Recent suffocation incidents in preschools in Japan call for active government intervention

Recent suffocation incidents in preschools in Japan call for active government intervention

A daycare worker feeds a child in an infant classroom at a certified nursery in Aira, Kagoshima Prefecture, in September 2023. (A daycare center unrelated to one in the same city where the fatal accident occurred) (Kyodo)

KAGOshima, Japan (Kyodo) — Recent incidents of children choking on fruit served at Japanese daycare centers have raised concerns that the government is failing to take the issue seriously through active engagement.

On April 18, a 6-month-old baby was fed an uncooked grated apple at a kindergarten in Aira, Kagoshima Prefecture, southwestern Japan, and fell unconscious.

The girl, whose face turned pale, was taken to hospital but never woke up and died on May 28. It was later discovered that a small piece of fruit had become lodged in her throat, suffocating her airway.

This archive photo shows an inspection committee meeting held in Aira, Kagoshima Prefecture, in June 2023 in response to the death of a girl at a licensed private daycare. (kyodo)

“This is where we entrust our children’s lives to you,” the girl’s father said, referring to the nursery, at a press conference in Ira in early October. “We ask him to reaffirm the government guidelines.”

According to a document published by the family in June, they explained to the nursery staff at a meeting before the girl joined the nursery that they always heat and mash the fruit before giving it to her. Staff responded that the nursery would “try not to serve her raw fruit”.

In the same month, the Aira City Office established an inspection committee, including experts, and conducted a survey of kindergartens in the city in September. The committee, which plans to publish its findings in a report, asked nurseries about their apple cooking methods, among other practices, and their understanding of government guidelines.

Another nursery director admitted, “We knew there were guidelines, but we overlooked some aspects of them,” adding that the nursery had stopped providing apples until the inspection committee’s report was issued.

National guidelines established in 2016 call for serving apples hot until an infant is fully weaned and starting to eat, as they can easily choke on the fruit or accidentally get it into their lungs.

Pears and persimmons are also dangerous for children up to about 5 years of age, as the lumps may be difficult to swallow even if the food is broken up during the chewing process. The guidelines also state that nurseries should avoid using grapes and cherries in meals because the pellets and peels can block a child’s airway if inhaled.

However, experts say the guidelines remain merely recommendations and lack a sense of urgency.

An infant’s airway is less than one centimeter in diameter, which can easily lead to inhalation of food.

According to the Consumer Affairs Agency, from 2014 to 2019, 80 children under the age of 14 died from suffocation due to inhaling food, with 73 children under the age of 5 accounting for about 90 percent of the deaths. For 51 people for whom choking foods were obvious, six ate fruits such as apples or grapes.

In 2020, a 4-year-old boy choked to death on a grape at a kindergarten in Hachioji, west of Tokyo.

In Niihama, Ehime Prefecture, western Japan, an 8-month-old baby fell unconscious and was left in critical condition after eating a cut, uncooked apple in May this year. An investigation by the county and city later concluded that the nursery did not follow guidelines for serving fruit.

An official at the Children and Families Agency said the guidelines are “technical advice.” The official added that since there are different types of fruits and different heating facilities in each day care, “it is difficult to determine a uniform way to provide them.”

“Apple grating alone can leave lumps,” noted Tatsuhiro Yamanaka, president of Safe Kids Japan, a non-profit organization that works to prevent accidents involving children.

In particular, he said, apples given to infants whose back teeth have not fully developed should be heated until soft, lest this lead to aspiration. “So we have to be very careful about how we present the fruit.”

“It is not enough for the government to simply notify nurseries of the guidelines,” said Yuichi Murayama, director of the Day Care Research Organization, who runs a kindergarten himself.

He said active government involvement is crucial, such as increasing the number of preschool workers trained in how to serve baby food and reviewing staffing standards so they can notice any changes in children’s behavior that may be concerning or out of the ordinary.

“It is necessary to create an environment that prevents accidents from occurring in the first place,” Murayama said.

    (Tags for translation)Social Issues

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