Safety Recommendations for Tu BiShvat

Tu BiShvat is a time for celebrating the produce of the land, and it is traditionally observed by eating fresh and dried fruits and different kinds of nuts. It is important to remember that what may be delicious and enjoyable for adults can pose a severe choking hazard for young children. Experts from Schneider Children's Medical Center of Clalit group provide essential safety guidelines for the holiday.

Dr. Oshrat Weiss Sela, Director of the Institute for Language, Speech, Voice and Swallowing at Schneider Children's, reminds parents that peanuts, almonds, walnuts, cashews, hazelnuts, pistachios, and other nuts are leading choking hazards for children. Therefore, they should not be given to infants or children under five or left within reach. It is also essential to ensure that no hazardous food items fall to the floor where crawling infants may find them. For children under 5, nuts and almonds should only be given if they are completely ground and free of any fragments. Food should always be eaten while seated and under adult supervision to reduce the risk of choking.

Sticky dried fruits such as apricots, dates, prunes, cranberries, or raisins require extensive chewing and can stick to the trachea if inhaled into the lungs. These fruits may be given to children aged 3 to 5 years, but only if pitted, cut into small pieces (not whole), and consumed under adult supervision.

Fibrous dried fruits such as pineapple, kiwi, papaya, and mango require prolonged and effective chewing. Hard-dried fruits, such as dried bananas, require a firm bite and efficient chewing; therefore, they are not recommended for children under 5.

It is essential to understand that chewing ability develops gradually in children. Eating nuts, sticky foods, and fibrous dried fruits requires advanced and sustained chewing skills. Since infants and young children have very small airways, even small foods such as nut fragments and half peanuts can easily block them. Children may accidentally inhale nuts and dried fruits into the trachea, nuts are hard and many have a round shape, therefore, they can completely obstruct the airway, leading to complete respiratory blockage and choking. Additionally, nuts and dried fruits tend to absorb fluids and expand, further increasing the risk of airway obstruction.

Dr. Ron Berant, Director of the Emergency Medicine Department (ER) at Schneider Children's, emphasizes that in the event of breathing difficulties and suspected choking in infants and children, parents should immediately call Magen David Adom (MDA) and follow the paramedics' instructions until the medical team arrives. Simultaneously, if the child is able, encourage coughing, as it is the most effective mechanism for expelling a foreign object. If possible, bend the child forward and firmly pat between their shoulder blades while continuing to encourage coughing until the object is dislodged.