Thursday 24 July 2014

Children and choking ... some thoughts

‘Ofsted say lack of supervision was largely responsible for child’s nursery death’ (Nursery World, 07.2014) -

In this tragic incident, a young child wandered over to a sensory jelly play tray set up in her nursery, picked up a piece of jelly and popped it in her mouth. She choked and the staff could not get it out. She was apparently unsupervised because staff were in the vicinity but not directly with her.

The Ofsted judgement that lack of supervision was to blame for the tragic incident could have very serious consequences for all early years providers. We all offer opportunities for messy play and we all feed children. If we turn our backs even for a moment - or if we leave the room to answer the door or support a child on the loo - or if we pop into the house from the garden when children are playing – or if some children want to go outside to play while others want to stay in the house… what do we do?

Can we really make our gardens / homes so safe that we remove everything that might be a risk ‘just in case’ a child chokes and we are blamed for not supervising them properly? What about the 9 year old who chokes on a grape? What about the 4 year old who, totally out of character, decides to hide behind the garage and eat a snail – shell and all – and it gets stuck? Both these scenarios have happened to me – should I have cut up the grape for a 9 year old… how could I possibly have foreseen my own normally sensible 4 year old would be so daft as to wonder what a snail tastes like?

Even if it's not messy play that causes a child to choke, it could be a pebble at the park… a conker in the garden... a piece of Lego in the playroom... a crayon at toddler group… some food or a small toy another child has dropped on the floor and the practitioner has missed. We would all hope that we have been well prepared by our first aid training and can get it out but we know that sometimes obstructions cause a perfect plug and no amount of back blows and abdominal thrusts are going to shift them.

The EYFS states that ‘Children must usually be within sight and hearing of staff and always within sight or hearing’ (EYFS 2014 requirement 3.28). I imagine the staff at the nursery in this tragic accident were hovering, like we all do from time to time, between rooms supervising children who want to do different things … a bit like when Ofsted inspectors tell us we should offer free outside access but there is only one childminder and John wants to be outside while Jane wants to play in the house - and we can’t be in 2 places at once!!

The Nursery World article states that Ofsted judged ‘nobody saw or heard her choke’ … we know from first aid training that when children are properly choking we don’t hear it … and we know from our own practice that children do things when we are not watching them - so we cannot possibly see everything they do all day.

For the future, I think we all need a choking risk assessment linked to this Ofsted judgement so we cannot be accused of failing to think about how we supervise the children adequately. Risk assessments do not save lives – they are only a piece of paper - but having a robust risk assessment helps us to show evidence to Ofsted and our insurance companies that we have thought through what we do and considered the risks.

I think we need to consider the following in our risk assessment –
• Should we Velcro all children to us and keep them with us at all times? How will that work when we are in the kitchen preparing food (depending on house layout) or going to the toilet?
• Should we remove messy play or food from the children every time we turn our back?
• Should we have a ‘one in all in’ rule for garden play, regardless of what some Ofsted inspectors say about free flow play?
• Should we reflect on whether using food for messy play is a good idea?
• Should we limit resources so if we have younger children in the house / garden we only offer toys that are suitable for them eg no small Lego or small parts play for older children on days little ones attend?
I also think each one of us should look at how well we supervise children through the day and see if there are any areas of our provision where we cannot see / hear them and think about how we can rectify this.

Hopefully this will be enough to protect everyone – until the next tragic incident presents us with yet another judgement we need to consider.