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A Preventable Tragedy: Choking to Death in the School Cafeteria

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Last month a Brooklyn nine-year-old named Jonathan Jewth tragically choked to death while eating meatballs in his school cafeteria. The New York Post, which first broke the story, reported that the lunchroom workers on duty at the time were unable to assist the boy. Said an eyewitness quoted in the Post:

The only thing the lunch ladies did was go up to the boy on the floor and yell at him to put his own fingers down his throat. He had been unconscious already for a while.... Nobody was paying attention and they didn't know how to give aid, nobody knew what to do.

This episode, while undeniably horrific, struck me as a highly unlikely occurrence. But then I started thinking about the typical elementary school lunch room: children talking, laughing, shouting and sometimes playfully shoving each other as they eat. I also considered the fact that higher-risk foods like carrot sticks, hot dogs and grapes are commonly found in kids' lunches, and that, thanks to No Child Left Behind, public schools lunch periods are shorter than ever, with some children getting as little as fifteen minutes to scarf down their entire meal.
I did some investigating and was surprised to learn that during the very same month Jonathan Jewth died from choking, two other children (coincidentally also in New York state) were reported to have choked on food in school lunch rooms. These children, however, were fortunate in having an adult nearby who (a) recognized that they were in distress and (b) were trained in performing the Heimlich maneuver. (Nine-year-old Hannah Goldberg, just like Jonathan Jewth, choked on a meatball and was saved by an English teacher who had learned the Heimlich in a first aid course; twelve-year-old Nirvana Blake choked on a breadstick and was rescued by a teacher's aide trained in the technique.)
While I was unable to find any statistics on choking on school grounds per se, the American Academy of Pediatrics reported last year that "[c]hoking on food causes the death of approximately 1 child every 5 days in the United States," and some of the characteristics of the typical school cafeteria eating experience were identified in the report as enhancing the risk of choking:

Behavioral factors may also affect a child's risk for choking. High activity levels while eating, such as walking or running, talking, laughing, and eating quickly, may increase a child's risk of choking.

Indeed, I learned of one Rhode Island school that several years ago actually experienced three choking incidents in a single month, leading the school to adopt a controversial "no talking" policy in the cafeteria. I also found numerous other media reports documenting cases of children who were rescued from choking in the lunch room by heroic fellow students who had seen or read about the Heimlich. (A Houston-area fourth-grader who saved a girl choking on a Cheeto reported that "other students thought the girl was just laughing," showing just how easily this incident could have turned into tragedy.)
When I asked my own school district, Houston ISD (the nation's seventh largest), how it prepares for possible choking in the cafeteria, I was told by a spokesperson that "posters that provide instructions on how to administer the Heimlich maneuver are displayed in every cafeteria. In addition, physical education teachers are trained in CPR and first aid techniques." But physical education teachers aren't required by the district to be present in the cafeteria during meals, and it's unlikely that many actually are there on a regular basis.
My district is certainly not alone in relying on posters as the sole means of providing choking first aid -- a multi-state survey conducted in 2004 found this to be the standard requirement in the vast majority of those states addressing the issue in their statutes regulating food service establishments. But even professional chefs who are required to post a Heimlich illustration in their restaurants don't always know how to actually employ the technique in an emergency. Cookbook author Joan Nathan recounted in the New York Times how she once choked on a piece of chicken in a room full of well-known chefs, some of whom later admitted they were unsure of how to help. (Fortunately, celebrity chef Tom Colicchio knew what to do.) And while the media reports I found were silent on the point, it's very likely that the Brooklyn school food service workers in the Jonathan Jeweth case were standing in close proximity to just such a poster, which is legally required to be prominently placed in all New York food service establishments.
It's notable, then, that the American Academy of Pediatrics recommends that choking first aid for children actually "be taught to parents, teachers, child care providers and others who care for children." In the specific context of schools, I was able to find one state, Ohio, which has made it mandatory for an adult trained in choking first aid to be in attendance in the cafeteria while meals are served, and the state of Virginia passed legislation over a decade ago "encouraging" the same practice.
Of course, we can't prevent every conceivable tragedy that might strike our kids at school, and taking extreme or costly measures to ward off unlikely occurrences isn't justified. But in the case of a choking, physically demonstrating the Heimlich maneuver to school food service workers as part of their regular training hardly seems burdensome.
And as the Jeweth case sadly demonstrates, those few minutes of extra training could easily save a child's life.