Two-year-old dies after choking on a piece of sausage at nursery

Sadie Salt tragically died on Saturday, after she stopped breathing while having lunch at Mini Learners nursery in Radlett, Hertfordshire.

Sadie was taken by air ambulance from the setting to St Mary's Hospital,  paediatric Intensive Care Unit in Paddington, London, where she died two days later (14 November).

A spokesperson for Mini Learners Nursery told Nursery World, ‘We are absolutely devastated by this news and our sincere and heartfelt condolences go out to the family.

‘The safety and wellbeing of the children in our care is, and has always been, our utmost priority and we are working closely with the relevant bodies at this time. We are also taking steps to provide support to the children, families and staff team at our nursery at this incredibly difficult time.’

Friends of the family have launched a petition to ban sausages and grapes from all nursery settings.

It states, ‘Our friends have lost their baby. Our baby has lost his friend. Two young boys have lost their little sister. 

'We are fully aware that accidents happen but things can also be put in place to prevent these accidents occurring.

‘Sausages are renowned for their awkward shape and tough skin, thus making it extra challenging for small children to chew. Grapes fall into the same category.

‘We are appealing to get sausages and grapes to be banned from all nursery settings ASAP so no other family has to go through the devastation and heartbreak that so many people have felt this weekend.’

More than 6,300 people have so far signed the petition.

Family fundraiser for ICU care

Sadie's father, Adam Salt, has launched a Just Giving Fundraiser page for COSMIC, which supports children’s and neonatal intensive care units at St Mary’s and Queen Charlotte’s Hospitals London, helping frontline intensive care staff deliver vital critical care, and supporting families with children on the units. It also supports research initiatives to improve intensive care.

To date, it has raised more than £44,000.

A message shared on the page read,  'On behalf of Zoe, Adam, Zachary and Joshua, this page is to pay thanks to the wonderful care and support given to Sadie and us, after her tragic incident on Thursday 12th November.
'We are devastated to have lost our beautiful Sadie on Saturday 14th November. 

'Sadie spent two days in St Mary's Hospital paediatric ICU where the care she, mummy and daddy received was incredible. 

'The team at the ICU are beyond amazing and the care for Sadie and the support for us was outstanding.

'They do an amazing job and fully deserve all the support they can get. 
'They took tremendous care of our Sadie and us and nothing was too much to make us all feel loved, cared for and supported.

'We are in terrible pain as we suffer the untimely loss of our daughter and sister, but the huge support of love from you all has been overwhelming.
'We are so proud to tell you that she was able to help others by donating vital organs to go on and save lives. 

'Please show your love and support for Sadie and us by giving to this wonderful charity. It means so much to us all and from the bottom of our hearts we thank you all for thinking of us.'

To donate to the family's fundraiser, click here. The petition is available here.  

Sector response

Purnima Tanuku, chief executive of National Day Nurseries Association, said, ‘We are deeply saddened to learn of the sudden death of Sadie Salt this week. The death of a child is always devastating and our hearts go out to her family and friends at this unimaginably distressing time.

‘We know that nurseries and their staff work incredibly hard to keep children safe when they are in their care, with policies, procedures and training in place. Sadly, incidents and accidents can still happen.

‘There are clearly a lot of strong feelings around this issue as a result of this tragic incident. The advice we provide to nurseries is to ensure children are well supervised at meal and snack times and that all food should be cut into manageable pieces for young children.

‘It is important that staff are trained, are able to react quickly and have the confidence to respond to any incidents. NDNA continues to work with Millie’s Trust and support nurseries with access to advice, guidance and training to help minimise these risks.

‘Good staff supervision of children during meals and snack times is essential as children can choke on the slightest thing if it goes down the wrong way.  Practitioners are able to make sensible decisions about the food they offer and ensure it is cut into manageable pieces. 

‘Before banning any particular types of food it is important for nurseries to review their menus in terms of any risks but also the nutritional aspects of what they serve. It is important to discuss this with parents, especially where concerns are raised by tragic incidents like this one.’

Expert view

Edwina Revel, programme director for nutrition at Early Start, said, ‘Choking is something that a lot of practitioners worry about but it’s good to know that it is very uncommon. We would advise them to always stay with children while they are eating or drinking.

'It is important to consider the eating environment to ensure children are in a sitting position to allow them to swallow the food safely or spit it out, if required. Avoid distractions at mealtimes to support little ones to focus on the texture of the food and to co-ordinate putting it to their mouth to bite or chew and swallow safely.

‘It is also important to think about how foods are prepared (see below). Avoid giving babies pieces of sausage, chunks of meat or cheese, whole grapes or chunks of raw vegetables or fruit that can be swallowed and lodge in the airways.

'Avoid giving babies hard foods, such as whole nuts or hard sweets, or foods which may be sticky, like marshmallows. Textures of food can develop as children become more confident eaters. It is important to encourage, role model and support children at mealtimes to manage foods safely.

Recommendations from Edwina Revel for when feeding babies and toddlers

Edwina says: 'It is quite tricky to put a specific age on the food items below and overall the key message is that children can realistically choke on anything. However, there are certain foods that may pose more of a risk of choking for babies and children. They include the food items listed below, but note this is not an exhaustive list.'

Food Preparation

Choking can be a cause of injury in young children, mainly because their small airways are more easily obstructed. Follow these tips to reduce the risk of choking:

• Think about how foods are prepared. For babies if offering finger foods it’s important to make sure that foods are cut into soft, manageable strips/ pieces that are easy for little ones to grip, a good guide is to make them about the size of our index fingers in a stick or chip kind of shape, finger food should be soft, so test to see if the finger food is “squishable” between your thumb and forefinger and just make sure that they don’t contain any pips, stones, tough skin or stringy bits.
• Don’t give pieces of sausage, chunks of meat or cheese - again cut them into small manageable strips
• Cut round foods such as cherry tomatoes or grapes into small pieces
• For babies peel the skin off fruit, vegetables and sausages
• Avoid giving chunks of raw vegetables or fruit. Cut them into manageable soft finger foods pieces
• Remove bones from meat or fish
• Avoid giving hard foods such as whole nuts and hard sweets
• Avoid sticky foods such as marshmallows and raw jelly cubes
• Foods (such as cereal or rusks) should never be added to a baby’s bottle as this can cause choking

The NHS and Red Cross website have some helpful videos about choking  (www.redcross.org.uk/first-aid/learn-first-aid-forbabies-and-children/choking-baby or see www.nhs.uk/choking-baby )