Choking is a leading cause of mortality in children. Over half of choking injuries occur due to food, and the remaining injuries involve common household objects. Purpose: The purpose of this study was to evaluate Behavioral Skills Training (BST) to teach choking hazard identification and correction to substitute caregivers. Method: This study evaluated the efficacy of using BST to teach nonedible choking hazard identification (Phase 1) and edible choking hazard identification and correction (Phase 2) to substitute caregivers following guidelines from the Home Accident Prevention Inventory-Revised Protocol. Results: The results found that all participants significantly improved their hazard identification and correction following BST in both phases. Generalization probes were high in baseline for all participants across phases; however, all participants scored 100% correct on the final generalization probes. Discussion: Implications for practice and future research considerations for choking prevention training are discussed.
AnderstJ.TeranP.DowdM. D.SimonS.SchnitzerP. (2015). The association of the rapid assessment of supervision scale score and unintentional childhood injury. Child Maltreatment, 20(2), 141–145. https://doi.org/10.1177/1077559514566450
3.
BaroneV. J.GreeneB. F.LutzkerJ. R. (1986). Home safety with families being treated for child abuse and neglect. Behavior Modification, 10(1), 93–114. https://doi.org/10.1177/01454455860101006
4.
BentivegnaK. C.BorrupK. T.CloughM. E.SchoemS. R. (2018). Basic choking education to improve parental knowledge. International Journal of Pediatric Otorhinolaryngology, 113(May), 234–239. https://doi.org/10.1016/j.ijporl.2018.08.002
5.
CarrowJ. N.VladescuJ. C.ReeveS. A.KisamoreA. N. (2020). Back to sleep: Teaching adults to arrange safe infant sleep environments. Journal of Applied Behavior Analysis, 53(3), 1321–1336. https://doi.org/10.1002/jaba.681
6.
Centers for Disease Control and Prevention (2002). Nonfatal choking-related episodes among children: United States, 2001. Morbidity and Mortality Weekly Report, 51(42), 945–948.
7.
ChangD. T.AbdoK.BhattJ. M.HuohK. C.PhamN. S.AhujaG. S. (2021). Persistence of choking injuries in children. International Journal of Pediatric Otorhinolaryngology, 144(May), 110685. https://doi.org/10.1016/j.ijporl.2021.110685
8.
ChapinM. M.RochetteL. M.AnnestJ. L.HaileyesusT.ConnerK. A.SmithG. A. (2013). Nonfatal choking on food among children 14 years or younger in the United States, 2001–2009. Pediatrics, 132(2), 275–281. https://doi.org/10.1542/peds.2013-0260
9.
Committee on Injury, Violence, and Poison Prevention (2010). Prevention of choking among children. Pediatrics, 125(3), 601–607. https://doi.org/10.1542/peds.2009-2862
10.
CourtemancheA. B.TurnerL. B.MolteniJ. D.GroskreutzN. C. (2021). Scaling up behavioral skills training: Effectiveness of large-scale and multiskill trainings. Behavior Analysis in Practice,14(1), 36–50. https://doi.org/10.1007/s40617-020-00480-5
11.
DavisC. S.GodfreyS. E.RankinK. M. (2013). Unintentional injury in early childhood: Its relationship with childcare setting and provider. Maternal and Child Health Journal, 17(9), 1541–1549. https://doi.org/10.1007/s10995-012-1110-z
12.
DolgunE.KalkimA.ErgünS. (2017). The determination of home accident risks and measures to prevent accident of children: Quasi-experimental research. Turkish Journal of Family Medicine and Primary Care, 11(2), 100–107. https://doi.org/10.21763/tjfmpc.317852
13.
GiannakakosA. R.VladescuJ. C.KisamoreA. N.ReeveK. F.FienupD. M. (2020). A review of the literature on safety response training. Journal of Behavioral Education, 29(1), 64–121. https://doi.org/10.1007/s10864-019-09347-4
14.
HarrisC. S.BakerS. P.SmithG. A.HarrisR. M. (1984). Childhood asphyxiation by food: A national analysis and overview. Journal of the American Medical Association, 251(17), 2231–2235. https://doi.org/10.1001/jama.1984.03340410039029
15.
HiguchiO.AdachiY.AdachiY. S.TaneichiH.IchimaruT.KawasakiK. (2013). Mothers’ knowledge about foreign body aspiration in young children. International Journal of Pediatric Otorhinolaryngology, 77(1), 41–44. https://doi.org/10.1016/j.ijporl.2012.09.026
16.
HimleM. B.MiltenbergerR. G.GatheridgeB. J.FlessnerC. A. (2004). An evaluation of two procedures for training skills to prevent gun play in children. Pediatrics, 113(1), 70–77. https://doi.org/10.1542/peds.113.1.70
17.
HouvourasI. V.HarveyA. J.TM. (2014). Establishing fire safety skills using behavioral skills training. Journal of Applied Behavior Analysis, 47(2), 420–424. https://doi.org/10.1002/jaba.113
18.
JohnsonB. M.MiltenbergerR. G.Egemo-HelmK.JostadC. M.FlessnerC.GatheridgeB. (2005). Evaluation of behavioral skills training for teaching abduction-prevention skills to young children. Journal of Applied Behavior Analysis, 38(1), 67–78. https://doi.org/10.1901/jaba.2005.26-04
19.
JohnsonB. M.MiltenbergerR. G.KnudsonP.Egemo-HelmK.KelsoP.JostadC.LangleyL. (2006). A preliminary evaluation of two behavioral skills training procedures for teaching abduction-prevention skills to schoolchildren. Journal of Applied Behavior Analysis, 39(1), 25–34. https://doi.org/10.1901/jaba.2006.167-04
20.
KopjarB.WickizerT. (1996). How safe are day care centers? Day care versus home injuries among children in Norway. Pediatrics, 97(1), 43–47. https://doi.org/10.1542/peds.97.1.43
21.
KouranyR. F.LaBarberaJ. D. (1986). Babysitting: A milestone of early adolescence. The Journal of Early Adolescence, 6(2), 197–200. https://doi.org/10.1177/0272431686062009
22.
KuhnJ.DamashekA. (2015). The role of proximal circumstances and child behaviour in toddlers’ risk for minor unintentional injuries. Injury Prevention, 21(1), 30–34. https://doi.org/10.1136/injuryprev-2014-041247
23.
LaBrotZ. C.KupzykS.Strong-BakW.Bates-BrantleyK.CasertaA. (2022). Generalization and maintenance of caregivers’ effective instruction delivery following group behavioral skills training. Behavioral Interventions, 37(3), 640–659. https://doi.org/10.1002/bin.1866
24.
LorenzoniG.AzzolinaD.BaldasS.MessiG.LaneraC.FrenchM. A.Da DaltL.GregoriD. (2019). Increasing awareness of food-choking and nutrition in children through education of caregivers: The CHOP community intervention trial study protocol. BMC Public Health, 19(1), 1–7. https://doi.org/10.1186/s12889-019-7469-7
25.
LorenzoniG.LaneraC.AzzolinaD.BaldasS.MessiG.GregoriD. (2021). Assessing school-based intervention strategies to foster the prevention of choking injuries in children: The results of the CHOP (CHOking Prevention) trial. Health & Social Care in the Community.
MaxfieldT. C.MiltenbergerR. G.NovotnyM. A. (2019). Evaluating small-scale simulation for training firearm safety skills. Journal of Applied Behavior Analysis, 52(2), 491–498. https://doi.org/10.1002/jaba.535
28.
MetchikianK. L.MinkJ. M.BigelowK. M.LutzkerJ. R.DoctorR. M. (1999). Reducing home safety hazards in the homes of parents reported for neglect. Child & Family Behavior Therapy, 21(3), 23–34. https://doi.org/10.1300/J019v21n03_02
29.
MiltenbergerR. G. (2008). Teaching safety skills to children: Prevention of firearm injury as an exemplar of best practice in assessment, training, and generalization of safety skills. Behavior Analysis in Practice, 1(1), 30–36. https://doi.org/10.1007/BF03391718
30.
MiltenbergerR. G.FlessnerC.GatheridgeB.JohnsonB.SatterlundM.EgemoK. (2004). Evaluation of behavioral skills training to prevent gun play in children. Journal of Applied Behavior Analysis, 37(4), 513–516. https://doi.org/10.1901/jaba.2004.37-513
31.
MorrongielloB. A.CorbettM.McCourtM.JohnstonN. (2006). Understanding unintentional injury risk in young children II. The contribution of caregiver supervision, child attributes, and parent attributes. Journal of Pediatric Psychology, 31(6), 540–551. https://doi.org/10.1093/jpepsy/jsj073
NicholsB. G.VisotckyA.AbergerM.BraunN. M.ShahR.TarimaS.BrownD. J. (2012). Pediatric exposure to choking hazards is associated with parental knowledge of choking hazards. International Journal of Pediatric Otorhinolaryngology, 76(2), 169–173. https://doi.org/10.1016/j.ijporl.2011.10.018
34.
NovotnyM. A.MiltenbergerR. G.FrederickK.MaxfieldT. C. (2020). An evaluation of parent implemented web-based behavioral skills training for firearm safety. Behavioral Interventions, 35(4), 498–507. https://doi.org/10.1002/bin.1728
35.
Pan-SkaddenJ.WilderD. A.SparlingJ.SevertsonE.DonaldsonJ.PostmaN.NeidertP. (2009). The use of behavioral skills training and in-situ training to teach children to solicit help when lost: A preliminary investigation. Education and Treatment of Children, 32(3), 359–370. https://doi.org/10.1353/etc.0.0063
36.
RimellF. L.ThomeA.StoolS.ReillyJ. S.RiderG.StoolD.WilsonC. L. (1995). Characteristics of objects that cause choking in children. Journal of the American Medical Association, 274(22), 1763–1766. https://doi.org/10.1001/jama.1995.03530220029027
37.
SchnitzerP. G. (2006). Prevention of unintentional childhood injuries. American Family Physician, 74(11), 1864–1869.
38.
SchnitzerP. G.EwigmanB. G. (2008). Household composition and fatal unintentional injuries related to child maltreatment. Journal of Nursing Scholarship, 40(1), 91–97. https://doi.org/10.1111/j.1547-5069.2007.00211.x
39.
SchwebelD. C.BrezausekC. M.BelskyJ. (2006). Does time spent in childcare influence risk for unintentional injury?Journal of Pediatric Psychology, 31(2), 184–193. https://doi.org/10.1093/jpepsy/jsj007
40.
SmithS. A.NorrisB. (2003). Reducing the risk of choking hazards: Mouthing behaviour of children aged 1 month to 5 years. Injury Control and Safety Promotion, 10(3), 145–154. https://doi.org/10.1076/icsp.10.3.145.14562
41.
Susy Safe Working Group (2012). The Susy Safe project overview after the first four years of activity. International Journal of Pediatric Otorhinolaryngology, 76(May), S3–S11. https://doi.org/10.1016/j.ijporl.2012.02.003
42.
TertingerD. A.GreeneB. F.LutzkerJ. R. (1984). Home safety: Development and validation of one component of an ecobehavioral treatment program for abused and neglected children. Journal of Applied Behavior Analysis, 17(2), 159–174. https://doi.org/10.1901/jaba.1984.17-159
VanselowN. R.HanleyG. P. (2014). An evaluation of computerized behavioral skills training to teach safety skills to young children. Journal of Applied Behavior Analysis, 47(1), 51–69. https://doi.org/10.1002/jaba.105
45.
Ward-HornerJ.SturmeyP. (2012). Component analysis of behavior skills training in functional analysis. Behavioral Interventions,27(2), 75–92. https://doi.org/10.1002/bin.1339
46.
WatsonP. J.WorkmanE. A. (1981). The non-concurrent multiple baseline across individuals design: An extension of the traditional multiple baseline design. Journal of Behavior Therapy and Experimental Psychiatry,12(3), 257–259. https://doi.org/10.1016/0005-7916(81)90055-0
47.
WinterlingV.GastD. L.WoleryM.FarmerJ. A. (1992). Teaching safety skills to high school students with moderate disabilities. Journal of Applied Behavior Analysis, 25(1), 217–227. https://doi.org/10.1901/jaba.1992.25-217
