Hot Dog Security

A nice dose of risk reality:

Last week, the American Academy of Pediatrics issued a statement calling for large-type warning labels on the foods that kids most commonly choke on—grapes, nuts, carrots, candy and public enemy No. 1: the frank. Then the lead author of the report, pediatric emergency room doctor Gary Smith, went one step further.

He called for a redesign of the hot dog.

The reason, he said, is that hot dogs are "high-risk." But are they? I mean, I certainly diced my share of Oscar Mayers when my kids were younger, but if once in a while we stopped for a hot dog and I gave it to 'em whole, was I really taking a crazy risk?

Here are the facts: About 61 children each year choke to death on food, or one in a million. Of them, 17 percent—or about 10—choke on franks. So now we are talking 1 in 6 million. This is still tragic; the death of any child is. But to call it "high-risk" means we would have to call pretty much all of life "high-risk." Especially getting in a car! About 1,300 kids younger than 14 die each year as car passengers, compared with 10 a year from hot dogs.

What's happening is that the concept of "risk" is broadening to encompass almost everything a kid ever does, from running to sitting to sleeping. Literally!

There's a lot of good stuff on this website about how to raise children without being crazy paranoid. She comments on my worst-case thinking essay, too.

Posted on June 17, 2010 at 2:28 PM • 65 Comments

Comments

HJohnJune 17, 2010 2:38 PM

One in six million could die of almost anything. I suspect hot dogs are a culprit this often (which is not often at all), not because they are deadly but because they are common. I doubt many kids choke on shrimp cocktail and caviar.

I do understand paranoid fear with children. My twin daughters just turned 1 yesterday, and my wife and I will have to be careful not to be overprotective, because it took us so many years and heartbreaks to have kids (while most our friends' kids were turning teen).

Kids need to learn a few lessons that are best to learn when their parents are their. Don't put too much in your mouth, chew it before you swallow it, etc. are in that list. Check for peanuts if you are allergic is another.

What a redesign of the hot dog and the overprotection of children will not measure is how many of them will die or get injured in the future because they were shielded from learning life's important lessons when under the protective care of a parent.

PatrickJune 17, 2010 3:08 PM

I'm just wondering, what would this re-designed hot dog look like? Liquid?

HJohn June 17, 2010 3:12 PM

@Patrick: I'm just wondering, what would this re-designed hot dog look like? Liquid?
___________

Perhaps another contest?

How about something in honor of those who are crusading, like... (_|_)

mcbJune 17, 2010 3:40 PM

@ HJohn

"What a redesign of the hot dog and the overprotection of children will not measure is how many of them will die or get injured in the future because they were shielded from learning life's important lessons when under the protective care of a parent."

Regardless the apparent negligence of our parents or the current epidemic of mollycoddling I suspect the death rate in the future will remain about the same...

JoeJune 17, 2010 4:02 PM

Good grief!

Why stop at the hot dog? Even though it was the leading cause of choking, with that few events it could have been a random fluctuation that made the hot dog #1. Lets call for genetically modified grapes, peanuts, etc. so they are impossible to choke upon.

Heck, if you asked my kids, they'd probably support a complete ban on carrots.

EzraJune 17, 2010 4:03 PM

Bruce, I love your blog, but your actuarial science could use some work.

Population is not the right expsoure base -- you really care about how many kids tried to eat whole hot dogs . If 100 parents gave their kids whole franks and 10 died, then I think you'd agree that whole-dog eating is, indeed, high risk.

If all 60m kids tried it last year, then I agree with you.

Now, you might counterargue that the low number of fatalities suggests that exposure is still low.

I suspect that the driver here is that exposures and fatalities used to be higher but a public awareness campaign brought exposure down (I have no data). This, then, could be a reinvestment in a relatively efficient risk reduction campaign.

Cheers,
Ezra

Todd KuipersJune 17, 2010 4:18 PM

This is quite cool. I've for years (2 at least) connected Lenore Skenazy and Bruce Schneier in my mind and have brought them up in the same conversations - and my copies of their books share the same shelf space. It's nice to see them connected intellectually. (I see them as two people who are Hayek-style self-responsible individualists (I'm not going to use the L word) that don't necessarily describe themselves that way.) Collaborating on a book that combines Beyond Fear with Free-Range kids would be fabulous.

Ezra, you make an interesting point, but it is highly likely that 50%+ of American children had a hotdog/weiner/bratwurst/sausage in the past year. Suggesting otherwise to demonstrate actuarial acumen is revealing.

Toivo VollJune 17, 2010 4:21 PM

NPR had a bit on this when it first came out, and they interviewed a major hot dog maker. His solution seemed reasonable to me. Either don't feed hot dogs to kids that are too young, or cut them up before giving it to the children.

Joe BuckJune 17, 2010 4:32 PM

When my daughter was young, we "redesigned" her hot dogs: we sliced them lengthwise before giving them to her. With a semi-circle cross-section they can't seal the throat, and the already tiny risk drops to essentially zero so we can worry about something else.

GriskuparJune 17, 2010 4:50 PM

Drove past a school today. Sign out front said "Have a safe summer".

Todd KuipersJune 17, 2010 5:17 PM

While they're thinking of designing a new safer hot dog, we should also think about designing safer smaller-bite-sized-steakettes, grapes, bananas, croutons, cheese sticks, etc. As for liquid hotdogs, you could still get that stuff into your lungs - very dangerous.

Maybe it's just better to ban dangerous food shapes entirely. A puree that isn't too thin to easily inhaled but not so thick that it can't easily be swallowed might do the trick. Something akin to applesauce.

I'm with HJohn - another Schneier Contest (tm) is in order.

LauraJune 17, 2010 5:56 PM

"H is for hand lotion ..." is actually my least-favorite Gashlycrumb Terrors line, and I notice that "hot dog" starts with H ...

EliJune 17, 2010 6:08 PM

The contest for the redesign has some pre-existing competition. Check out http://www.octodog.net/

I have to wonder if there isn't a connection between this "risk" getting touted and this product being offered....

HarryJune 17, 2010 7:14 PM

Risks to pregnant women and children are notoriously ill-defined. Pregnant women are told to avoid undercooked meats, soft cheese and other listeria vectors because of high risk to the fetus; amniocentesis is decribed as safe. The exposure-adjusted risk from listeriosis is approximately 0.0033%;[1] the risk from amniocentesis is 0.25-0.5%. [2]

After a friend told me of this one, I started being a lot more skeptical of risk reports that did not include actual numbers.


[1] These numbers, the best I know of, are for Great Britain, http://www.amm.co.uk/newamm/files/factsabout/fa_list.htm.
[2] American College of Obstricians and Gynecologists.

JBBJune 17, 2010 7:31 PM

Sounds ridiculous, but let's look at the big picture... Without this fearmongering, we never would have gotten www.bigasshotdog.com and their 7-lb hot dog.

That makes it all worthwhile.

pfoggJune 17, 2010 9:32 PM

f the American Association of Pediatrics is spending time and effort on this, it implies that they don't have enough medically relevant issues to pursue.

alreadyonthelistJune 17, 2010 10:23 PM

Great pieces presented here.

Congratulations HJohn. As an older parent I hear ya.

I think that the article presented by the Free Range Kids author is terrific. I read her book. I cut up/personally redesigned the hot dogs too. Not to mention all the mashing of other stuff. Some people might say don't feed your kids hot dogs as they aren't really healthy, that might be a bigger risk than choking long term. Then we were told by our pediatrician not to feed them tuna or fish from the Great Lakes because of the elevated mercury levels and the effects on brain dev. before age 8.

Free Range Kids is a great book!

JimJune 17, 2010 11:22 PM

How about a training video consisting of the annual hotdog eating contest at Coney Island, NYC given to every kindergarten class!

AC2June 18, 2010 12:39 AM

1. Watch little kids when they are eating
2. If they swallow without chewing and choke help them
3. Kids learn to swallow after chewing down

Clive RobinsonJune 18, 2010 1:24 AM

I see this as part of the "living for ever" problem.

If you remove all risks from your life would it be a life you want to live?

Would the human race evolve without risk?

Would there be a human race if there was no risk?

Risk is there for good reason so we should learn to deal with it on a personal level at an early age.

So either cut up the hotdogs and teach your children to recognise risk and deal with it, or move into your personal low risk padded cell.

@ Joe re carrots, my son would be very upset if your kids got a ban, it's his favourite food, and he prefers them to most sweets...

LarsJune 18, 2010 1:40 AM

I really like to see how the simple concept of "common sense" has so many useful applications. *g* Occam would cry from joy to see people not jumping for strange and complex solutions to imagined risks. (Hello Octodog, using a 5-step gadget where a already available tool (knife) could be applied in a single one).

TommyJune 18, 2010 2:53 AM

Why can't pediatrics just tell the few parents that lack even basic commons sense that stuffing big objects down your throat will make you choke, and that kids have smaller throats than adults? They neet warning labels to cover their ass?

Can parents this ignorant keep their kids alive anyway, or do they expect the kids to read the warning label themselves? :)

A nonny bunnyJune 18, 2010 4:54 AM

@Patrick
"I'm just wondering, what would this re-designed hot dog look like? Liquid?"

Are you crazy? They could drown!
We should also ban soup.

A nonny bunnyJune 18, 2010 5:19 AM

@Harry

I'm not entirely clear on what "exposure-adjusted risk" is. But if that means the risk per exposure-event, then a high-frequency event with low risk (say, eating food that may contain listeria) may well outweigh a low-frequency higher-risk event (say, a medical procedure like amniocentesis).

WooJune 18, 2010 5:36 AM

I wonder why we don't have a worldwide ban on Bretzels already... hell, your former president almost DIED of one!

Peter A.June 18, 2010 6:50 AM

Well, the simplest and natural solution is just to keep an eye on your kids and adjust the form of their meals if you see them having trouble.

All my three kids started eating not completely pureed foods (e.g. stewed vegetables only somewhat mashed with a fork not fine-ground in a blender) at the age of 5-6 months or so; and at the age just below or at 1 year they already were eating the same food as their parents did - minus their personal dislikes or obvious no-no's like alcohol or very spicy food (which I am very fond of but have to cook it for and by myself as no one in the family can withstand the capsaicin level). No more separately cooked special meals for them.

It just took a positive experimenting approach - kids are naturally curious of their surroundings and want to try new things. Whenever a kid streched its little hand in a 'daddy please give me that' gesture, I did - but carefully observed its actions. If, for example, I saw the kid having trouble chewing on a particular food item, I took it and cut it in smaller pieces or otherwise "re-designed" (what an expression!) it and it went down OK next time.

Parents, just allow your children to learn the world by themselves - but keep a watchful eye and try to provide some guidance.

DayOwlJune 18, 2010 7:45 AM

The hot dog is scored lengthwise so that it breaks into eight pieces in the mouth.

I tried cutting hot dogs and breaking graham crackers up for my kids, only to discover they had more problems with small pieces than when I gave them the entire thing and they could take bites that suited them individually. I persisted with this blasphemy despite pressures from others. From time to time they would take bites that were unmanageable, but they learned from these experiences and adjusted their eating methods.

I think this campaign is not just about choking dangers presented by hot dogs. It goes much deeper. There is an element that believes that the processed origins and convenience of hot dogs is a moral problem and that children should not be fed hot dogs for this reason. By promoting the use of "safe" dogs only, which will be realatively expensive, the overall consumption of hot dogs would be reduced.

Prior to the "choking hazard" scare campaign, the was the "hot dogs are unhealthy and run the risk of making mothers lazy" campaign. There really are organized groups out there that would like to see entire categories of foods removed from the supply chain. I know it sounds kooky but anyone with small children will run into such people frequently.

I think this campaign is not just about choking dangers presented by hot dogs. It goes much deeper. There is an element that believes that the processed origins convenience of hot dogs is a moral problem and that children should not be fed hot dogs for this reason. Prior to the "choking hazard" scare campaign, the was the "hot dogs are unhealthy and run the risk of making mothers lazy" campaign. There really are organized groups out there that would like to see entire categories of foods removed from the supply chain. I know it sounds kooky but anyone with small children will run into such people frequently.

AppSecJune 18, 2010 9:03 AM

@mcb:
"Regardless the apparent negligence of our parents or the current epidemic of mollycoddling I suspect the death rate in the future will remain about the same..."

That would be 100%, correct....

Andy DingleyJune 18, 2010 9:04 AM

When 17% of a sample involves only one cause, that means either something approaching 17% of that sample's meals were hotdogs, or else there's some other cause that warrants investigation. Neither is a good healthcare situation.

As this is Schneier and it's Friday, surely the answer is the Octodog?
http://www.octodog.net/

freedomofeverythingJune 18, 2010 9:35 AM

Oscar Mayer: good luck getting your name off the terrorist watch list!

KHJune 18, 2010 9:40 AM

Favorite bumpersticker:
"I tried to child-proof my house, but they got in anyway."

Clive RobinsonJune 18, 2010 10:46 AM

@ mcb,

"http://www.octodog.net/step4.htm Shades of unholy Cthulhu! I may never eat a skinless, tube-shaped, emulsified meat product again...eegah!"

It's the strange look in the eyes of the dog holder that kind of says what a surprise it is to eject the pink tube of flaby product of questionable origin and content...

I'll never be able to look a frank in the eye again, (skined or unskined) let again contemplate putting it anywhere near my mouth...

Now where's a nice healthy bunch of carrots to munch on...

Clive RobinsonJune 18, 2010 10:59 AM

@ mcb, AppSec,

"Regardless the apparent negligence of our parents or the current epidemic of mollycoddling I suspect the death rate in the future will remain about the same..."

Yup one death per person been that way for as long as anyone can remember and then sum...

Ken DyckJune 18, 2010 11:17 AM

Calling hot dogs a "high-risk" hazard is a misnomer. Agreed. It is a rare event, by any standard.

But does that automatically make a wiener redesign a bad idea? That's not so clear.

What are the lives of 10 children per year worth? How much would it cost to correct the design of wieners so that all choking could be avoided? If the former outweighs the latter, wouldn't a redesign would be worth it?

Charles FeltmanJune 18, 2010 12:02 PM

It's the effects on your body after swallowing that's the problem.

Let's be frank: when casing the sausage aisle in the market, it's difficult to find a nutritional wiener.

mcbJune 18, 2010 12:02 PM

@ Ken Dyck

"How much would it cost to correct the design of wieners so that all choking could be avoided?"

Are we talking about re-engineering all sausage-shaped food products in 0.75-1.00 inch diameter range on a world-wide basis? Wouldn't it be more cost effective to let parents continue to slice and dice these potential "throat plugs" as their risk tolerance dictates?

Der FrankensteinJune 18, 2010 12:03 PM

I realize that the shape of hot dogs makes them easy to block the throat, but their slippery and smooth surface should help somewhat in their movement out of the throat (or into the stomach) as well.

I didn't notice in the original article if the death rate from choking on hot dogs separated the incidents from eating "plain" hot dogs and those when the hot dog was in a bun.

As we know, the bun itself can compress in the mouth, but expand in the throat, increasing the choking hazard.

Maybe we should outlaw hot dog buns.

chrisJune 18, 2010 1:55 PM

I have had the unpleasant experience of choking on food (not a hot dog, but a misjudged bite of tuna salad sandwich) and receiving the Heimlich Maneuver from my 14-year old son. I can't quite say he saved my life; my 16-year old daughter was also present and Heimlich-trained and presumably would have stepped in if needed but he was closer. Or I could have tried self-administration (using a chair back, but I think that because of my weight this would be very difficult). "Defense in depth" summarizes my risk-reduction strategy.

No, they didn't read "Raising Free Range Parents" - his training was from the Boy Scouts of America, hers was from the Red Cross. Based on my experience, if you don't do it hard enough to break a rib, you're probably not doing it hard enough to do any good (caveat - I am not qualified to have an "expert" opinion, just keep it in mind).

Interesting factoid - Dr. Heimlich has never personally administered the Heimlich maneuver.

jayJune 18, 2010 9:28 PM

Grapes are indeed dangerous to young folk - they are compressible enough to get in a tight spot, and smooth enough to get in there, and tough enough to resist young jaws chewing them up. My children loved grapes, so as a responsible parent I (a) watched them eating them, and (b) cut the grapes in half with scissors - cutting them made the soft grape amenable to chewing, solving the choking problem.

Eileen KaplanJune 18, 2010 10:45 PM

Reality check, always welcomed. Hot dogs in combination with a variety of environmental dangers have increased parental fears while reducing common sense.

Clive RobinsonJune 18, 2010 10:50 PM

@ Mike Saldiva,

"I suspect far more children choke on broccoli and spinach than on hot dogs"

Do you mean "gag" not "choke"

That is some children will appear to choke on food they realy don't like, however what the are actually doing is consciously/subconsciously invoking the "gag" or "vomit" reflex to get the food item out of their system. They can and do however continue to breath as the airway is not actually blocked by the food item.

jgrecoJune 19, 2010 12:28 AM

I can speak on this subject with some degree of authority I guess. When I was about 11 or 12, I choked on a hotdog. Tried to swallow a 2-3" piece of it without chewing and it predictably got lodged in my throat. Thankfully I kept calm and didn't panic, and was able to use the back of a chair to dislodge it.

End result? I learned that despite being 12 years old, I should still chew my food well before swallowing like babies. I also learned that when choking the most important thing is to not panic, the average person can have an obstructed airway for a suprizing amount of time before lossing conciousness. Basically, it was a learning experiance. Not like I was scarred for life or anything either, to this day I still love hotdogs.

JPJune 19, 2010 3:21 AM

I wander when someone will come with a suggestion to keep kids in a cage and feed them through tubes in order to save them from risks of life.

JPJune 19, 2010 3:25 AM

@jgreco: Could you, please, describe the procedure used to dislodge a hotdog using the back of a chair? I have some troubles to imagine how it is done. This life saving practice should not be kept secret but become widespread knowledge. From now on the parents of potentially choking kids only need to take a chair with them when taking the kids out for a hotdog.

Matt from CTJune 20, 2010 11:24 AM

>@jgreco: Could you, please, describe
>the procedure used to dislodge a
>hotdog using the back of a chair? I
>have some troubles to imagine how it
>is done. This life saving practice
>should not be kept secret but become
>widespread knowledge.

It's a standard part of training in the Heimlich Maneuver for at least 25 years.

http://www.cprflorida.net/images/reference/heimlich.jpg

nicfJune 21, 2010 1:09 AM

I remember reading an identical item in Omni magazine (anyone remember that) in 1985! Similar figures, and recommendations for flatter hotdogs. 25 years later and no change? must be the oscar-meyer conspiracy!

JohnJune 21, 2010 11:52 AM

@jgreco:

When I was 21 I choked on a large piece of a hotdog. My reaction was to ignore it (it'll pass) for about a minute and a half...

... then I went downstairs and started waving my hands at my mom, who was on the phone. She kept talking, and looked at me and shrugged.

A full SIX MINUTES LATER (I was initially at a computer; I knew what time it was), I gagged it up by brute force. It was at this point my dad heard noise and came out to see wtf was going on.

I can survive a surprisingly long time with an obstructed airway. If I'd been able to inhale air in my lungs it would have been easy to fire that thing out but well. The eventuality was I managed to force gas out of my stomach (belch).

I'm not really worried about children dying of hotdog choking, but that's mostly because I'm not worried about children dying. The fact that I survived without impressive medical technique and quick thinking is besides the point.

SR6June 21, 2010 2:16 PM

No !@#$!@#$ joke! My friends daughter is *not allowed to run* on the playground! A kid! Not allowed to run! WTF?!?!?!?!

People are so afraid of the lawsuit, they steer clear of living life. Hotdogs, peanuts, that lint the vacuum missed, dog kibble, buttons, etc, etc, etc. Take hot dogs out of the equation...there are still thousands of other things kids can choke on.

You ever wonder how many of the anti-hot dog soldiers *SMOKE* around their kids??

--SR6

HJohnJune 21, 2010 3:06 PM

@SR6 on Hot Dog Security

I think a lot of it stems from a person's natural desire to feel important. Unfortunately, times have changed. We deal with what we see, and we used to feel important by improving our own communities, families, workplaces, etc.

Now, the information age has enabled every rare injustice or misfortune in any corner of the world to be brought to everyone's living room. Most of us would never meet the relatives of the 1 in 6 million who choke on a hot dog, or even know someone who knows someone who knows one. However, since we hear about it, some people are on a crusade to never let it happen again.

Sometimes, a noble desire to help and protect becomes an irrational way to control.

Life expectancy is about as high as it has ever been, but we're probably more afraid than people in years where they weren't expected to live as long.

CourtneyJune 21, 2010 3:13 PM

As an EMT, I'm not so concerned about hot dogs as I am about peanut butter. Hot dogs can be fished or ejected out of a trachea. Peanut butter is so sticky that I've even seen it hinder a tracheotomy (cutting a hole in the throat below the obstruction). It can cause death, even WITH prompt medical attention.

But, as already stated, any foods (including natural ones like grapes & bananas) can serve as obstructions. I vote for parental education. As much as we might like to, we can't (and shouldn't) child-proof the entire world.

HJohnJune 21, 2010 3:21 PM

@Courtney: As much as we might like to, we can't (and shouldn't) child-proof the entire world.
______________

Amen.

My wife and I take the approach to our daughters that "we don't baby-proof our house, we house proof our baby." Now, we'll keep harmful chemicals and silverware out of their reach, no question. But we want them to learn that just because they can reach something means they can have it--otherwise they go to someone else's house having never learned the word "no."

Same with food. I'd rather teach them to not put too much in their mouth, chew before they swallow, ask if something they aren't familiar with has peanutes before eating it, etc. Otherwise, they'll go out and hurt themselves because they didn't learn.

Rob LewisJune 22, 2010 5:38 PM

I suppose that it would confound things if kids choked on hot dogs while in cars.

Another risk from hot dogs that seemed more practical to heed when my kids were young was due to the news that eating more than 9 hot dogs a month (very possible during summer b-b-que, camp season etc) suppposedly significantly increased the risk of childhood leukemia due to nitrites content. Needless to say, hot dog consumption (supervised) for my kids was cut back. I don't know if anything has changed in that regard today.

Mark FowlerJuly 15, 2010 2:27 PM

I would love a discussion on helmet wearing for motorcycle riders...compare to head injuries in car passengers?

JohnNovember 29, 2010 10:04 PM

I'm a CPR Instructor in Tampa http://www.tccpr.org and we discuss hot dogs during the choking portion of every class. It's amazing right? Hot dogs are by far the worst food for kids choking, and restaurants usually just cut the hot dog down the middle, which does nothing to protect the child.

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