Q: Last January our 4-year-old daughter choked to death on a hot dog. Four adults were present and we did what we could to help while an ambulance was called. The fire department responded within three minutes, but our daughter's heart stopped on the way to the hospital and she could not be revived. I'm writing in the hope that you can alert parents to the dangers of hot dogs in small children.
A: I know that nothing can bring your daughter back to you, but I hope that educating other parents about the dangers of certain foods in children can help ease your terrible tragedy.
Studies of choking in small children show that a handful of foods are especially dangerous. These include hot dogs, hard candies, nuts, peanuts, grapes, carrots, popcorn and apple pieces. As you can see, the common features these foods share are that they are either difficult to chew or are likely to be swallowed whole. They're also about the right size for blocking a small child's windpipe.
Infants under 1 year of age are especially vulnerable, and should not be given any solid foods that require much in the way of chewing, particularly hot dogs and apple pieces. At age 2, nuts, peanuts and grapes are common culprits. But by far, hot dogs are the most common cause of the 60 to 70 choking deaths in U.S. children under 5 each year.
The American Academy of Pediatrics has recently revised its recommendations on the treatment of choking in children. Along with the American Heart Association and the American Red Cross, the academy now endorses the Heimlich maneuver for children over 1 year of age. Previously it had recommended back blows and chest thrusts to dislodge food stuck in a small child's windpipe. Illustration and related story, Page 7.
The Heimlich maneuver consists of four abdominal thrusts -- quick, short jabs just under the breastbone -- usually performed by encircling your arms around the choking victim from behind, placing your fist over the middle of the upper abdomen and grasping your fist with your other hand. You then thrust upward, forcing air in the lungs to blow the obstructing piece of food out of the way.
If the obstruction is not relieved, the next step is opening the child's mouth and, if the obstructing object can be seen, removing it by sweeping a finger across the back of the throat. If this is unsuccessful, mouth to mouth resuscitation should be tried next. You should repeat this sequence until the obstruction is relieved or medical assistance arrives.
For infants under 1 year of age, the recommended approach is somewhat different, consisting of back blows and chest thrusts. First, place the infant face down over your forearm, with the head tilted down about 60 degrees. With the heel of your hand, give four rapid back blows high between the shoulder blades. If this is unsuccessful, place the infant on a flat firm surface, face up. Using two fingers placed over the breastbone, give four rapid chest thrusts. The next two steps, finger sweeping the back of the throat and mouth-to-mouth resuscitation, are the same as described for older children.
I recommend that all families learn how to perform these life-saving maneuvers. I'd also like to thank this couple for the opportunity to discuss this important topic.
Q: What causes easy bruising? I have always had this problem, but it's been worse in the past year since I started taking the antibiotic Minocin for acne. Could this medicine be making my bruising worse?
Also, my grandmother started to bruise easily a year or two ago. When the black and blue mark goes away, it leaves a darkened spot, mainly on her forearms. Her doctor has done blood tests, but they've been normal. Does this condition run in families?
A: Easy bruising is common, especially in women, and usually harmless.
In most cases, it is caused by a minor problem with either your blood vessels or platelets -- tiny particles in the blood that help form clots and stop you from bleeding. After you get a bruise, your body absorbs the blood under the skin. Sometimes, however, some blood pigments leave a discoloration behind.
Older people, whose skin has lost some of the supportive tissues that protect blood vessels, are prone to bruise easily, especially on the forearms. This common condition is called senile purpura.
Occasionally, however, easy bruising can be a sign of a more serious underlying disorder, so it's worth mentioning to your doctor.
Some people have too few platelets, a condition called thrombocytopenia (medical shorthand for "too few cells that make clots" -- thrombo means clot, cyto means cell and penia means lack of).
Medications, alcohol abuse, infections and disorders of your immune system can all reduce the function or number of platelets in your circulation. An unusual platelet disorder that causes large black and blue marks is idiopathic thrombocytopenic purpura, known as ITP (idiopathic means the cause isn't known, and purpura is the Latin word for purple).
Minocin is not known for causing easy bruising, but it has been known to reduce the platelet count, so you might ask your doctor whether it's worth stopping to see if your bruising improves. Aspirin and other anti-inflammatory drugs can hinder the way platelets work. If you take aspirin frequently, you might try acetaminophen (Tylenol) instead and see whether your condition improves.
Easy bruising does seem to run in some families, particularly among women. This kind of bruising is generally harmless and is probably due to minor abnormalities of your platelets.
A simple blood test can measure your platelet count and a bleeding test will tell how well you stop bleeding after getting a small cut. However, your doctor may do these only if he or she suspects there's something worth looking into. In most cases, easy bruising that's been going on for years is not a cause for alarm.