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Choking, Aspiration, and Suffocation Interventions
Education
Background
Education is a more active intervention that is designed to instruct the parent
or caregiver how to separate the child from the choking or suffocation hazard. Educational
intervention can include instruction on how to perform the Heimlich maneuver, and/or
how to administer CPR to a child who has stopped breathing. Two studies are discussed
below.
Review of education interventions:
Author | Sunde et al, 1998 |
Study design and target population | Ecologic study design.
Intervention group: Employees of Oslo insurance company. Norwegian
Child Safety Calendar and 2 day company child accident prevention campaign.
Comparison group: Norwegian Child Safety calendar mailed to
all members of Norwegian Air Ambulance (NLA). |
Intervention | Mass mailing of wall calendar illustrating
infant and child first aid and safety treatment-emphasis on CPR. Intervention
group had option to borrow a baby manikin for practice. No official CPR instruction. |
Outcomes | CPR skill test to determine how well
lay persons could handle an infant choking followed by cardiac arrest.
6 min test by expert followed by 2 min feedback & instruction. |
Results | Intervention group mean test scores
improved significantly from 27% precalendar (n=57) to 47% 1 week post calendar
(n=125) p<0.001.
Scores 6 mos. later were lower but still significant.
No change in comparison group scores. |
Study quality and conclusions | CPR educational material more effective
if it is part of a larger campaign.
Practice with manikin improved scores.
Mass mailing of CPR or other first aid materials free of charge
is ineffective. |
Author | Tertinger et al., 1984 |
Study design and target population | Before and after design
Families in rural southern Illinois receiving
services from Project 12-Ways (multi-faceted intervention program for families
referred for child abuse and/or neglect) and that had at least one child 4
years or younger. (n=6 families) |
Intervention | Home Accident Prevention Inventory (HAPI), an educational
intervention aimed at reducing number of hazards that would place children at
risk for injury in the home, largely through parent(s) eliminating hazard (i.e.,
childproofing the home).
Hazards included for this review are suffocation
by ingested object and suffocation by mechanical means. |
Outcomes | Baseline household hazard assessment, followed by second
home check using HAPI (during which education-feedback was administered). |
Results | For all six families, 53 of 70 home visits (76%) revealed
at least a 50% reduction in number of suffocation hazards present in home. However,
no consistent downward trend is present in any of families’ data.
Unscheduled follow-up home visits, 2-3 weeks after
HAPI score showed at least a 50% reduction in number of household hazards
present between baseline and second home visit.
No information on change in reported
child accidents during study (presumed to be none). |
Study quality and conclusions | Very intensive, structured, and home-specific intervention.
Widespread use of this educational intervention neither feasible nor recommended
based on results.
Two of six families moved to new homes during study,
rendering any trends in data specious.
Intervention was subsumed under larger
program aimed at preventing child abuse. Charges of child neglect brought
against these dysfunctional families were impetus of study enrollment; generalizability
to other families likely to be low. |
Summary of education interventions
The Tertinger study that assess an educational intervention of choking and suffocation
is, unfortunately, extremely limited in its findings. While it did find that the
highly-structured and personalized education offered to the parents was instrumental
in removing at least half of the observed suffocation hazards in the home, there
is no evidence that t he intervention has a lasting effect. Whether the results
can be generalized to other, non-dysfunctional families, whether reducing the absolute
number of suffocation risks is as good as removing the risk entirely is not known.
The Norwegian study by Sunde and colleagues illustrates an innovative educational
approach in the general population. Educational information appears to be more effective
when the information is distributed as part of a general safety campaign and opportunity
for "hands on" practice is provided.
Recommendations on education programs
No recommendations can be made at this time on educational programs to reduce the
risk of suffocation and choking.
Recommendations for future research
Clearly, more information is needed in the area of educational programs
to reduce the risk of suffocation and choking. Studies that examine innovative educational
programs that involve active participation and skill measurement should be designed
and evaluated.
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