Dr. Sudhir Kumar, neurologist at Apollo Hospital Hyderabad, explained that choking risks depend on age. While the 11-year-old in this case was older, younger children in LKG or nursery are more vulnerable due to smaller esophagi.
Published Nov 27, 2024 | 9:32 AM ⚊ Updated Nov 27, 2024 | 6:42 PM
Hyderabad witnessed a heartbreaking tragedy on Monday, 25 November when an 11-year-old boy choked to death while eating lunch at school.
The victim, Viren Jain, was a student of Class 6 at Akshara Vagdevi International School. It was reported that he was attempting to hurriedly eat his lunch, and stuffed three pooris into his mouth at once.
A complaint filed with local police by the boy’s father, Gowtham Jain, said school authorities informed him that his son had choked while eating. The boy struggled to breathe and collapsed, staff at the school reportedly stated.
Begumpet Police Inspector CH Ramayya confirmed that the boy had brought pooris to school in his lunchbox.
“During the break, he attempted to eat three pooris at a time, which blocked his airway, causing him to choke and collapse,” the inspector said.
The school staff acted swiftly, rushing Viren to Geetha Nursing Home in West Marredpally. From there, doctors referred him to Apollo Hospital in Secunderabad for advanced care.
Tragically, upon arrival, the doctors at Apollo declared the boy dead.
Medical professionals say choking can occur when food is consumed too quickly or in large quantities, even if what is eaten is soft. The incident serves as a sobering reminder of the risks of eating hurriedly.
Hyderabad based pediatrician and First Aid trainer Dr Sivaranjani Santosh emphasises the importance of teaching children safe eating habits to prevent choking.
“Children should be taught to avoid talking or laughing while eating. They must eat mindfully, ideally not watching TV or multi-tasking while eating. Parents play a crucial role in setting an example. The family must ideally gather together and eat their meals calmly,” she told South First.
She said children learn from observing parents that they must not overstuff their mouth, because it increases the risk of choking.
In case a child chokes, parents and caregivers should be familiar with First Aid techniques used in choking emergencies, such as the Heimlich maneuver, described at the end of this report.
Dr. Sivaranjani said there are specific foods that pose choking hazards, particularly for younger children.
“Uncut strawberries, uncut grapes, and whole nuts are common choking risks. Even if a child appears capable of eating these foods, it is recommended that parents avoid giving them to children under three years of age. For whole nuts, the age limit extends to five or six years.”
While uncut fruit like strawberries and grapes may be acceptable in slightly older children, nuts should be given in a safe form, such as ground or as paste, until the child is mature enough to handle them safely.
Neurologist at Hyderabad based Apollo Hospital Dr Sudhir Kumar said any type of food can potentially cause choking; the risk depends on the age of the child.
In this particular case, the child was 11 years old, so slightly older. Much younger children, such as those in LKG, nursery, or preparatory classes, who carry lunch boxes to school, are at higher risk.
“Children have smaller esophagi, which is the food pipe connecting the throat to the stomach. From the throat, there are two passages: the esophagus (food pipe) and the trachea (breathing passage). Normally, when we eat and are conscious, the body automatically ensures that the trachea closes and the esophagus opens during swallowing, allowing food to pass safely into the food pipe,” said Dr Kumar to South First.
Problems can arise when this reflex is disrupted, such as when a person is sleeping or drowsy.
For instance, some parents may feed their children while they are asleep, which is not a good practice.
When someone is asleep or only half awake, they may lose control over this swallowing reflex, causing food to enter the trachea instead of the esophagus, leading to choking.
Parents must ensure that children are fully awake and alert before feeding them. This is especially important if the child is very young or has a tendency to fall asleep while eating.
If a child is still drowsy and parents try to feed him, the risk of choking increases significantly because the proper swallowing reflex may not function correctly.
“The second key factor is the size and texture of the food being consumed. It’s important to understand that in children, both the windpipe (trachea) and food pipe (esophagus) are naturally narrower than in adults. When consuming foods like pooris, the general practice is to tear them into smaller pieces to eat them comfortably, which applies to rotis as well,” said Dr Kumar.
In this case, reports suggest the child attempted to eat three pooris at once, without tearing them into smaller portions.
“Even adults would struggle to chew and swallow such a quantity at once. The sheer volume of food may not only fail to pass through the esophagus but can also block the trachea, as these two passages are located very close to each other in the throat,” said Dr Kumar.
The trachea, located at the front of the throat (behind the Adam’s apple), sits directly in front of the esophagus.
If the throat is overwhelmed by excessive food, both passages can become obstructed.
When food enters the windpipe, the body triggers a reflexive cough to expel it.
While smaller pieces of food can often be cleared with a strong cough, larger pieces may not dislodge, causing a complete airway blockage.
“This situation can escalate rapidly. If air cannot pass through the trachea, oxygen supply to the body is cut off. Within a few minutes, the person may lose consciousness, and breathing will stop altogether, leading to fatal consequences if not addressed immediately,” said Dr Kumar.
Another factor to consider is the consistency of the food. Pooris, especially those packed in lunch boxes, may harden over time. This often happens when pooris are prepared hours earlier, such as for school lunches or events, making them difficult to tear or chew.
Many adults encounter this issue at gatherings or weddings where pooris become tough and difficult to handle.
“Some foods, depending on their texture, can pose a choking risk. For example, dry foods, sticky foods, or those that require significant chewing can be particularly challenging.
Take sticky foods like peanut butter —if consumed in large amounts, such as a spoonful at a time, they can be difficult to swallow because of their adhesive nature.
Similarly, dry foods, such as sattu or dry snacks, require thorough mixing with saliva before they can be swallowed easily. Without sufficient moisture, dry food can get stuck in the throat.
“Proper chewing plays a crucial role here. The process of chewing breaks food into smaller, manageable pieces and mixes it with saliva, which serves two important purposes. First, smaller pieces are easier to swallow safely. Second, saliva contains enzymes, such as amylase, which begins breaking down carbohydrates into simpler forms like glucose, and lipase, which starts the breakdown of fats. This initial stage of digestion occurs in the mouth before the food even reaches the stomach,” said Dr Kumar.
Allowing food to mix with saliva for at least a minute or two ensures it becomes moist and easier to swallow. For example, trying to eat dry sattu powder without mixing it with water is difficult because saliva alone cannot sufficiently moisten it. However, once mixed with water or another liquid, it becomes far easier to consume.
The exact circumstances in which Viren Jain tried to hurry through his lunch are not known; even so, here are few principles to prevent such needless tragedy:
Chew food thoroughly to reduce the size of what is ingested and aid digestion
Allow saliva to moisten food for easier swallowing
Ensure dry or sticky foods are appropriately prepared or paired with liquids to prevent choking.
When foods like idli are consumed, they are typically paired with moist accompaniments such as sambhar or chutney to make them easier to swallow. However, if eaten dry, they should be cut into smaller pieces, chewed thoroughly, and mixed with saliva to facilitate safe swallowing.
In situations like a school environment, understanding and implementing basic first aid is crucial.
One of the most effective techniques to address choking is the Heimlich maneuver, also known as abdominal thrusts. Here’s how it works:
(Edited by Rosamma Thomas)
