and I've been wondering whether we should have a basic suction machine in each nursery and train the staff to use them. If the police and some train drivers can be trained to use onboard defib equipment, wouldn't a suction unit in a nursery make sense. Hopefully it would never be used, but littlies do have a habit of choking. I (obsessively) cut up grapes, cherry toms etc for the tinies (18 months) but even then, some children seem pre-disposed to having chewing/swallowing difficulties.
I am an RN with current registration and have spent the last few years suctioning post-op gunge out of airways in a recovery room. I also hold the ENB998 Teaching and assessing cert. (but as this is for teaching within a clinical setting, would I need another cert to teach in another setting?) I would feel totally confident in teaching the staff how to use suction equipment. What do you think? Even if the equipment is never used, doesn't it make sense to have treatment for one of the most common childhood emergencies?

TIA for any thoughts.

My gut feeling is bad idea tbh. Just my opinion though.

Duly noted and gratefully received, northender.

Just to put it into context. How do you feel about carers in the community suctioning? As they often do on a daily basis? Is the chronic nature (which may be marked by acute episodes, though) of the condition/symptoms they are treating, likely to result in less room for trauma?

Bubble in answer to your simple question, I think it is a good idea and that involving the paramedics will establish whether it is a viable idea.

The little girl who die after choking on a meatball was a young local girl at a school about 5 minutes drive from me The hospital is just over the road from me. The first aiders and the ambulance crew worked hard on her, she was tranferred to GOS and died 5 days later. It was a school, not a nursery.

And if another child has died in Herts from a meatball, I will be annoyed as Herts education dept. have taken meatballs off the menu.

Bubble was talking about a nursery in Middlesex, Sparkly - after I'd asked whether it was in Herts.

But it does seem strange that there should be two cases recently where children have choked on meatballs...

The case I'm referring to was a three year old boy, (he has now been named) He died last Thursday after choking during lunch at an Asquith nursery which is attached to a primary school in SW London/Middx borders. All Asquith nurseries attached to schools are private nurseries, they are not funded by the LEA. Asquith did a deal nationally to set up nurseries to provide full, sessional and wraparound care on school sites. I have major issues with Asquith piggy-backing onto the name/reputation of government funded schools, they operate private nurseries which just so happen to be on school sites.

Sorry I realised that you meant a boy in the first post but you said later on that another child had died recently after choking on a meatball, I thought you had meant the little girl here

Another one?

My DS1 flipped a 5p piece in the air, looked up to see where it went, with mouth open wide, and it went straight down his throat.

I did what I could, he was having difficulty breating. I rang the GP surgery. The receptionist said the GP's were in surgery and too busy to talk to me!!!!!!!!!! Anyway, apparently a more "experienced" receptionist overheard her call and related it to our GP. 3 Mins later and he was bashing our door down.

What he did helped to save my DS1. He made sure the 5p was in such a position that it went down his windpipe. Eventually it passed right through him (we still have it in a frame). I digress, sorry - I think that if anyone can be trained to deal with choking on foreign objects, it can only be a good thing. And, if I had a child in a nursery, I would expect, as a basic requirement, that SOMEONE in the nursery knew how to deal with obstacles. I think that the more equipment and training you and your staff can get, then jolly well done to you! For a child to swallow something accidently is a very common occurance; to keep them alive afterwards........

we had a case here a few months back where a 5 year old girl died after choking on her meatball at school, I thought you were referring to her. My mistake.

Let me get this straight. We had a 5 year old die here, a 3 year old in Surrey died and soemone said that another child had also died.

Exactly, Pisces. I'm not suggesting that nursery staff should bypass all attempts at first aid to remove the object. But, if (with correct training) they were able to do what an ambulance crew would do anyway when they eventually arrived, it seems like a good plan.

My main point is that if London Underground staff are being trained to use defibs (on children as well as adults) then I would think that nursery staff could be trained to use last resort suction.

The nursery where the 3 year old I'm talking about is near Richmond (about 2 miles away) which is in Surrey. I think you and I are talikng about the same 3 year old, SM.

right sorry, its late. Terrrible thing to happen again. Herts education dept. took meatballs off the menu after the 5 yr old died here.
I am not sure about the suction thing, are you saying about getting one for every school and nursery. I think it would work if the item isn't too far down. My dd1 regularly choked when she was younger as she had a problem with her mouth and throat and its scary, so I think its a good idea

I'm off to bed now. Night Spookily (when do we start the Christmas name changes, BTW? Is there a firework'y one in between?)

XX

I think mid-nov for xmas names.

OMG. I am so glad I took DD out of Asquith (Kingston).

Bubble. If I return to the UK I had already made plans to put DD in your Petersham nusery. In which case I would be thrilled if you had a suction machine.

I'm paranoid about choking as I heard it was the most common cause of death in under 5s.

Excuse the hijack, as you're in the business, I thought I'd tell you about DD's current nursery -the BEST nursery ever in Sydney. All organic food, prepared on site, children serve themselves with tongs, the staff take digital photos all day and then put on a slide show for the parents at the end of the day, italian lessons, music and movement, bike track, huge outdoor play area, lots of cooking, kids hatted and sunscreened before going outside, staff listen to parents and implement suggested changes(!), big emphasis on manners. Absolutely thrilled with it. (DD is 2.10).

Interested to see Asquith is expanding by setting up nurseries linked to state schools. This is a company which is so badly run it can't cope with childcare vouchers - overcharged us by £1,500 by not crediting vouchers at one stage (we had to fight to get our money back) and then failed to collect vouchers for four months, causing dh endless problems with his employer.

More importantly, they charge parents an arm and a leg, but pay their staff a pittance - hence very high staff turnover which is extremely bad for the children. My son's keyworker was unqualified and paid just £11,000 pa - while pulling in £3k a month for them (1:3 staffing ratio). They refused to fund her to do her NVQ, having promised that when she joined. Only £500 to them - peanuts - yet a huge amount of money to her.

They also rely on fundraising from parents to buy equipment - coffee mornings and so on. And pretend to raise money for charity while actually keeping 50 per cent for themselves. Then the money raised goes to head office and the branch never sees it!

Isn't it the case that even adults die from choking incidents?...i.e. all very tragic but just 'one of those things'?..thus not necessarily a reflection on the Nursery concerned...

Bubble - training in the use of suction machines; seems like an excellent idea to me, coupled with, of course awareness from the staff about what constitutes a choking risk (which I am sure at your nurseries they are...)

HMC. Totally. I'm not suggesting that the nursery staff didn't do everything possible. I could be really unfair and suspect that, as an Asquith nursery, the chances of them following OFSTED regs and having a qualified first aider ( and, for that matter even enough staff on duty) is open to question. That wouldn't be fair though as, even when my son attended one of their nurseries, there were dedicated and professional individuals working there.

The problem, as Edam has pointed out, seems to be a reluctance to pay staff properly or allow further training. An NVQ or CACHE course does rely on the employer funding the course, but most other courses provided by the EYDCP (Early years development and childcare partnership) are free. I suspect that the reason why staff are not encouraged or even allowed to attend training is that Asquith would then have to pay for bank or agency staff to cover for them.

Bubble, I do think it is easier to cause trauma in a child. Also you're using much smaller catheters ie much harder to pick up an obstruction. I think my general gut feeling against this is based on some of the awful examples I've seen on the wards over the years from trained professional staff. In theory a great idea but not so sure in practice.

I've taught on trache care courses where there have been carers who are doing suction on a regular basis with minimal training and it does scare me.

I think the best approach is thorough risk assessment, supervision and education of staff including first aid training. Also the importance of calling for help ASAP - it doesn't matter if it's a false alarm.
Ambulance suction equipment wouldn't be too effective on much other than vomit, and a laryngoscope is not a piece of equipment that should be given alone to anyone who isn't properly trained and equipped in advanced airway management.
Children who have almost liquid diets and who are more prone to swallowing difficulties could benefit from suction but would probably already come with established methods of dealing with any incidents.
Choking is horrific Bubble and just the thought of it makes me so upset too.

I've been thinking about this today. Would a suction catheter retrieve a meatball? I've never tried, having been used to secretions only. What do you think? If it's a bad idea I'll drop it and you obviously know your stuff. Would it be worth talking to an A&E bod? I'm just struck by the thought that the nursery 'phoned an ambulance asap and it was still not soon enough.

Thats what I have bee trying to say all along Bubble. Say ( now I know that they should never be in a nursury) a nut, or a marble, they are 'heavier' items and I don't know that they would be retrieved. Certainly not without the help of a laryngoscope. And then that is another thing to risk damage with. Agree still that speaking to a Para or a and e person will be able to help. xxx