Tu B'Shvat Do's and Don’t's

We celebrate the festival of Tu Bishvat (Birthday for Trees) through the fruits of the land, and customarily eat dried fruits and different kinds of nuts. But while delicious and enjoyable for adults, it can also be very dangerous to small children. Schneider Children’s specialists have issued cautionary and safety guidelines for the holiday.

Dr. Oshrat Weiss Sela, Director of Speech Therapy at Schneider Children's, reminds parents that peanuts, almonds, walnuts, cashews, hazel nuts, pistachios and sunflower seeds, are the leading cause for choking in children, and therefore, they should not be given or left in the reach of infants and small children under the age of 5 years. It is also important to pay attention to any foodstuffs fallen on the floor that are dangerous to crawling and curious infants. Under the age of 5, children should only eat walnuts and almonds that have been ground without pieces, and in any event, should be eaten sitting up to reduce the possibility of choking, and under adult supervision. Sticky dried fruits such as apricots, dates, prunes, cranberries or raisins that require a lot of chewing can by chance stick to the air passages and inhaled into the lungs. Sticky dried fruits should only be given to children from the age of 3-5 without pits, cut into small pieces and eaten under adult supervision.

Fiberous dried fruits such as pineapple, kiwi, papaya require prolonged and efficient chewing. Hard dried fruits such as bananas require a strong bite and efficient chewing and thus should not be given to children under the age of 5.

It is worth knowing that the ability to chew develops gradually in children. Chewing nuts, sticky and fibrous foods require elaborate and prolonged chewing. The size of the airways in infants and toddlers is very small so that even tiny portions like slivers of nuts or half a peanut can easily block the airways. Children can breathe the nuts and dried fruits into the airways and since the various kinds of nuts are hard and many of them are round, they can totally block the airways and lead to choking. Nuts and dried fruits tend to absorb fluids and swell, which can also lead to blockage of the airways.

Dr. Ron Berant, Director of the Emergency Medicine Unit (ER) at Schneider Children’s, adds that in the event of breathing distress or choking in infants and toddlers, Magen David Adom emergency services must be summoned immediately while following the instructions of the paramedic on the phone until the team arrives. At the same time, the child should be encouraged to cough in the event he is able to, as this is the most effective way to release the foreign body. If possible, the child should be bent over forwards and hit on the back between the shoulders while encouraging him to cough, until the foreign body is expelled.