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Child Care Licensing
Prevent tragedy during meal times

Meal times are a great time of the day to sit together, talk about the day, and listen to children talk about their world, all while meeting their nutritional and social and emotional needs.

The reality for some centers and homes is a meal time that becomes an assembly line, rushed and hurried. When this occurs, the opportunity for social and emotional development gets lost, and the meal becomes a setting for potential tragedy.

Recently Texas Child Care Licensing has experienced three choking fatalities. Would you be surprised to hear that in two of the fatalities, pancakes and pears were the foods served? In each circumstance, the risk came from a large serving size of dense, slippery foods and lax supervision.

Child Care Licensing, the Child Care and Adult Food Program, the Texas Rising Star program, and the National Association for the Education of Young Children all have standards/competencies in place around meal times. While the goal of enhancing nutritional, social and emotional development is important, we also have to ensure the safety of the children where food is involved.

Prevention: Many choking fatalities could have been prevented. Let’s take a look at the standards and focus on minimum requirements to keep our children safe while eating.

§746.2419 Are there specific requirements for feeding infants?

(3) Never prop bottles. The child or an adult must hold the bottle.

Research has shown that propping bottles can cause choking and aspiration.

Many challenges come with feeding more than one baby at a time while caring for a group of children. The key to success here is planning ahead.
Have bottles ready based on the known needs of the infants in your care.
Anticipate what the other children will need during this time. For example, if you are a home provider, plan child-directed activities during the time frame for feeding an infant. In this way, older children will be engaged while you feed the infant.
If you care for infants in a center, try to limit caregiver-directed activities at feeding time.

§746.3317 What general requirements apply to food service and preparation?

(7) You must not serve foods that present a risk of choking for infants and toddlers.

Caregivers and teachers should not offer children younger than 4 foods that are associated with young children’s choking incidents (round, hard, small, thick and sticky, smooth, compressible, dense, or slippery). Some examples of these foods are hot dogs and other meat sticks (whole or sliced into rounds), raw carrot rounds, whole grapes, hard candy, nuts, seeds, raw peas, hard pretzels, chips, peanuts, popcorn, rice cakes, marshmallows, spoonfuls of peanut butter, and chunks of meat larger than can be swallowed whole. Food for infants should be cut into pieces one-quarter inch or smaller; food for toddlers should be cut into pieces one-half inch or smaller to prevent choking.

Precautions: A supervising adult should watch for several common problems that typically occur when children in mid-infancy begin to feed themselves. “Squirreling” of several pieces of food in the cheeks increases the likelihood of choking.

Remember the pancakes and pears? These items do not typically come to mind when thinking about food service with young children. But consider that a child “squirreling” pancakes (a dense food) swallows a large amount. When not supervised, the child could become a fatality. Likewise, the canned pear half that is dense and slippery is a risk to a child in your care. Careful preparation of foods served and active supervision is imperative.
A commercial choke tube or empty toilet paper roll can be used to test toys and other objects in the room that a child may choke on. Place the toy or object into the tube. If it easily passes through the tube, a child may choke on it, and it should be removed from the room. For food, a good test is the “nickel measure”-- any food the size of a nickel is a choking hazard.
If you need to take your focus off an infant or toddler eating to intervene with other children, have a plan in place for the safety of the child eating. For example, remove the plate of food and exchange it with a toy, or set the milk bottle down to assist other children. Will the child be upset to see the food go away? You bet, but better upset for a moment and safe in the long run.
Choking is not a loud event. Because the airway is blocked, no sound of crying or coughing will come from an infant or toddler. A quiet baby during meal time should grab your attention quickly.
All providers should know how to assist a choking infant and call for help. If you are not comfortable with your current CPR and first-aid knowledge, take an additional class so that you are able to act in an emergency situation.
Call 911. Never waste time in a choking event. Better to have EMS arrive and find the object has been dislodged due to good first aid than a delayed EMS arrival and a dead child.


Supervision is key
§746.1203 What additional responsibilities do my caregivers counted in the child to caregiver ratio have?

(4) Supervise children at all times, as specified in §746.1205 of this title (relating to What does Licensing mean by “supervise children at all times”?).
What exactly does supervision look like when infants and children in your care are eating? Supervised eating promotes the children’s safety by discouraging activities that can lead to choking. For best practice, supervise children of all ages when they are eating. Adults can monitor age-appropriate portion size and consumption when seated with the children and model appropriate eating.
Make sure children are seated upright and calm when eating. Meals should take place in a quiet area away from noise and distractions, such as TV, loud music, and activities.
The presence of adult caregivers during meal time will help prevent behaviors that increase risk such as fighting, feeding each other, and stuffing food into the mouth. Supervised eating also ensures that children do not eat while talking, crying, laughing, or playing.

When Child Care Licensing spends time in your program and observes a potential choking or meal time supervision risk, consider the information above. Remember that among the small details of caring for your children, a single detail can be the one that saves a life.