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Danger of suffocation for infants from nuts

37/2009, 22.12.2009

BfR recommends consumer information on packaging

The Federal Institute for Risk Assessment has data at its disposal indicating that the foreign objects that infants swallow the wrong way are often nuts, in particular peanuts. The risk of swallowing nuts or pieces of nuts, which then reach the respiratory tract, is significantly higher than the risk of infants swallowing small parts of toys the wrong way. Because of their shape, small size and oily surface nuts can reach the windpipe and penetrate the deeper areas of the airways more easily than other foods. "Small children often nibble on nuts whilst playing, not just in the run-up to Christmas", says BfR President Professor Dr. Dr. Andreas Hensel. Warnings like "Caution. Nuts can reach children’s airways" should, therefore, be printed on the packaging of nuts.

If foreign objects go down the wrong way and reach the respiratory tract, this is often called an aspiration accident. This, in turn, can cause serious harm to health and, in rare cases, suffocation. During childhood the risk of objects going down the wrong way and ending up in the lungs is particularly high as children under the age of four are prone to putting things in their mouths. Hence, there is a labelling obligation for toys. A warning is printed on the packaging that small parts can be swallowed. Up to now there has been no such labelling obligation for nuts.

Aspiration accidents are not systematically recorded in Germany. In isolated cases doctors notify them to the German poison information and treatment centres where they are recorded as foreign body aspiration under “intoxication”. In contrast to the ingestion of chemicals the aspiration of foreign bodies doesn’t have to be notified to BfR as no toxic components are released. In the opinion of BfR the latest figures from the German Society for Paediatric Pulmonology clearly highlight the risk of accidents and the accident ratio of nuts to other small pieces or toy parts. Between 2004 and 2005 98 cases of foreign body aspiration were documented in six clinics. In more than half of the cases (50 notifications) children had swallowed nuts or pieces of nuts the wrong way. Peanuts were involved in 29 of these cases. In 16 cases other food components like pieces of carrots had gone down the wrong way and in ten cases parts of toys had reached the respiratory tract. This means that the risk of nuts reaching the windpipe of infants is significantly higher than the risk of parts of toys reaching the windpipe.

BfR recommends printing a warning on nut packaging like, for instance, “Caution. Nuts can reach the airways of children” in order to inform consumers about the risk. Furthermore, BfR points out that nuts, and in particular, peanuts should not be left within reach of younger children. They should only eat nuts in quiet eating situations under the supervision of their parents. However, if a piece of a nut should reach the airways triggering persistent coughing or respiratory problems, then the emergency doctor should be called.

The BfR brochure “Risk of intoxication accidents with children”, which is available free-of-charge (in German) from the BfR Press Office, also contains tips about the steps to be taken in the event of foreign bodies being swallowed the wrong way.

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