A Preventable Tragedy: Choking to Death in the School Cafeteria

by Bettina Elias Siegel on January 20, 2012

[Ed Update:  As the comments which came in on this post on May 14, 2012 tragically demonstrate, this issue continues to threaten the lives of children in schools where cafeteria workers are not trained to handle choking incidents.]

Last month a Brooklyn nine-year-old named Jonathan Jewth tragically choked to death while eating meatballs in his school cafeteria.  The New York Post, which first broke the story, reported that the lunchroom workers on duty at the time were unable to assist the boy.  Said an eyewitness quoted in the Post:

The only thing the lunch ladies did was go up to the boy on the floor and yell at him to put his own fingers down his throat. He had been unconscious already for a while. . . . Nobody was paying attention and they didn’t know how to give aid, nobody knew what to do.

This episode, while undeniably horrific, struck me as a highly unlikely occurrence.  But then I started thinking about the typical elementary school lunch room:  children talking, laughing, shouting and sometimes playfully shoving each other as they eat.  I also considered the fact that higher-risk foods like carrot sticks, hot dogs and grapes are commonly found in kids’ lunches, and that, thanks to No Child Left Behind, public school lunch periods are shorter than ever, with some children getting as little as fifteen minutes to scarf down their entire meal.

I did some investigating and was surprised to learn that during the very same month Jonathan Jewth died from choking, two other children (coincidentally also in New York state) were reported to have choked on food in school lunch rooms.  These children, however, were fortunate in having an adult nearby who (a) recognized that they were in distress and (b) were trained in performing the Heimlich maneuver.   (Nine-year-old Hannah Goldberg, just like Jonathan Jewth, choked on a meatball and was saved by an English teacher who had learned the Heimlich in a first aid course; twelve-year-old Nirvana Blake choked on a breadstick and was rescued by a teacher’s aide trained in the technique.)

While I was unable to find any statistics on choking on school grounds per se, the American Academy of Pediatrics reported last year that “[c]hoking on food causes the death of approximately 1 child every 5 days in the United States,” and some of the characteristics of the typical school cafeteria eating experience were identified in the report as enhancing the risk of choking:

Behavioral factors may also affect a child’s risk for choking. High activity levels while eating, such as walking or running, talking, laughing, and eating quickly, may increase a child’s risk of choking.

Indeed, I learned of one Rhode Island school that several years ago actually experienced three choking incidents in a single month, leading the school to adopt a controversial “no talking” policy in the cafeteria.  I also found numerous other media reports documenting cases of children who were rescued from choking in the lunch room by heroic fellow students who had seen or read about the Heimlich.  (A Houston-area fourth-grader who saved a girl choking on a Cheeto reported that “other students thought the girl was just laughing,” showing just how easily this incident could have turned into tragedy.)

When I asked my own school district, Houston ISD (the nation’s seventh largest), how it prepares for possible choking in the cafeteria, I was told by a spokesperson that “posters that provide instructions on how to administer the Heimlich maneuver are displayed in every cafeteria. In addition, physical education teachers are trained in CPR and first aid techniques.”  But physical education teachers aren’t required by the district to be present in the cafeteria during meals, and it’s unlikely that many actually are there on a regular basis.

My district is certainly not alone in relying on posters as the sole means of providing choking first aid — a multi-state survey conducted in 2004 found this to be the standard requirement in the vast majority of those states addressing the issue in their statutes regulating food service establishments.  But even professional chefs who are required to post a Heimlich illustration in their restaurants don’t always know how to actually employ the technique in an emergency.  Cookbook author Joan Nathan recounted in the New York Times how she once choked on a piece of chicken in a room full of well-known chefs, some of whom later admitted they were unsure of how to help.  (Fortunately, celebrity chef Tom Colicchio knew what to do.)  And while the media reports I found were silent on the point, it’s very likely that the Brooklyn school food service workers in the Jonathan Jeweth case were standing in close proximity to just such a poster, which is legally required to be prominently placed in all New York food service establishments.

It’s notable, then, that the American Academy of Pediatrics recommends that choking first aid for children actually “be taught to parents, teachers, child care providers and others who care for children.”  In the specific context of schools, I was able to find one state, Ohio, which has made it mandatory for an adult trained in choking first aid to be in attendance in the cafeteria while meals are served, and the state of Virginia passed legislation over a decade ago “encouraging” the same practice.

Of course, we can’t prevent every conceivable tragedy that might strike our kids at school, and taking extreme or costly measures to ward off unlikely occurrences isn’t justified.  But in the case of a choking, physically demonstrating the Heimlich maneuver to school food service workers as part of their regular training hardly seems burdensome.

And as the Jeweth case sadly demonstrates, those few minutes of extra training could easily save a child’s life.

[This post also appears in The Huffington Post.]

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{ 30 comments… read them below or add one }

Bri January 20, 2012 at 2:51 pm

I’ll never forget the day my son’s preschool called me at work. The first words out of the director’s mouth were “He’s okay, he’s okay, he’s okay.” She went on to explain to me, through tears, that my 3-year-old had been served a hot dog during a school party, and he choked on it. His teacher, bless her, performed the Heimlich and was able to save him. She said afterwards, he looked at her, said, “Thank you, Ms. Kathy,” and sat back down. He handed the hot dog back to her and said he would rather have “Mommy’s lunch.”
Here’s the thing: things would have been very different if the teacher weren’t sitting with the children at lunch, observing everything and interacting with them. They also would have been very different if every adult in that school hadn’t been CPR certified and trained in the Heimlich. Thank goodness they were. I think there is a minimum standard of safety and care that is required of us where our children are involved, and there are so many very simple steps that could be taken to prevent this kind of tragedy that it’s absolutely inexcusable.

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Bettina Elias Siegel January 20, 2012 at 5:57 pm

Horrible, Bri. As your experience (and the tragic NYC death) shows, the fear of choking at school isn’t unfounded. Thank you for sharing what I know must still be an upsetting memory.

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Gems January 20, 2012 at 9:53 pm

It worries me so much as our school lunch program is run by untrained ‘helpers’ with a school nurse on call if needed somewhere in the building. I have no idea what would happen if a child choked…I honestly don’t think it would be handled properly.

My son choked on New Year’s Day, on fatty bacon my friend did not cook to crunchy. Luckily I broke the rule and stuck in my hand in and pulled out about4 inches of fat which was caught in his throat. I was sitting right next to him…I won’t be in school.

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Bettina Elias Siegel January 22, 2012 at 5:57 am

This stories are so distressing! I will say, though, that since writing this post I asked our own elementary principal how they prepare for choking incidents and learned that the school brings in a first aid trainer every year and that at least one lunch room attendant is trained for this emergency. But it seems that in doing so, my school is going above and beyond our district’s policy. It seems this ought to be a requirement, as your son’s experience shows. Thanks for sharing this story with us.

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Betty January 21, 2012 at 9:19 pm

My grown daughter recently choked on a hot dog at a fast food counter. Most of the 2 dozen people around her just sat there or did nothing despite her using the universal sign for choking. Finally ONE man stepped up & did the Heimlich & saved her. Sad that so many people apparently “don’t want to get involved” to save another person in distress anymore.

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Bettina Elias Siegel January 22, 2012 at 5:53 am

Wow. That’s terrible, Betty! I wonder if it’s was a desire to not get involved or just fear/ignorance? Either way, so glad to hear someone DID know what to do and stepped forward.

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Pilar Gray January 26, 2012 at 6:48 pm

Our school food service professionals here at Fort Bragg Unified School District (CA) have been trained in the Heimlich Maneuver, CPR and other basic first aid. The small cost of the class and the little bit of extra-hire we paid is more than worth it if they’ll ever need those skills! All schools should consider making this minor investment to save something so valuable as a child’s life.

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Bettina Elias Siegel January 26, 2012 at 8:17 pm

That’s great to hear, and I hope other districts are following suit. I found out that my own school at least, if not my district, does have a CPR trained person in the lunch room.

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cayela mattocks May 14, 2012 at 10:46 am

My eight year old niece passed away in February from choking on a hot dog in her school cafeteria. We still don’t know the full story as to if the lunch ladies helped her or not because the school won’t talk. We do know though, that if they would have helped her immediately she would still be alive but have some brain damage. We are from mercer, pa.

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Bettina Elias Siegel May 14, 2012 at 10:52 am

Cayela: I am so very sorry to hear that. My sincere condolences to you and your family.

When I first wrote about this issue I feared I might be being too alarmist, but the reaction to the post has made it clear that choking at school is a very real and preventable danger. I can only hope that more awareness will help prevent tragic losses like the one suffered by your family.

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Jamie m May 14, 2012 at 10:52 am

My niece chocked on a hotdog at school february 13th 2012 and later passed away February 15th 2012. This happened in mercer Pa. She was 8. She went unseen by the lunch monitors for a while, and the kids at her table got up to tell them. She then stood up, started walking towards them and collapsed due to lack of oxygen to her heart & brain. She never regained contiousness and was life lighted. Something needs to be done about this.

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Bettina Elias Siegel May 14, 2012 at 8:08 pm

Jamie: I assume you’re related to Cayela given that you both seem to be describing the same incident. I’m so sorry your family has suffered this tragic loss, all the more terrible because it might have been prevented. Thank you both for sharing your story here and helping bring awareness to the problem.

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Jamie m May 15, 2012 at 12:43 am

Your welcome. Something needs to be done about. We need to make people aware that this isn’t rare, but it happens all the time and the people we are suppose to trust with our children 8hrs out of a day, can’t even help them if they start to choke. You never think this could happen to you & your family.. But it can and it just tears your world upside down knowing that those kids could of been saved by those adults who could of taken an hour out of their day and got CPR certified. The 2 lunch room monitors no longer work on our cafeteria. Possibly the feeling of guilt? Who knows.

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Karl G. May 15, 2012 at 9:50 am

I recently had to perform the Heimlich on my five year old son at our own dinner table and while it scared us all, the food was quickly dislodged with the Heimlich. Before this happened I had made sure that both our boys know the international sign for choking and my 15 year old knows the Heimlich as well as some other basic first aid. I can remember learning these things in school 20+ years ago. We had an assembly at the beginning of every school year where the school nurse would refresh our memories. We all knew what sign to give if we started to choke or to grab an adult if one of our friends started to choke. Being a Marine, the importance of basic first aid has been drilled into my head and has been proven to work on more that one occasion. My wife and I required our babysitter to be CPR qualified and I go as far as making sure any family members they are staying with know what to do as well. I had assumed that the adults supervising lunch at school would be certified. The thought of the adults in our schools not knowing what to do scares me. Especially in elementary schools where the kids are more likely, in my opinion, to choke. I will now be checking with our school district to see what their policy is. Thank you for bringing this to my attention.

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Bettina Elias Siegel May 15, 2012 at 10:05 am

Karl G. First of all, thank goodness you were so prepared when you needed to be. And yes, it really is shocking that there are lunch rooms (many, apparently) where the staff is untrained. I’m glad this post was useful to you and hope it spurs needed change.

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Lisa September 1, 2012 at 3:17 am

In the 90’s my cousin died. She was at school, was served a hotdog for lunch and died. She started to choke and a little boy went and told a teacher who then told him to sit down because he interupted her talking with another adult, he went back to his seat but knowing it was serious he went back up and told the teacher again about a minute or 2 later and when she glanced up finally she saw a crowd of kids and ran over… Tiffany died a horrific death. By the time they tried to save her it was too late. They tore up her throat trying to get it out, made a hole… the school paid for 1/2 of her funeral.. I miss her. To this day I chew my food really good and my childrens food I mash up and cut into the tiniest of pieces… I watch them eat. Loosing my cousin they way I did really stuck with me. :(

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Bettina Elias Siegel September 1, 2012 at 10:04 am

Lisa, I’m so sorry to hear of your family’s tragic loss. My heart breaks at the image of the boy trying desperately to get help for your cousin and being ignored. Your story illustrates that choking in school cafeterias is real risk and that all school personnel need to be sensitized to it. Thank you for sharing your story with us.

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Mary October 23, 2012 at 9:42 am

I am glad to see that you shared this story. I have personally used the Heimlich on my 5 year old son twice in the last two years. Both times he started choking while eating with me because he was eating way too fast. (As small children often do.) I thank Texas Children’s Hospital for teaching us basic first aid, CPR and the Heimlich before allowing us to take our children home from the hospital after they were born. He is alive today because of that policy. Our schools should be doing this as a refresher once per year at their first teacher inservice. I would bet that a volunteer from a local hospital, Junior League, Red Cross, etc. would be happy to come do this for free.

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Bettina Elias Siegel October 23, 2012 at 10:08 am

I didn’t realize that TCH had that policy – that’s such a good idea and I wish it were more widespread. Thanks for sharing here.

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Laura J December 12, 2012 at 3:01 pm

I live in Canada, so I don’t know if our situation in common throughout Canada, or just on our region. Most of our local primary schools don’t have a cafeteria. The students bring their lunch from home (except for the occasional “hot lunch day”) and eat in their classrooms.
The teachers, understandably, take lunch in the staff room. The kindergarten classes are “supervised” by a few students from grade 4 & 5. There is no first aid training; in the case of a medical emergency, one of the “supervisors” must go to the office and find a trained staff member to come assist. There are 3 paid, adult supervisors who check in amongst the 16 classrooms throughout the lunch period as well.
When I questioned the wisdom of this policy I was told nobody has ever had an issue with it in the past.

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Bettina Elias Siegel December 12, 2012 at 3:28 pm

Laura J: I’d heard that, for the most part, there’s no school lunch program in Canada, which is so different from the US. And I agree, the system you’re describing could result in tragedy if a child did choke and a qualified responder didn’t get to him/her in time. You might want to share this post with the supervisors, particularly the comments where real TLT readers share their own tragic stories of choking or near-choking during school lunch. It might get them thinking.

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Richard January 8, 2013 at 7:59 am

I recently almost choked to death in a local steakhouse and was saved moments before passing out by a patron sitting behind us who was involved in the medical field. This may be somewhat off topic since I’m an adult and this didn’t happen in a school cafeteria, but I was shocked that none of the staff in the restaurant were trained in CPR or the Heimlich. The waiter had no idea how to administer the Heimlich and none of 20 some employees knew how to handle the situation. One of the waiters said that 2 people had died in the resaurant during his tenure working there. They called 911 after about 30 seconds of not knowing what to do, and I thought for sure that I was going to die because it was a complete blockage. Thank god for the other patrons dining that evening…

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Bettina Elias Siegel January 8, 2013 at 10:29 pm

Richard, that’s a terrifying story. I’m so glad you’re OK and that there was someone on site to help you.

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Elisabeth September 3, 2013 at 5:45 pm

Not a school story, but while at a buffet restaurant with my mom and young son, I started to choke on a cucumber from my salad. My mom was away from the table, and my son was with me. The waitress came by to refill drinks and I made the international sign for choking (I was in the military and we had pretty good first aid training – I thought I was saved.) She thought I was nodding at her (I guess my hands weren’t as close to my throat as I thought – I was panicking big time!) and left the table! Thankfully it dislodge with my efforts and I was ok without any help, but holy cow, if an adult with knowledge of how to ask for help can’t get any assistance, I can see how easy it could be for a child in a crowded, busy lunchroom to be overlooked. Scares me because my son has a peanut and tree nut allergy … imagine if HIS symptoms were overlooked when he has a reaction. Schools need to SLOW down.

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Bettina Elias Siegel September 3, 2013 at 9:43 pm

Elisabeth: That’s a very frightening story! I’m so glad you’re OK and thank you for sharing it here. And I agree- these emergencies call for a level of attention/vigilance that’s not always present in busy school cafeterias.

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Alex January 5, 2014 at 2:39 am

Had a terrifying situation this evening , my 15 year old son choked on a piece of baked potato . He went down to his knees and I rushed over to him and used the blow to the back , it immediately dislodged the piece but my son continued to choke somewhat as he started to gag . The ordeal was over after a few minutes . I put him to bed later in the evening and plan on teaching him and his brother how to administer the Heimlich to themselves if they have to . So we should, also train the children in self administering etc

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Bettina Elias Siegel January 5, 2014 at 11:20 am

Alex: Thank you for sharing this story here and thank goodness your son is OK! And despite my interest in this topic, I honestly hadn’t thought about teaching my kids (11 and 13) to self-administer the maneuver. That’s a very good idea.

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Dan Oros April 3, 2014 at 1:17 pm

Hi Bettina, I would like to ask permission to use some of the above comments in a letter I write to School Administrators and Summer Camp Counselors to convince them the importance of First Aid and CPR training. I will give full credit to you and add the link in the letter. May I have your permission?
Thank you,
Dan Oros

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Bettina Elias Siegel April 3, 2014 at 1:19 pm

Dan: Absolutely! I hope they help.

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Amanda-Beth May 27, 2014 at 12:05 pm

I encourage all human beings 10 and over to take basic first aid class you never know when it will come in handy. You meed to know cpr,infant cpr and himlech on infants,children and adults and even how to do self himlech in case no one is around to help. It is just important. Any child 2 and over who speaks well can be taught how and when to dial 911 or equivalent in other countries. It is good for them to know.

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