This past Monday, the American Academy of Pediatrics (AAP) released a new policy statement on choking prevention for children, recommending, among other things, changes in government oversight of food choking hazards, and asking food manufacturers to consider redesigning potentially dangerous food products, such as hot dogs and hard candies. In the U.S., 10,000 children ages 14 and younger visit the emergency room due to food-related choking each year, and between 66 to 77 children age 10 and younger die each year from food-related choking. According to one study cited in the report, 17% of food-related choking deaths involve hot dogs. To better understand the magnitude of childhood choking risks, what the AAP hopes to accomplish with the new recommendations, and what a redesigned hot dog might look like, TIME spoke with Dr. Gary Smith, immediate past chairman of the Committee on Injury Violence and Poison Prevention at the American Academy of Pediatrics and lead author of the AAP policy statement:
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TIME: The study includes a list of 10 foods that pose a high choking risk: hot dogs, hard candy, whole grapes, raw carrots, peanut butter, chewing gum, marshmallows, peanuts/nuts, popcorn and sausages. For the man-made products, notably including the hot dog, the AAP policy suggests redesign as a way to reduce choking risk?

DR. SMITH: Hot dogs are the leading cause of food-related choking death in this country. A child dies every five days in this country due to choking on food, and among those cases, hot dogs are the most common type of food. The reasons for this are actually not hard to understand. If you were to take the best engineers in the world, and you said to them, 'Design for me the perfect plug for a child's airway,' you couldn't do better than a hot dog. Unfortunately, it's exactly the right shape of the airway, it's the right diameter—it forms a plug, completely sealing off the upper airway, right above the vocal chords. Because of its shape and size, and because it's compressible, it wedges itself in. It's almost impossible to dislodge. Then it's only a matter of minutes before there is irreparable brain damage and even death. As a pediatric emergency medicine physician, I can tell you, even if we are standing right there with all of our skill and experience, with all of the correct equipment and lighting, it is really hard to get those objects out of a child's airway once they're wedged in like that. It's almost impossible. That's why preventing this from occurring in the first place is so important.