Dr Sarah Alexander
19 November 2019
In the past people argued against making it compulsory for children to be strapped into car seats when travelling in a car, and that caregivers shouldn’t be banned from smoking in centres. But we have got used to such rules.
Today we see some people saying they don’t see a problem with children in early childhood education services having food that is of known high risk to them for choking even while seated and supervised.
- Apples are cheapest to buy so give the under-2s, cut apple slices and don't waste time stewing the apple.
- If you are not giving them foods to eat like nuts and raw carrot (when they are too young to have their back molar teeth that are essential for chewing and have small passageways for swallowing) then they can never develop strong jaws from chewing and won't learn to talk properly.
- If you do not let your toddler eat cheerios and popcorn you are depriving them of a kiwi childhood. It's stupid to deprive them of such wonderful foods just because these are a high choking hazard for under-5s and especially for under-3s.
- Children shouldn’t be wrapped in cotton-wool; they need to be exposed to harm because that’s life. What doesn’t kill them only makes them stronger.
- Children won't choke on what ever food they are given that is dangerous for their age and development, as long as there are adequate ratios and teachers are watching children eat.
It is attitudes and beliefs like the above that make rules necessary.
The Ministry of Education has signalled that it intends to make it a requirement under its licensing criteria for services to follow Ministry of Health guidelines on food safety related to the prevention of choking.
But the Early Childhood business Council (ECC) says there is no need for this. CEO Peter Reynolds argues that it is a “bureaucrat's piece of licensing criteria.” (quoted in a Stuff article on 31 October 2019).
According to the ECC "if a teacher feels that a child is struggling with some items of food ... not really ready for it, then that's an opportunity for the teacher to be able to have a conversation with the parent and say look ... here's some strategies that would help get your child to the point where they can handle a carrot stick."
However, the business council assumes that teachers have training to be able to instruct children and parents on this, the time to do this, and that early childhood teachers are willing to professionally and personally put themselves on the line and not accept what the Ministry of Health says and recommended best practice.
Staff in early childhood education centres are unqualified or qualified teachers. Teacher training typically does not include food safety, the mechanics of teaching children how to eat, and the anatomy of teeth.
The ECC has already said that its member childcare centres are struggling to get enough staff. How then can it be confident that existing staff will be able find time to provide one-on-one child supervision, instruct parents on strategies to test their child’s resilience against choking, and be willing to take on this additional role?
This is just plain lunacy by the ECC. It is expressing opposition and ignorance (it has admitted that it only knows of 1 case of a child choking in ECE and it only knew about this because it was directly questioned about it) for the sake of it.
The ECC could get itself in trouble with at least some of its member childcare centres who may see it as providing inadequate representation of their views and practices. Evolve Education Ltd, which owns the centre at which a 1 ½ year old child, Neihana, choked on a chunk of raw apple and nearly died, has been and may still be a paid member of the ECC. WorkSafe reported following the 2016 incident involving Neihana that “all Evolve owned early childhood centres no longer supply raw or uncooked apples, or carrot to children under three years of age”.
Dr Marama Renata, mother of Neihana, welcomes the Ministry of Education taking a firmer hand to ensure child safety in all ECE services:
“This is not proposing to ban or puree everything. It's recognising we are not born with the ability to eat all foods, and that with growth, development and teeth, we progress to be able to eat food more skilfully.
“Why throw the most difficult foods at them [children] when they have no teeth and expect them to cope with it? There are bound to be casualties – and there are.” (Reference: Renata article Nov 2019)
As long ago as 2008 the Ministry of Education promised the mother of a 1 year old who died after choking on raw apple at a centre that services would not be permitted to provide apples to young children unless the texture was changed first through boiling, mashing, or grating.
No more children should die, suffer serious injury or experience the trauma of choking because the Ministry of Education allows services to do what the Ministry of Health says is dangerous to do, and this is to give high risk foods to children at highest risk of choking.
A precedent has already been set in the Ministry of Education's licensing criteria for controlling risks which children are not able to control themselves. We know for example, that hot water can burn, so the ministry requires centres as part of its licensing criteria to install a tempering value to control the temperature of water even when an adult is watching. Had it not been a licensing requirement that water temperature be controlled, the Ministry would not have downgraded the licence of a centre owned by a long-standing member of the ECC senior executive team after a child was seriously burned, and made it make improvements to prevent more children from being harmed.
It is unacceptable to treat choking on food any differently and increase the risk to children of a serious choking event when they have no control over the food given.
The important thing now is that the Ministry of Education proceeds with the changes proposed and does not give in to lobbying by those who think they know better than health experts or don’t care enough about children’s lives.
A note on the number of first-aid trained staff necessary
The Ministry of Education is also looking at increasing the number of adults in a service required to have training in first aid. Currently only one adult to every 50 children is required to have completed a first aid course.
One adult is not sufficient when an incident is serious. For example, when Neihana, aged 11/2 years, choked on a chunk of apple he was given for afternoon tea, it took two teachers to work on him. What is more, these were teachers who were not even his usual teachers, one was the centre manager and the other abandoned her room of older children to assist.
A note on whether having an adult(s) present who holds a current first aid certificate makes it okay to give young children food that presents a high risk of choking
There are two points to be made here.
- When a child chokes this is traumatic for the child concerned, for the children watching, and for the adults.
- It is important to have adults present who have had training in first aid. However, every adult reacts differently and, in the stress and panic of the moment, they may or may not be able to remember the correct actions to take and be able to take them. For example, when Neihana was choking the ambulance was not immediately called. The first aid initially performed was not the recommended first aid for a child who is choking and may have made it worse, causing more harm for Neihana. Also, one of the two teachers found she couldn’t cope with working on Neihana after he vomited and had to stand back.
Therefore, it is better to work to prevent choking from occurring in the first place.